Angiosarcoma

ANGIOSARCOMA Report of a Case HARRIS BLAKE,

D.D.S.,”

AND

FRED S. BLAKE,

D.D.S.,**

PATERSON,

N.

J.

SARCOMA retaining

has been defined as a tumor arising from connective tissue and most of the general characteristics of that t,issue. These tumors are pre-eminent,ly characterized by the rapid growth of their cells, and this in itself brings about the morphologic differences between them and corresponding benign tumors arising from similar structures in the connective tissue. The malignant character of the tumor is evident in the infiltrating, destructive manner of its growth when it is well established, but in the beginning it may be difficult to recognize this. In these tumors there is usually one type of cell which predominates and the name of the tumor is derived from this variety of cell. The angiosarcoma is a malignant form of the hemangioma. Its appearance is not radically different from the nonmalignant form; however, there is usually a history of rapid growth and the tumor is poorly delimited and fades out into the surrounding tissue. The angiosarcoma is differentiated from its benign analogue by the presence of mitotic figures in areas in which there is no i&ammation. It is this distinguishing characteristic which gives the tumor the potentialities of malignancy and it must be treated as such. Case Report of a lesioll A 26year-old white man was referred on July 10, 1952, for examination on the ridge of the left mandibular first molar area. The patient stated that the left lower srcond premolar and first molar had been extrackd sis years previously and that recovery had been uneventful. The space had never been repla& hy a restoration. The patient, first became aware of the lesion one month prior to cxamina.tion, and it had increased ill There was no pain or discomfort. size since that time. Examination.The patient appeared to be a well-developed, normal young man in no There mere no swellings or paldistrrss. Extraoral examination was essentially negative. examination revealed a soft tissue mass, measuring approxipable lymph nodes. Intraoral mately 1.0 cm. in diameter, attached by a wide base to tho ridge on the left mandibular The lesion was lobular in appearance, round in shape, and red in color. first molar area. It was not painful, hut appeared to be highly vascular. It was soft, but firm in consistency. Y’he mucous membrane covering the lesion was ulcerated, probably from the trauma caused hy mastication (Fig. 1 ) . Oral hygiene and general appearance of the mouth were good. *Acting Attending Oral Surgeon, Barnert Memorial Hospital, Paterson, New Jersey. **Adjunct Oral Surgeon, Barnert Memorial Hospital, Paterson, New Jersey: Instructor in Oral Surgery, Albert Einstein College of Medicine; an<1 Assistant Visiting Oral Surgeon, Kronx Mrmiripal Hospital Center, Bronx, New York.

821

slight (Fig.

Roentgenographic Examination.-Pcriapical and lateral jaw roentgenograms fuzzy, scoopc&ont appcaranc~~ of the in ihr~ lower left first 2). A preoperative

diagnosis

of giant-ccl1

cpulis

Fig. l.--Photograph

Fig.

2.-Roentgenogram

showing

fuzzy

showed a molar area

was matlc.

of the lesion.

appearance

of bone in the area

of the lesion.

Operation.-On July 14, 1952, the patient was prcmedicatcd with 1.5 gr. Seconal and anesthetized with 2 per cent Xylocaine and epinophrinc 1:50,000. An incision was made circumscribing the tumor buccally and lingually. The tumor was then separated from the underlying bone with a periosteal rlevator and removed en masse. The area was extremely vascular and the bleeding was controlled by the use of silk sutures and Adrenalin gauze packs. Pathologist’s Report.-&. Margit Freund reported that microscopic examination of the specimen showed a tumor made up of endothelial-lined vascular spaces of various sizes. It was cellular, and not infrequently mitotic figures were seen. Toward the surface it extended to the covering epithelium, and it was seen between bony particles at the site of removal. The surface was ulcerated and inflammatory cells extended into the tumor (Figs. 3 and 4). A diagnosis made.

of ulcerated

angiosarcoma

(with

possibility

of incomplete

removal)

was

ANGiIOB$KCOhIh

Fig.

3.

824

BLAKE

AND

BLAKE

Oral Surg., Oral Med., & 01al Pall. August, 1956

Course.-The postoperative course was uneventful. In view of the pathologist’s and the potentialities of the lesion, however, a second operation was performed.

report

Second Operation.---On Aug. 7, 1952, t,hc patient was prepared by sedation with 1.5 gr. Seconal and anesthetized with 2 per cent Xylocaine. The lower left second molar was removed and a block of soft tissue and bone was removed from the area of the second molar forward to the distal surface of the first premolar and from the buccal through to the lingual The bone wound was smoothed and areas to a depth of approximately 5 mm. (Pig. 5). cleared of all debris, and the buceal and lingual flaps were sutured with 000 silk sutures.

Fig. 5.-Photograph

of specimen

from

second operation.

Pathelogist’a Report.-The pathologist reported that microscopic examination entire material (except the tooth) showed no remnants of the tumor which appeared been removed completely previously. The bone was well preserved.

o.f the to have

A slight swelling of the left side Course.-The postoperative course was uneventful. of the face developed but gradually subsided. The patient experienced very little pain or distress. The sutures were removed on the sixth postoperative day. One month after operation the patient was inducted into the United States Army. Two years later, on Dee. 8, 1954, the area was examined and there was no clinical or roentgenologic evidence of recurrence of the lesion.

Comment A tumor that is very rarely seen in the oral cavity has been described. Examination of the medical and dental literature by the Reference Division of the Armed Forces Medical Library shows only two previously reported cases of angiosarcoma of the jaws. This unusual tumor is characterized by endothelial-lined vascular spaces and the presence of mitotic figures with invasive potentialities in areas in which no inflammation is present. In this latter respect, it differs from the benign angioma and must be classified as a malignant lesion. Without histologic examination, a case of this type could easily be misdiagnosed, which could lead to serious consequences.

ANGIOSARCOM

.\.

References J. Foot, N. Chandler: Identification of Tumors, Philadelphia, 1948, J. R. Lippincott Compaoy. pp. 60-67. 2. Henny, Fred A.: Angiosarcoma of the Maxilla in a 3-Month-Old Infant: Report of a Case, J. Oral Surg. 7: 250-252, 1949. 3. Hergcr, Adolph: Hemangioma of the Mandible (Metastxtici, hnn. lkmt. 1: 15-20, 19.1-Z 17 CHURCH

ST.