Destructive upper limb malignant ulcer: A case report of angiosarcoma

Angiosarcomas are rare malignant neoplasms arising from vascular or lymphatic endothelial cells, characterised by aggressive local invasion and a high propensity for early metastasis. They commonly affect the head and neck regions in elderly individuals.

We report the case of a 43-year-old woman who presented with a four-year history of a progressive ulcerative lesion, foul-smelling, fungating, extending from the left hand to the mid-forearm, associated with limb dysfunction and anaemia. Previous local excisions were performed without histopathological evaluation. Clinical and radiological features were suggestive of malignancy. Incisional biopsy raised suspicion for malignant melanoma. However, following trans-humeral amputation, histopathological examination was suggestive of high-grade angiosarcoma, which was subsequently confirmed by immunohistochemistry.

Histologically, angiosarcomas can pose a diagnostic challenge due to their overlapping morphology with other spindle cell malignancies such as malignant melanoma. Immunohistochemistry is important in confirming angiosarcoma, and CD31 is the most sensitive immunohistochemical marker. Metastatic work up with appropriate imaging is important due to early metastasis tendency of angiosarcoma. Owing to the high cost of immunohistochemistry and advanced imaging, and chemoradiotherapy, diagnosis, staging and treatment of angiosarcoma in lower-middle income countries is challenging.

This case underscores the diagnostic and therapeutic challenges posed by angiosarcoma in resource-limited settings.