Abstract

Angiosarcoma is an aggressive, malignant endothelial cell tumor of vascular or lymphatic origin most often appearing on the head or neck. Angiosarcoma usually expresses endothelial markers CD31 and CD34 and nuclear stain ERG. We present a case of a 75-year-old man presenting to the ENT clinic for treatment of a previously biopsied BCC of the nose. During the examination, he was noted to have a subcutaneous nodule on the right face which was biopsied. This biopsy showed a central ruptured follicular cyst which nearly obscured a subtle proliferation of histiocytoid cells with epithelioid clustering and focal areas of vasoformation with hobnail endothelial cells. Upon further investigation, these cells stained positive for CD31 and ERG resulting in a final diagnosis of angiosarcoma with entrapped ruptured follicular cyst. We present this case because the diagnosis of angiosarcoma could have been easily overlooked if the clinician had simply only considered the ruptured cyst without careful evaluation of the rest of the slide. It is important to remember that there can be more than one diagnosis in a biopsy to avoid the pitfall of missing a subtle background malignancy such as angiosarcoma.

Financial Disclosure:
No current or relevant financial relationships exist.