title: Spindle cell angiosarcoma following irradiation therapy for cervical carcinoma.
abstract: BACKGROUND
  Angiosarcomas arise in the scalp and face in the elderly, in association with chronic lymphedema (Stewart-Treves syndrome), and in irradiated areas. Rarely in these settings, angiosarcomas exhibit pure spindle cell phenotype.
  
  
  METHODS
  Herein, the clinicopathologic features of a 72-year-old-woman with spindle cell angiosarcoma are described.
  
  
  RESULTS
  A 72-year-old woman presented with numerous nodules and diffuse induration from the lower abdomen to the right buttock, corresponding to the area exposed to 60Co-irradiation during treatment for cervical carcinoma 10 years earlier. Histopathological examination revealed inflitrative, atypical, spindle cells that labeled with antibodies to CD31, CD34, and factor VIII-related antigen. Ultrastructurally, these malignant spindle cells contained Weibel-Palade bodies. No features suggesting radiation dermatitis (sclerosis or bizarre, large fibroblasts) were identified, but lymphangiectases and widely spaced collagen bundles(lymphedema) were prominent in the skin surrounding the angiosarcoma. Computed tomographic scan of the abdomen highlighted this histologic finding by demonstrating tumor masses limited to areas of lymphedema. Treatment with intravenous and local injections of recombinant interleukin 2 (rIL 2) followed by electron beam irradiation were initially effective with tumor remission for 2 months. However, the recurrent tumor did not respond to a second course of one-shot injection of rIL 2 through the abdominal aorta and the patient succumbed to her angiosarcoma 19 months after diagnosis.
  
  
  CONCLUSIONS
  Radiation-induced lymphedema may be a factor in angiosarcoma associated with radiotherapy.
authors.affiliation: Department of Dermatology, Fukui Medical University, Yoshida-gun, Japan. kiyo@fmsrsa.fukui-med.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kiyohara
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kumakiri
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kobayashl
authors.forename: Kei
authors.initials: K
authors.lastname: Itoh
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Lao
authors.forename: Akira
authors.initials: A
authors.lastname: Ohkawara
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakmura
mesh_terms: D000368:Aged; D003037:Cobalt Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006394:Hemangiosarcoma / Q000188:drug therapy / Q000209:etiology* / Q000532:radiotherapy / Q000648:ultrastructure; D006801:Humans; D007376:Interleukin-2 / Q000627:therapeutic use; D008209:Lymphedema / Q000209:etiology; D009381:Neoplasms, Radiation-Induced / Q000473:pathology*; D016609:Neoplasms, Second Primary / Q000209:etiology*; D009383:Neoplasms, Vascular Tissue / Q000188:drug therapy / Q000209:etiology* / Q000532:radiotherapy / Q000648:ultrastructure; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy
chemical_list: D003037:Cobalt Radioisotopes; D007376:Interleukin-2