Syndrome de Stewart-Treves (angiosarcome sur lymphœdème) : complication rare du lymphœdème

Stewart-Treves syndrome: a case report of lymphedema-related angiosarcoma

Stewart-Treves syndrome (STS) is an angiosarcoma associated with lymphedema deriving more often from radical mastectomy and longstanding lymphedema, first described in 1948. Irradiation is also commonly associated with chronic lymphedema of extremities. It generally occurs about 10 years after the mastectomy and/or radiotherapy. The prognosis is very poor with a mean survival of 20 months from the diagnosis especially when radical surgery is not possible. We present the case of STS in an 89-year-old female who underwent left upper outer quadrantectomy for invasive ductal carcinoma in 2009 followed by axillary lymphadenectomy, radiotherapy, and hormonal therapy until 2014. She presented swollen upper left limb associated with hemorrhagic red papular lesions. Skin biopsy revealed the presence of lymphedema-associated angiosarcoma. Radical surgery was not possible, so she underwent conservative therapy with pazopanib, a tyrosine kinase inhibitor, with benefit. Long-term follow-up of these patients is crucial to intercept this condition at an early stage.

Antiprogrammed cell death protein 1 immunotherapy for angiosarcoma with high programmed death-ligand 1 expression: a case report

Background: Angiosarcoma (AS) is a rare malignancy originating from lymphatic or vascular endothelial cells. Prognosis of the disease is usually dismal and there is no effective treatment. Immunotherapy has been proved to be effective for various cancer types. Programmed death-ligand 1 (PD-L1) expression is generally recognized as a biomarker for the prediction of response to anti-PD-(L)1 immunotherapies. Methods & results: Here, we discuss a single case by highlighting the treatment of the antiprogrammed cell death protein 1 drug pembrolizumab with high PD-L1 expression. CT scan demonstrated a confirmed size reduction of some lesions compared with original lesions, which indicates the possible clinical benefit. Conclusion: We speculate that early anti-PD-1 treatment may be a promising strategy for angiosarcoma patients with high PD-L1 expression.

Stewart-Treves Syndrome Involving Chronic Lymphedema after Mastectomy of Breast Cancer

Steward-Treves syndrome is a cutaneous angiosarcoma that usually appears after long evolution of a lymphoedema after mastectomy for mammary neoplasia associated with an axillary dissection. This is a rare disease develop most of the time in upper arm and often confounded with cutaneous metastasis. Only the biopsy and immunohistochemical study confirm the diagnosis. The treatment is surgical and consists of large cutaneous excision, an amputation of the limb or even its disarticulation and will be followed by chemotherapy. Despite the treatment, the prognosis remains severe with poor survival. We report the case of a patient who had a Steward-Treves syndrome 20 years after lymphoedema following a left mastectomy with axillary dissection.

Stewart-Treves Syndrome after Bilateral Mastectomy and Radiotherapy for Breast Carcinoma: Case Report

Stewart-Treves syndrome is an angiosarcoma that occurs because of chronic lymphedema, which in most cases is a complication after mastectomy with axillary node dissection and postoperative radiation. Prognosis for this rare tumor is poor. The best therapy is early and radical excision. Chronic lymphedema seems to be an important pathogenic factor. We report a 59-year-old patient with chronic lymphedema and lymphangiosarcoma of the left upper limb who had a left modified radical mastectomy with axillary node dissection and postoperative radiation nine years ago. Additionally, the patient underwent a right modified radical mastectomy with axillary node dissection and postoperative radiation one year ago. In this report, we present a case of Stewart-Treves syndrome after the patient was operated for bilateral breast carcinoma, a review of literature, and principles of treatment.

Current views on diagnostic approach and treatment of lymphedema

Lymphedema is a chronic, progressive, and often debilitating condition. Primary lymphedema is a lymphatic malformation developing during the later stage of lymphangiogenesis. Secondary lymphedema is the result of obstruction or disruption of the lymphatic system, which can occur as a consequence of tumors, surgery, trauma, infection, inflammation, and radiation therapy. In this review, we report an update upon the diagnostic approach and the medical and surgical therapy for both primary and secondary lymphedema.