A 62-year-old woman who underwent radical mastectomy with axillary irradiation 12 years ago now has several purple-red nodules spreading across the skin of the ipsilateral arm and chest wall. Biopsy shows malignant spindle cells forming vascular channels. What is the diagnosis?
- A Stewart-Treves syndrome (post-mastectomy lymphangiosarcoma) ✓
- B Recurrent breast carcinoma with dermal lymphatic spread
- C Malignant melanoma metastatic to the skin
- D Cutaneous angiosarcoma unrelated to prior surgery
Correct answer: A. Stewart-Treves syndrome (post-mastectomy lymphangiosarcoma)
Explanation
Stewart-Treves syndrome is lymphangiosarcoma arising in chronic post-mastectomy lymphoedematous tissue, classically 5 to 15 years after radical mastectomy, particularly when radiotherapy was given. It appears as multiple bruise-like purple nodules and shows malignant endothelial cells lining vascular spaces. The key discriminator from recurrent carcinoma is the long latency, the vascular immunophenotype, and the origin within chronically oedematous rather than scar tissue.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.