Internal cardiac defibrillator implant-associated angiosarcoma presenting as suspected implant pouch infection

Medical implants have been rarely associated with the development of sarcomas. We report, to our knowledge, the first case of a high-grade epithelioid angiosarcoma developing in the capsule of an internal cardiac defibrillator implanted subcutaneously over the abdomen over 20 years ago. Although the internal cardiac defibrillator generator had been exchanged in the intervening years, recently, the patient showed a year-long history of systemic symptoms suspicious for implant infection, necessitating several internal cardiac defibrillator pocket hematoma evacuations, always with negative microbiologic cultures. Final reexploration identified suspicious tissue with excessive bleeding which was biopsied and proven to be angiosarcoma on histologic examination. Subsequent imaging demonstrated precipitous progression to liver and lung metastases. Though rare, foreign-body-related sarcoma should be considered in the differential diagnosis for presentations suggestive of hemorrhagic or infectious sequelae of medical implants; this case broadens the range of medical devices associated with angiosarcoma to include now very commonly used implantable medical devices.