presented by Drs. Douglas Johnson and George Reizner
(Note: We recognize that the person's eyes should be blacked out to preserve anonymity; but have decided not to do so initially as seeing this man as he is may help when thinking about therapy. After 1 - 2 weeks, we will change the image to comply with standard presentations)
The patient is an otherwise healthy 94 year old man who lives in a rural Amazonian village that has limited access to medical care. History reveals that he has had a growing vascular lesion of the left elbow for at least three years. Biopsy showed a capillary hemangioma without atypical features. He has congestive heart failure and hypertension but his only medication is metoprolol. He declined surgery in 2024. His only abnormal finding is that he cannot dorsiflex his left thumb.
Pathology: Biopsy is reported to show a proliferation of blood vessels without atypia suspended in a fibrous stroma, This image was taken from the path report.
Diarnosis: Giant Hemangioms of the left elbow. Another dermatopathologist questioned whether this is an angiosarcoma.
Few dermatologists have much experience with lesions like this. What therapy, if any, should be offered this patient? He lives in a medically underserved rural village..
