{"title":"致命转移性诊断缺陷:由溃疡性头皮损伤引起的假淋巴瘤上皮样皮肤血管肉瘤。","authors":"Michelle Y. Zhu, Mahyar Khazaeli","doi":"10.1111/cup.14813","DOIUrl":null,"url":null,"abstract":"<div>\n \n <p>Rare morphological variants of cutaneous angiosarcoma (AS) can be diagnostically challenging. Angiosarcoma located on the head and scalp of the elderly has been associated with especially poor prognosis. We report a difficult diagnostic pitfall of pseudolymphomatous AS variant with overlapping features of epithelioid variant and aberrant immunohistochemistry staining, arising on an ulcerative scalp lesion in a 79-year old woman. Initial histopathological exam showed extensive cutaneous necrosis with prominent dermal inflammation within which, scattered large cells were CD31 positive and CD34 negative. After cutaneous lymphoma was ruled out, these large cells within the inflammatory infiltrate were determined to be dermal histiocytes and initial biopsy was diagnosed as benign. Subsequent re-biopsy showed similar features and was also called benign. Post-mortem re-review found the large cells were positive for ERG and formed solid clusters and papillae in some areas. A diagnosis of pseudolymphomatous epithelioid AS was rendered. Autopsy demonstrated lung nodules to be metastatic AS, consistent with findings from scalp primary. Our case draws attention to multiple features that can confound angiosarcoma diagnosis, and we discuss the appropriate endothelial IHC panel to rule out angiosarcoma in this clinical context.</p>\n </div>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":"52 7","pages":"469-473"},"PeriodicalIF":1.1000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Fatally Metastatic Diagnostic Pitfall: Pseudolymphomatous Epithelioid Cutaneous Angiosarcoma Arising From an Ulcerative Scalp Injury\",\"authors\":\"Michelle Y. Zhu, Mahyar Khazaeli\",\"doi\":\"10.1111/cup.14813\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n <p>Rare morphological variants of cutaneous angiosarcoma (AS) can be diagnostically challenging. Angiosarcoma located on the head and scalp of the elderly has been associated with especially poor prognosis. We report a difficult diagnostic pitfall of pseudolymphomatous AS variant with overlapping features of epithelioid variant and aberrant immunohistochemistry staining, arising on an ulcerative scalp lesion in a 79-year old woman. Initial histopathological exam showed extensive cutaneous necrosis with prominent dermal inflammation within which, scattered large cells were CD31 positive and CD34 negative. After cutaneous lymphoma was ruled out, these large cells within the inflammatory infiltrate were determined to be dermal histiocytes and initial biopsy was diagnosed as benign. Subsequent re-biopsy showed similar features and was also called benign. Post-mortem re-review found the large cells were positive for ERG and formed solid clusters and papillae in some areas. A diagnosis of pseudolymphomatous epithelioid AS was rendered. Autopsy demonstrated lung nodules to be metastatic AS, consistent with findings from scalp primary. Our case draws attention to multiple features that can confound angiosarcoma diagnosis, and we discuss the appropriate endothelial IHC panel to rule out angiosarcoma in this clinical context.</p>\\n </div>\",\"PeriodicalId\":15407,\"journal\":{\"name\":\"Journal of Cutaneous Pathology\",\"volume\":\"52 7\",\"pages\":\"469-473\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-04-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cutaneous Pathology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/cup.14813\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"DERMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cutaneous Pathology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cup.14813","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"DERMATOLOGY","Score":null,"Total":0}
Fatally Metastatic Diagnostic Pitfall: Pseudolymphomatous Epithelioid Cutaneous Angiosarcoma Arising From an Ulcerative Scalp Injury
Rare morphological variants of cutaneous angiosarcoma (AS) can be diagnostically challenging. Angiosarcoma located on the head and scalp of the elderly has been associated with especially poor prognosis. We report a difficult diagnostic pitfall of pseudolymphomatous AS variant with overlapping features of epithelioid variant and aberrant immunohistochemistry staining, arising on an ulcerative scalp lesion in a 79-year old woman. Initial histopathological exam showed extensive cutaneous necrosis with prominent dermal inflammation within which, scattered large cells were CD31 positive and CD34 negative. After cutaneous lymphoma was ruled out, these large cells within the inflammatory infiltrate were determined to be dermal histiocytes and initial biopsy was diagnosed as benign. Subsequent re-biopsy showed similar features and was also called benign. Post-mortem re-review found the large cells were positive for ERG and formed solid clusters and papillae in some areas. A diagnosis of pseudolymphomatous epithelioid AS was rendered. Autopsy demonstrated lung nodules to be metastatic AS, consistent with findings from scalp primary. Our case draws attention to multiple features that can confound angiosarcoma diagnosis, and we discuss the appropriate endothelial IHC panel to rule out angiosarcoma in this clinical context.
期刊介绍:
Journal of Cutaneous Pathology publishes manuscripts broadly relevant to diseases of the skin and mucosae, with the aims of advancing scientific knowledge regarding dermatopathology and enhancing the communication between clinical practitioners and research scientists. Original scientific manuscripts on diagnostic and experimental cutaneous pathology are especially desirable. Timely, pertinent review articles also will be given high priority. Manuscripts based on light, fluorescence, and electron microscopy, histochemistry, immunology, molecular biology, and genetics, as well as allied sciences, are all welcome, provided their principal focus is on cutaneous pathology. Publication time will be kept as short as possible, ensuring that articles will be quickly available to all interested in this speciality.