Large primary cutaneous angiosarcoma of the nose successfully treated surgically

Angiosarcoma is a rare malignant neoplasm. It is a vascular soft-tissue tumour. Cutaneous angiosarcomas most frequently affect elderly people and usually are localized on the head and neck. Clinical presentations differ as erythematous plaques, macules or nodules may be observed, what, in some cases, may suggest benign conditions and the diagnosis is delayed. Histopathological examination is obligatory and the first-line therapy is surgical excision. The prognosis is poor, associated with high rates of local recurrence. We report a case of a 70-year-old male patient with angiosarcoma of the nose successfully treated with surgical excision in combination with reconstruction of nasal soft tissues using the forehead flap with an aesthetically satisfactory outcome.
A 70-year-old male patient was admitted to our Clinic to diagnose and treat the tumour of the nose. The lesion developed for about 7 months. First the patient observed erythematous macules within skin of the nose, after 3 months the tumour developed.
Before the admission to the hospital the patient was consulted laryngologically. Pus and blood were evacuated from the blister localized within tumour. The patient was treated orally with cloxacillin and topically with chloramphenicol with no improvement. The blister was punctured again but the blood and pus recurred, what suggested infiltration of deeper tissues.
The patient also suffered from hypertension, type 2 diabetes, generalized atherosclerosis and hypercholesterolemia.
On admission to the Clinic the patient presented purple tumour of 4-cm diameter with irregular borders and surface and reduced density in palpation localized on the nose. The lesion involved frontal parts of the nostrils and columella. Within tumour a blister filled with blood and pus was found. Several violaceous, satellite lesions were observed nearby (Figures 1 A, B). The nasal mucosa remained unchanged. In physical examination cervical and submandibular lymphadenopathies were found.
The basic blood laboratory tests showed normocytic anaemia and elevated levels of D-dimers and glucose. Anti-neutrophil cytoplasmic antibodies (cANCA, pANCA) and anti-nuclear antibodies were negative. Abdominal ultrasonography and chest X-ray did not reveal any abnormalities. The computed tomography of the head showed a lesion of 24 × 17 × 29 mm in size within the apex of the nose with an increasing density from 50 HU (Hounsfield units) to 68 HU partially...


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