title: Stewart-Treves syndrome following idiopathic leg lymphoedema: remember sarcoma.
abstract: Patients with skin complaints secondary to oedema are commonly encountered and can be a diagnostic challenge. Here, we present the case of a 78-year-old lady with Stewart-Treves syndrome, a rare cutaneous angiosarcoma. The histology showed angiocutaneous sarcoma with poorly defined margins. The prognosis remains extremely poor. A successful transfemoral amputation reduced the massive tumour burden and cleared a source of sepsis from this fungating tumour. Our aim is to highlight this rare but high-grade sarcoma which results from chronic lymphoedema. The red flag signs of sarcoma are masses greater than 5 cm, tumours which are rapidly growing, deep to fascia or painful, and tumours that recur after previous surgery. Non-healing or progressive ulceration in the background of chronic lymphoedema should raise the possibility of underlying malignancy. We need a low threshold for biopsy and early referral to an appropriate multidisciplinary team for the optimum management of the patient.
authors.affiliation: Liverpool Sarcoma Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Merseyside, UK.
authors.forename: W D
authors.initials: WD
authors.lastname: Harrison
authors.affiliation: Liverpool Sarcoma Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Merseyside, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Chandrasekar
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D001706:Biopsy; D002908:Chronic Disease; D055088:Early Detection of Cancer; D005260:Female; D006394:Hemangiosarcoma / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007866:Leg; D008204:Lymphangiosarcoma / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D008209:Lymphedema / Q000150:complications*; D011379:Prognosis; D016896:Treatment Outcome
keywords: Stewart–Treves syndrome; lymphoedema; sarcoma; ulceration