title: Angiosarcoma: A Case Report of Gingival Disease with Both Palatine Tonsils Localization.
abstract: Angiosarcomas are one of the rarest subtypes of sarcomas; those are malignant vascular tumors arising from vascular endothelial cells. Occurrence of intra-oral angiosarcoma is extremely rare (0.0077% of all cancers in Europe). We present here, to our knowledge, the first case of a 83-year-old man with gingival and both palatine tonsils localization of a grade-two angiosarcoma discovered after a two months history of a painful lesion followed by hematoma and spontaneous bleeding. Chemotherapy with paclitaxel and hemostatic radiotherapy were inefficient and he died seven months after the first symptoms. It is essential to use the vascular markers, such as CD34, CD31, ERG and FLI1, for a correct histological diagnosis, which remains difficult because it displays a wide range of morphological appearances and multiple patterns may be present in the same tumor. The main prognostic factors are chronic pre-existing lymphedema and tumor size greater than five centimeters. Malignancy grade and stage classification should be provided in all cases in which this is feasible because of predictive meaning. When possible, wide surgical resection with negative margins remains the cornerstone for the treatment of localized angiosarcomas, but despite the improvement of surgical techniques the prognosis is poor with more than half of patients died within the first year. Adjuvant radiotherapy is the standard treatment of high-grade (two and three), deep lesions, regardless of size, because it improved the local recurrence-free survival. For advanced disease, if possible, metastasectomy should be considered. The first-line chemotherapy with doxorubicin or paclitaxel should be discussed compared to best supportive care according to patient comorbidities and preference.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Nord Franche-Comté , Belfort.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Chamberland
authors.affiliation: Department of Oncology, University Hospital Center Jean Minjoz , Besançon, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Maurina
authors.affiliation: Department of Pathology, University Hospital Center Jean Minjoz , Besançon, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Degano-Valmary
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Nord Franche-Comté , Belfort.
authors.forename: Thierry
authors.initials: T
authors.lastname: Spicarolen
authors.affiliation: Department of Oncology, University Hospital Center Jean Minjoz , Besançon, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Chaigneau
keywords: Angiosarcoma; gingiva; head and neck; palatine tonsil