A 58-year-old woman who underwent modified radical mastectomy with axillary clearance and radiotherapy 11 years ago now has progressive swelling of the ipsilateral arm with violaceous nodules and bruise-like plaques on the forearm. Biopsy shows malignant endothelial cells lining dilated lymphatics. What is the diagnosis?
- A Angiosarcoma arising in chronic lymphoedema (Stewart-Treves syndrome) ✓
- B Kaposi sarcoma
- C Recurrent breast carcinoma infiltrating skin
- D Cutaneous metastasis of melanoma
Correct answer: A. Angiosarcoma arising in chronic lymphoedema (Stewart-Treves syndrome)
Explanation
Stewart-Treves syndrome is lymphangiosarcoma arising in a chronically lymphoedematous limb, classically many years after mastectomy and axillary radiotherapy. It presents as bruise-like plaques or violaceous nodules on the swollen arm and carries a poor prognosis, treated by wide excision or amputation. Kaposi sarcoma is linked to human herpesvirus 8 and immunosuppression rather than lymphoedema, and recurrent carcinoma would show adenocarcinoma histology, not malignant endothelium.
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.