Diagnostic dilemma; report of a bizarre case of advanced scalp and face angiosarcoma and literature review

A 36-year-old male painter presented to our service in 2007 with an ulcerated solitary scalp swelling of 8 months’ duration. The mass was a dormant, painless, pea-sized growth, which he had had since childhood and which he bruised in a passenger motorcycle road traffic accident 8 months prior to presentation. The accident caused it to flare up and progressively increase in size, with associated pain, contact bleeding, and ulceration. A work-up for excision biopsy was proposed, but the patient defaulted and presented 2 years later with an increased number of lesions all around the scalp and face and in an obviously deteriorating clinical status with regional lymph node involvement at this stage. An incisional biopsy was then carried out and the histological reports came out with three different diagnoses of glioblastoma multiforme, poorly differentiated angiosarcoma, and squamous cell carcinoma, constituting a major diagnostic dilemma for our service.