Peritoneal angiosarcoma in a patient with a history of cervical cancer treated with radiotherapy: A case report

Angiosarcoma is a highly malignant endothelial neoplasm that accounts for 1-2% of all soft tissue sarcomas in humans, and its marked biological aggressiveness constitutes a major clinical challenge. Early identification is particularly difficult in patients with a history of malignancies treated with radiotherapy, due to its histopathological heterogeneity and nonspecific clinical presentation, which often leads to confusion with other mesenchymal or epithelial neoplasms. We report the case of a 72-year-old woman with a history of cervical carcinoma treated with radiotherapy who presented with progressive pelvic pain, significant weight loss, and urinary symptoms. Initial imaging studies suggested peritoneal carcinomatosis, while multiple biopsies were negative for tumour recurrence. Given the discordance between morphological findings and initial immunohistochemical studies, a stepwise diagnostic approach using immunohistochemical panels was implemented. This approach confirmed peritoneal angiosarcoma following demonstration of CD31 positivity. This case highlights the importance of maintaining a high index of suspicion in patients with a history of pelvic irradiation, the utility of sequential diagnostic algorithms, the limitations of resource-limited settings, and the value of a multidisciplinary approach in the management of rare sarcomas.