Friday, October 11, 2013

Huge angiosarcoma of the scalp and face

Doctors in a Nigerian hospital were puzzled when they saw a strange growth on a man's scalp, but the case soon turned even stranger - and downright macabre. Emejulu et al. describe the story of a 36-year-old male painter with an enormous angiosarcoma encircling his head.

The patient first came to the Nnamdi Azikiwe University Teaching Hospital in Nnewi, Nigeria, in 2007 with an ulcerated scalp swelling which had festered for 8 months. The mass initially used to be a painless, pea-sized growth, which he had had since childhood but which he bruised in a passenger motorcycle road traffic accident. The accident caused the innocent-looking "bump" to flare up; it became painful, gradually increased in size and ulcerated, discharging pus. A biopsy was recommended to the patient, but was not carried out, since the man did not show up for a follow-up visit. 

Two years later he came back to the hospital, this time with huge lesions on his scalp and face that were foul-smelling, slough-filled and oozing with pus. His general condition had also worsened very much - he was pale and emaciated. This time, a biopsy was carried out and the histological reports came out with three different diagnoses of glioblastoma multiforme, poorly differentiated angiosarcoma, and squamous cell carcinoma, so that the doctors treating this man were faced with a major diagnostic dilemma. After several brainstorming sessions and a clinical conference, they finally agreed that the overwhelming evidence in this very confusing case weighed in favor of angiosarcoma.

Meanwhile, the patient was repeatedly transfused with blood because of persistent anemia. However, he progressively deteriorated and finally died in April 2010, about 3 years after his first visit to the hospital.

Huge angiosarcoma growing on a Nigerian painter's scalp and face: left, front and right. Image from: Emejulu et al. 2011 

Angiosarcomas are a rare type of vascular tumor, insidious in onset, since in early stages they appear quite innocent. An early-stage angiosarcoma is typically one or more bluish or violet lesions that initially resemble bruises, but later take the shape of nodules or plaques; they grow with time and may bleed or ulcerate. Angiosarcomas primarily affect older persons.

Source: Emejulu JK, Onyiaorah IV, Ukah CO et al. (2011) Diagnostic dilemma; report of a bizarre case of advanced scalp and face angiosarcoma and literature review. Int Med Case Rep J. 4: 73–77. Published online 2011 November 7. doi: 10.2147/IMCRJ.S24975.

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