Salameire Dimitri, Templier Isabelle, Charles Julie, Pinel Nicole, Morand Patrice, Leccia Marie-Thérèse, Lantuejoul Sylvie
Pôle de biologie-Département d'Anatomie et Cytologie Pathologiques, CHU Grenoble, France.
Am J Dermatopathol. 2008 Jun;30(3):265-8. doi: 10.1097/DAD.0b013e318169fd5f.
Cutaneous angiosarcoma (AGS) developing in a lymphedematous arm, after lymphadenectomy in the context of breast cancer, is the definition of the classical Stewart-Treves syndrome. Like AGS, many tumors such as Kaposi's sarcoma (KS) could develop in chronic lymphedema. We describe the case of a 50-year-old woman who presented with several nodules on the left lymphedematous arm evocative of a Stewart-Treves syndrome, 2 years after a left mastectomy and a homolateral lymphadenectomy. The histological examination revealed an atypical vascular proliferation suggesting AGS, but endothelial atypical cells nuclei were strongly stained by herpes human virus 8 antibody. The final diagnosis was an "anaplastic" KS mimicking a Stewart-Treves syndrome. The total regression of the lesion was obtained by elastic contention and intradermic liposomal doxorubicin. "Anaplastic" KS is a rare histological form of nodular KS, which mimics a cutaneous AGS but classically expresses herpes human virus 8. It is essential to know about this entity, particularly in a lymphedematous arm, to avoid aggressive treatment such as amputation.
在乳腺癌相关淋巴结清扫术后出现于淋巴水肿手臂的皮肤血管肉瘤(AGS),即典型的斯图尔特-特里夫斯综合征的定义。与AGS一样,许多肿瘤如卡波西肉瘤(KS)也可在慢性淋巴水肿中发生。我们描述了一名50岁女性的病例,她在左乳房切除及同侧淋巴结清扫术后2年,左淋巴水肿手臂出现多个结节,疑似斯图尔特-特里夫斯综合征。组织学检查显示非典型血管增生,提示为AGS,但内皮非典型细胞核被人疱疹病毒8抗体强烈染色。最终诊断为模仿斯图尔特-特里夫斯综合征的“间变性”KS。通过弹力绷带包扎和皮内注射脂质体阿霉素使病变完全消退。“间变性”KS是结节性KS的一种罕见组织学形式,它模仿皮肤AGS,但通常表达人疱疹病毒8。了解这一实体至关重要,尤其是在淋巴水肿手臂的情况下,以避免诸如截肢等激进治疗。