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Case Report Plastic and Aesthetic Research

Pseudoangiomatous squamous cell

carcinoma: a challenge for pathologists and

plastic surgeons

Dimitrios Kanakopoulos , Evgenios Evgeniou , Panayiotis A. Dimitriadis ,
2
1
3
Mahendra Kulkarni 4
1 Department of Plastic Surgery, Southmead Hospital, Bristol, BS105NB, UK.
2 Department of Plastic Surgery, Derriford Hospital, Plymouth, PL68DH, UK.
3 Department of ENT, Lister Hospital, Stevenage, SG14AB, UK.
4 Department of Plastic Surgery, Wexham Park Hospital, Slough, SL24HL, UK.
Address for correspondence: Mr. Evgenios Evgeniou, 43 Friars Place Lane, East Acton, London, W3 7AQ, UK.
E-mail: evgenios@doctors.org.uk

ABSTRACT
Pseudo-angiosarcomatous or pseudovascular squamous cell carcinoma (SCC) of the skin is an unusual
variant form of acantholytic SCC that mimics the histopathological appearance of angiosarcoma. We
describe a case of pseudovascular SCC in a 77-year-old lady to highlight the frequent recurrence and
aggressiveness, as well as the clinicopathological features of this rare form of cutaneous SCC, and
demonstrate the difficulties in establishing the correct diagnosis. Plastic surgeons involved in the care
of patients with cutaneous malignancies should be aware of this variant of SCC and its aggressive
nature in order to manage these patients appropriately.
Key words:
Carcinoma, pseudosarcoma, squamous, squamous cell carcinoma

INTRODUCTION of cells that have a glassy eosinophilic cytoplasm
and enlarged nuclei. Mitotic figures, keratin pearls,
[3]
Squamous cell carcinoma (SCC) is a nonmelanoma skin and dyskeratotic keratinocytes are variably present.
cancer and the second most common type of skin Pseudo‑angiosarcomatous or pseudovascular SCC of the
cancer. These cases most commonly arise in sun‑exposed skin is an unusual and highly aggressive variant form of
[1]
skin areas in middle‑aged or elderly patients. The SCC. [4]
[2]
classic presentation for a cutaneous SCC is a shallow
ulcer with heaped‑up edges, often covered by plaque, CASE REPORT
usually in a sun‑exposed area. Typical surface changes
may include a smooth or hyperkeratotic enlarged A 77‑year‑old lady was referred to plastic surgery from
plaque, nodule, ulceration, crusting, or cutaneous dermatology with a biopsy that confirmed the presence of
[1]
horn. Histologically, there is a characteristic proliferation a poorly differentiated acantholytic SCC. On examination,
of atypical keratinocytes that invade the dermis, with she had an exophytic growth on the anterior aspect of
areas of detachment from the overlying epidermis. These the lower third of her left leg, with multiple satellite
anastomosing growths of cords and nests are composed lesions and associated edema. There was no palpable
lymphadenopathy or organomegaly present. An X‑ray
Access this article online assessment of her left leg was performed, showing no
Quick Response Code: bony involvement. A wide local excision of the lesion
Website: with a 1 cm peripheral margin down to the fascia was
www.parjournal.net
performed, and the wound was resurfaced with a
split‑thickness skin graft. Although histology confirmed
DOI: that the tumor had been completely excised with an
10.4103/2347-9264.153208 adequate margin and the wound had healed nicely
within 3 weeks, the patient presented at 6 weeks with
88 Plast Aesthet Res || Vol 2 || Issue 2 || Mar 13, 2015