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Answer: Angiosarcoma of the hand associated with chronic exposure to polyvinyl chloride pipes and cement

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Fig. 1. Anteroposterior radiograph of the right hand, showing a well marginated lytic tumor in the distal part of the fifth metacarpal and a lytic lesion in the distal phalanx of the thumb.

Fig. 2. Anteroposterior radiograph of the fingers of the right hand, showing lytic lesions in the distal phalanges of the long and ring fingers secondary to erosion caused by the tumors in the nail-folds.

Fig. 3. T2-weighted axial magnetic resonance image showing a lesion in the soft tissues of the interspace between the third and fourth metacarpals (A) and another lesion in the region of the fifth metacarpal (B). (A third lesion, which was located within the thenar muscles, was seen on a different magnetic resonance image.)

Fig. 4. Photomicrograph of a specimen of tissue from the nail-fold, showing a grade-2 angiosarcoma26 with epithelioid features (hematoxylin and eosin, x 100). Note the characteristic fibroreticular pattern (A) separating aggregates of oval cells (B). A blood vessel (BV) also is seen.

Discussion

Angiosarcoma of the liver has been reported to be causally related to chronic exposure to polyvinyl chloride. Skin contact with products that contain polyvinyl chloride is known to cause a spectrum of vascular dysplasias.

In this case, a patient developed angiosarcoma of the hand after having been exposed to polyvinyl chloride over a period of eleven years. The patient had lesions involving the nail-folds of three digits (the thumb and the long and ring fingers) as well as several soft-tissue masses in the palm. He also had metastases to the lungs.

Angiosarcoma is an extremely rare vascular neoplasm that has been estimated to account for less than 1 per cent of all sarcomas.

Reference:

Mohler, D.G.; Chen, W.W.; and Bloom, H.: Angiosarcoma of the hand associated with chronic exposure to polyvinyl chloride pipes and cement. J Bone and Joint Surg [Am]. 80-A, 1349-1354, September 1998.