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Stewart-Treves Syndrome: A Case Report and Review of the Literature.

Berebichez-Fridman R, Deutsch YE, Joyal TM, Olvera PM, Benedetto PW, Rosenberg AE, Kett DH - Case Rep Oncol (2016)

Bottom Line: The pathology results of the punch biopsies were consistent with angiosarcoma.Because of the patient's weight and medical comorbidities, no further extensive diagnostic tests were performed to detect metastatic disease, and because of contraindications, no further medical treatment was provided.The patient subsequently died 1 month after diagnosis.

View Article: PubMed Central - PubMed

Affiliation: The William J. Harrington Medical Training Programs for Latin America and the Caribbean, University of Miami, Miller School of Medicine, Miami, Fla., USA; School of Medicine, Faculty of Health Sciences, Anáhuac University, Mexico City, Mexico.

ABSTRACT
The Stewart-Treves syndrome is a rare and deadly entity, which is defined as angiosarcoma arising in the setting of chronic lymphedema. It typically presents in women who develop lymphedema in the upper extremity secondary to axillary lymph node dissection for breast cancer surgery. It is extremely uncommon in the lower extremities as a result of idiopathic chronic lymphedema. Here, we present the case of a 63-year-old female patient with idiopathic chronic lymphedema of the lower extremities having morbid obesity (BMI 82.6) and multiple comorbidities. She developed multiple confluent, hemorrhagic and necrotic elevated purple-black papules in the lower extremities, for which the initial diagnosis was cellulitis. Because there was no improvement with antibiotics, a lower extremity ultrasound and biopsy was performed which showed multiple masses in the left inner upper calf with solid and cystic components. The pathology results of the punch biopsies were consistent with angiosarcoma. Immunohistochemical studies revealed positivity for CD31, FLI-1, and a high Ki-67 proliferation rate. Because of the patient's weight and medical comorbidities, no further extensive diagnostic tests were performed to detect metastatic disease, and because of contraindications, no further medical treatment was provided. The patient subsequently died 1 month after diagnosis.

No MeSH data available.


Related in: MedlinePlus

a Lower extremities of the patient. The morbid obesity and the lymphedema are evident. Also noted are some pressure ulcers in the posterior aspect of the legs with signs of infection. b Multiple hemorrhagic and elevated purple-black lesions as well as multiple small satellite lesions in the lower extremity. c Close-up of the multiple purple-black lesions of the lower extremity, with hemorrhagic characteristics and signs of infection.
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Figure 1: a Lower extremities of the patient. The morbid obesity and the lymphedema are evident. Also noted are some pressure ulcers in the posterior aspect of the legs with signs of infection. b Multiple hemorrhagic and elevated purple-black lesions as well as multiple small satellite lesions in the lower extremity. c Close-up of the multiple purple-black lesions of the lower extremity, with hemorrhagic characteristics and signs of infection.

Mentions: The patient developed multiple hemorrhagic and elevated purple-black lesions (fig. 1a–c). The initial diagnosis by the Internal Medicine and Dermatology Department was cellulitis of the lower extremities. However, there was no clinical improvement with antibiotics. A lower extremity ultrasound was performed which showed multiple masses in the left inner upper calf, with solid and cystic components, subcutaneous edema, and necrosis. Two 3-mm punch biopsies were performed.


Stewart-Treves Syndrome: A Case Report and Review of the Literature.

Berebichez-Fridman R, Deutsch YE, Joyal TM, Olvera PM, Benedetto PW, Rosenberg AE, Kett DH - Case Rep Oncol (2016)

a Lower extremities of the patient. The morbid obesity and the lymphedema are evident. Also noted are some pressure ulcers in the posterior aspect of the legs with signs of infection. b Multiple hemorrhagic and elevated purple-black lesions as well as multiple small satellite lesions in the lower extremity. c Close-up of the multiple purple-black lesions of the lower extremity, with hemorrhagic characteristics and signs of infection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836142&req=5

Figure 1: a Lower extremities of the patient. The morbid obesity and the lymphedema are evident. Also noted are some pressure ulcers in the posterior aspect of the legs with signs of infection. b Multiple hemorrhagic and elevated purple-black lesions as well as multiple small satellite lesions in the lower extremity. c Close-up of the multiple purple-black lesions of the lower extremity, with hemorrhagic characteristics and signs of infection.
Mentions: The patient developed multiple hemorrhagic and elevated purple-black lesions (fig. 1a–c). The initial diagnosis by the Internal Medicine and Dermatology Department was cellulitis of the lower extremities. However, there was no clinical improvement with antibiotics. A lower extremity ultrasound was performed which showed multiple masses in the left inner upper calf, with solid and cystic components, subcutaneous edema, and necrosis. Two 3-mm punch biopsies were performed.

Bottom Line: The pathology results of the punch biopsies were consistent with angiosarcoma.Because of the patient's weight and medical comorbidities, no further extensive diagnostic tests were performed to detect metastatic disease, and because of contraindications, no further medical treatment was provided.The patient subsequently died 1 month after diagnosis.

View Article: PubMed Central - PubMed

Affiliation: The William J. Harrington Medical Training Programs for Latin America and the Caribbean, University of Miami, Miller School of Medicine, Miami, Fla., USA; School of Medicine, Faculty of Health Sciences, Anáhuac University, Mexico City, Mexico.

ABSTRACT
The Stewart-Treves syndrome is a rare and deadly entity, which is defined as angiosarcoma arising in the setting of chronic lymphedema. It typically presents in women who develop lymphedema in the upper extremity secondary to axillary lymph node dissection for breast cancer surgery. It is extremely uncommon in the lower extremities as a result of idiopathic chronic lymphedema. Here, we present the case of a 63-year-old female patient with idiopathic chronic lymphedema of the lower extremities having morbid obesity (BMI 82.6) and multiple comorbidities. She developed multiple confluent, hemorrhagic and necrotic elevated purple-black papules in the lower extremities, for which the initial diagnosis was cellulitis. Because there was no improvement with antibiotics, a lower extremity ultrasound and biopsy was performed which showed multiple masses in the left inner upper calf with solid and cystic components. The pathology results of the punch biopsies were consistent with angiosarcoma. Immunohistochemical studies revealed positivity for CD31, FLI-1, and a high Ki-67 proliferation rate. Because of the patient's weight and medical comorbidities, no further extensive diagnostic tests were performed to detect metastatic disease, and because of contraindications, no further medical treatment was provided. The patient subsequently died 1 month after diagnosis.

No MeSH data available.


Related in: MedlinePlus