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PATHOLOGY OF VASCULAR SKIN LESIONS - PART 9

Trong báo cáo ban đầu của họ, các tác giả báo cáo sáu bệnh nhân postmastectomy phù bạch huyết trên cánh tay cùng bên người mà angiosarcomas phát triển vài năm sau khi thủ tục này. Một số lượng lớn các trường hợp bổ sung nhanh chóng xuất hiện trong các tài liệu | 258 Sangueza and Requena Pathology of Vascular Skin Lesions 7. CUTANEOUS ANGIOSARCOMA ASSOCIATED WITH LYMPHEDEMA Stewart and Treves 1 first described the development of cutaneous angiosarcoma in lymphedematous areas in 1948. Since then this disorder has been known as Stewart-Treves syndrome. In their original report these authors reported six patients with postmastectomy lymphedema on the ipsilateral arm in whom angiosarcomas developed several years after this procedure. A large number of additional cases rapidly appeared in the literature 2-10 . In addition to lymphedema secondary to mastectomy this type of angiosarcoma has also been described in areas of lymphedema secondary to a variety of other mechanisms including axillary node dissection for metastatic melanoma in males 11 lymphedema of the abdominal wall following lymph node dissection for carcinoma of the penis 12 congenital lymphedema 3 4 13-16 lymphedema secondary to a filarial infection 17-22 chronic idiopathic lymphedema 3 15 18 22-27 morbid obesity with lymphedema 28 and angiosarcoma complicating elephantiasis 29 . Angiosarcomas arising in areas of lymphedema have been designated lymphangiosarcomas on the presumption that the neoplasms originated from dilated lymphatic vessels. However this assertion has not been definitively proved and immunohistochemical and ultrastructural studies support a hemangiomatous differentiation. Therefore at this time the term angiosarcoma is justified for neoplasms that develop in lymphedematous areas 30 . More than 90 of all angiosarcomas associated with chronic lymphedema occur following mastectomy for breast carcinoma 3 . The mastectomy invariably includes removal of the axillary lymph nodes and in some patients but not all there is also the antecedent of adjuvant radiotherapy to the affected area. The risk of developing angiosarcoma in postmastectomy patients who have a survival of 5 years or more is approximately 0.5 19 . The interval between the mastectomy and the .