Stewart-Treves syndrome and other cutaneous malignancies in the context of chronic lymphedema: a systematic review

MRI features of Stewart-Treves syndrome: a case series and systematic review

PURPOSE

To comprehensively summarize the magnetic resonance imaging (MRI) features of angiosarcomas presenting as Stewart-Treves syndrome (STS) through a retrospective case series and systematic review of previous publications.

MATERIALS AND METHODS

We identified five patients with STS from our institutional database and 25 patients with STS from 15 publications through a systemic review. We reviewed the MR features of 30 patients with STS, including five males and 25 females with a mean age of 59.5 years.

RESULTS

The tumors most commonly involved both the cutis and subcutis (17/25, 68.0%); the remaining tumors were limited to the cutis or subcutis. Multiple tumors were observed in more than half of the cases (16/27, 59.3%), and most of the tumors had poorly defined margins (26/28, 92.9%). The most common signal intensities of the tumors on T1-weighted images were intermediate (16/19, 84.2%), and the remainder were a mixture of intermediate and high, with a predominance of intermediate signal intensity. The signal intensities of the tumors on T2-weighted images were intermediate in seven cases (7/13, 53.8%), a mixture of intermediate and high in five cases (5/13, 38.5%), and a mixture of intermediate and low in one case (1/13, 7.7%). Available diffusion-weighted images from four institutional cases showed restricted diffusion of the tumors with mean apparent diffusion coefficient (ADC) values ranging from 0.77 × 10-3 mm2/s to 0.96 × 10-3 mm2/s.

CONCLUSION

Typical MRI features of angiosarcomas in STS were superficially located in multiple masses with ill-defined margins. Internal signal intensity was intermediate on T1-weighted images, and intermediate or a mixture of intermediate and high on T2-weighted images. ADC values obtained from the limited number of cases were low.

Stewart-Treves syndrome: a complication following treatment for metastatic melanoma

An 81-year-old man presented in 2024 with a new left-sided chest wall mass and associated bruising at a site of previous radiotherapy and chronic lymphoedema.

Kaposi Sarcoma in the Context of Post-Modified Radical Mastectomy: A New Case Report and Brief Review

Kaposi sarcoma is a human herpesvirus 8-associated angio-proliferative tumor arising from lymphatic endothelial cells. Four clinical subtypes are known: classic, epidemic, endemic, and iatrogenic. The development of Kaposi sarcoma and lymphedema may be interlinked, where each condition could potentially support the progression of the other. Post-mastectomy lymphedema is a commonly recognized complication following radical mastectomy. Angiosarcoma is the most frequently reported neoplasm in such a situation. We present a 72-year-old female who developed Kaposi sarcoma on the same side of mastectomy 9 years following her initial diagnosis and treatment for cancer breast. The diagnosis of Kaposi sarcoma was based on the histopathologic findings and was confirmed with immunohistochemical staining for human herpes virus 8 and D2-40. Lymphedema may be associated with local immune suppression manifested in the form of defective cell-mediated immunity and antigen-presenting cell migration defect which may facilitate development of neoplasms. It is important to differentiate Kaposi sarcoma from other vascular tumors which may have a much worse prognosis. Patients with lymphedema should receive appropriate management and undergo long-term follow-up for early detection of any potential malignancies.

Lymph node involvement in secondary breast angiosarcoma - a case presentation

Angiosarcoma represents a group of rare tumors originating from vascular and lymphatic endothelial cells, characterized by marked aggressiveness, rapid growth and poor clinical outcome. The incidence of breast angiosarcoma accounts for approximately 0.05% of all malignant breast tumors and less than 1% of all sarcomas. In this article, we report the case of a 67-year-old female patient who presented to our Clinic due to a rapidly evolving, non-painful, vegetating mass, encompassing almost her entire left breast. Imaging studies revealed diffuse skin thickening in all quadrants and an intensely opaque axillary lymph node (LN). Interestingly, the patient had prior medical history of breast carcinoma treated conservatively in 2007 with limited breast resection and left axillary lymphadenectomy, followed by post-operative chemotherapy and radiotherapy. At the current presentation, we performed a radical mastectomy with ipsilateral lymphadenectomy. The histopathological examination revealed a secondary angiosarcoma with LN involvement mimicking an atypical vascular lesion. In this article, we report the clinicopathological particularities of this case and discuss the challenge of diagnosing LN involvement in angiosarcoma.

Cutaneous Angiosarcoma Subtypes: A Quantitative Systematic Review of Demographics, Treatments, and Outcomes Within Published Patient-Level Cases

BACKGROUND

Cutaneous angiosarcoma (cAS) is a highly aggressive malignancy arising from the vascular endothelium. Given its rarity, there is insufficient data detailing patient demographics, management, and survival outcomes.

OBJECTIVE

To systematically compile published patient-level cases of cAS and to quantify and analyze data on demographics, management, and outcomes while determining prognostic indicators.

MATERIALS AND METHODS

Searches of EBSCOhost, MEDLINE, EMBASE, and the Cochrane Library generated 1,500 cases of cAS with individual level data available. PRISMA guidelines were followed.

RESULTS

Cutaneous angiosarcoma presented most often on the scalp of elderly men. Metastasis occurred in 36.3% of cases. Aggregate 5-year survival was 31.6% with the median survival of 25 months. The best 5-year survival was in the radiation-associated subtype (48.8%), whereas the worst was in the Stewart-Treves subtype (21.6%). Using multivariate analysis, gender, age group, disease subtype, treatment modality, and metastasis at presentation had significant effects on survival outcomes ( p < .05).

CONCLUSION

The breadth of information obtained enables this study to serve as a resource that clinicians may reference when they encounter cAS.

Vascular Diseases in Women: Do Women Suffer from Them Differently?

According to the World Health Organization, cardiovascular disease (CVD) is the leading cause of death among women worldwide, yet its magnitude is often underestimated. Biological and gender differences affect health, diagnosis, and healthcare in numerous ways. The lack of sex and gender awareness in health research and healthcare is an ongoing issue that affects not only research but also treatment and outcomes. The importance of recognizing the impacts of both sex and gender on health and of knowing the differences between the two in healthcare is beginning to gain ground. There is more appreciation of the roles that biological differences (sex) and sociocultural power structures (gender) have, and both sex and gender affect health behavior, the development of diseases, their diagnosis, management, and the long-term effects of an illness. An important issue is the knowledge and awareness of women about vascular diseases. The risk of cardiovascular events is drastically underestimated by women themselves, as well as by those around them. The purpose of this review is to draw attention to improving the medical care and treatment of women with vascular diseases.

Association of Lower Extremity Lymphedema and Nonmelanoma Skin Cancers

OBJECTIVE

To determine whether patients with lymphedema of a lower extremity (LE) had a greater risk of skin cancer than those without lymphedema.

PATIENTS AND METHODS

This retrospective cohort study included patients with LE lymphedema examined at Mayo Clinic in Rochester, MN, USA, from January 1, 2000, through December 31, 2020. All patients with the phrase "lower extremity lymphedema" and a diagnostic code for lymphedema present in their electronic health record, as well as their age-, race-, and sex-matched controls without lymphedema, were included in the study. A Kaplan-Meier curve was constructed to examine the time to development of the first skin cancer for the lymphedema cohort and the controls. A Cox proportional hazards regression model was used to calculate hazard ratios.

RESULTS

In total, 4437 patients had lymphedema within the study period. Compared with the matched control group, the lymphedema group had a significantly increased risk of skin cancer. For the subset of patients with unilateral lymphedema, the lymphedematous extremity was 2.65 times as likely as the nonlymphedematous LE to have skin cancer, particularly basal cell carcinoma.

CONCLUSION

Lower extremity lymphedema appears to be a risk factor for squamous cell carcinoma, basal call carcinoma, and as expected, angiosarcoma. Clinicians caring for patients with LE lymphedema should be aware of this increased risk and monitor at-risk patients accordingly.

Clinicopathological analysis and prognostic treatment study of angiosarcoma of the breast: a SEER population-based analysis

INTRODUCTION

Breast angiosarcoma is a rare malignancy of endovascular origin, accounting for less than 1% of all mammary cancers. Our aim was to explore clinicopathological features and the factors associated with prognosis.

METHODS

We extracted information from the Surveillance, Epidemiology, and End Results Program (SEER) for all patients with breast angiosarcoma between 2004 and 2015. Chi-square analysis was used to compare the clinicopathological features in all patients. Overall survival (OS) was assessed using the Kaplan and Meier method. Univariate and multivariate analyses were performed to evaluate the factors associated with prognosis.

RESULTS

A total of 247 patients were included in the analyses. The median OS of patients with primary breast angiosarcoma (PBSA) and secondary breast angiosarcoma (SBAB) was 38 months and 42 months, respectively. The 1-, 3- and 5-year OS with PBSA was 80%, 39%, and 25%, respectively, and the 1-, 3- and 5-year OS with SBAB was 80%, 42%, and 34%, respectively. Multivariate analysis revealed that tumor size (p = 0.001), tumor grade (p < 0.001), tumor extension (p = 0.015), and tumor spread (p < 0.001) were statistically significant factors for OS. Partial mastectomy with radiation (HR = 0.160, 95% CI, 0.036-0.719, p = 0.016), partial mastectomy with chemotherapy (HR = 0.105, 95% CI, 0.011-1.015, p = 0.052), and partial mastectomy (HR = 0.125, 95% CI, 0.028-0.583, p = 0.007) were related to significantly better OS outcomes in primary angiosarcoma.

CONCLUSION

Primary breast angiosarcoma has a better clinical phenotype than secondary breast angiosarcoma. Although overall survival was not statistically significant, primary breast angiosarcoma was better than secondary breast angiosarcoma with systemic therapy. Depending on the outcome of survival, partial mastectomy is effective in treating primary breast angiosarcoma.

A retrospective analysis of Stewart-Treves syndrome in the context of chronic lymphedema

BACKGROUND

stewart-treves syndrome (STS) is an angiosarcoma associated with chronic lymphedema.

OBJECTIVES

This article analyses the characteristics of twenty-two patients and proposes active intervention in lymphedema and the early diagnosis of STS.

METHODS

Twenty-two patients with STS were diagnosed at the centre over an 11-year period. Clinical manifestations, a series of conventional analyses, and histopathology were used to study these cases retrospectively.

RESULTS

The age range of 22 patients with STS was 15 to 78 years. The main clinical manifestations included multiple skin and subcutaneous nodules and scattered red or purplish-red rashes in the lymphoedematous limbs. These patients often showed clinical symptoms such as lymphedema, weakness, emaciation, pain, mass, lymphadenopathy and so on. The positive rates of ultrasonography, MRI and radionuclide imaging were 66.7% (6/9), 92.3% (12/13) and 18.2% (2/11), respectively. The main points regarding active intervention in lymphedema and early diagnosis of STS were summarized.

STUDY LIMITATIONS

Since this was a retrospective study, the main points summarized by the author need to be further quantified in clinical work to guide the diagnosis of this kind of disease more conveniently. In addition, further clinical trials are needed to evaluate the role of lymphedema in the occurrence and development of malignant tumors.

CONCLUSIONS

STS can appear in lymphoedematous tissue many years after lymphedema onset. To avoid delays in the diagnosis and therapy of STS, physicians should actively look for signs or symptoms of malignant lymphedema during the follow-up period and promptly manage patients developing problems.

Risk factors for the development of local recurrence in extremity soft-tissue sarcoma

INTRODUCTION

Local recurrence (LR) is one of the main pitfalls in surgery for extremities soft tissue sarcoma (eSTS). Achieving clear histopathological margins is the most important factor to reduce the risk of LR, but the ability to do so depends on not only surgical technique but also the interplay between tumor biology, anatomical location and surgical approach. The balance between postoperative morbidity and oncological benefits in reducing the risk of LR needs to be considered.

AREAS COVERED

This review will cover which etiological factors for the development of eSTS lead to an increased risk of LR and discuss histological subtypes that have a high risk of LR and which surgical and neoadjuvant therapeutic strategies can minimize the risk of LR.

EXPERT OPINION

The traditional view that surgical radicality always results in low rates of LR, while marginality alone always leads to high rates of relapse, is outdated. In the modern era of surgical oncology, limb salvage and high-level function after resectional surgery are the key surgical goals. The best results are achieved by combining effective neoadjuvant treatments with planned bespoke oncological operations that consider the biological and anatomical factors of each individual sarcoma.