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


Submitted: 5 December 2022
Accepted: 3 March 2023
Published: 4 April 2023
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Authors

  • Agnese Di Prazza Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
  • Ligia J. Dominguez Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
  • Giuseppe Badalamenti Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy.
  • Mario Barbagallo Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.

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.


Clark MA, Fisher C, Judson I, Thomas JM. Soft-tissue sarcomas in adults. New Engl J Med 2005;353:701-11. DOI: https://doi.org/10.1056/NEJMra041866

Stewart FW, Treves N. Lymphangiosarcoma in postmastectomy lymphedema: a report of six cases in elephantiasis chirurgica. Cancer 1948;1:64-81. DOI: https://doi.org/10.1002/1097-0142(194805)1:1<64::AID-CNCR2820010105>3.0.CO;2-W

Van der Graaf WT, Blay JY, Chawla SP, et al. Pazopanib for metastatic soft-tissue sarcoma (palette): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2012;379:1879-86. DOI: https://doi.org/10.1016/S0140-6736(12)60651-5

Woodward A, Ivins JC, Soule EH. Lymphangiosarcoma arising in chronic lymphedematous extremities. Cancer 1972;30:562-72. DOI: https://doi.org/10.1002/1097-0142(197208)30:2<562::AID-CNCR2820300237>3.0.CO;2-V

Al-Najjar AA, Harrington CI, Slater DN. Angiosarcoma: a complication of varicose leg ulceration. Acta Derm Venereol 1986;66:167-70.

Krause KI, Hebert AA, Sanchez RL, Solomon Jr AR. Anterior abdominal wall angiosarcoma in a morbidly obese woman. J Am Acad Dermatol 1986;15:327-30. DOI: https://doi.org/10.1016/S0190-9622(86)70170-9

Fitzpatrick PJ. Lymphangiosarcoma and breast cancer. Can J Surg 1969;12:172-7.

Wierzbicka-Hainaut E, Guillet G. Stewart-Treves syndrome (angiosarcoma on lyphoedema): a rare complication of lymphoedema [Article in French]. Presse Med 2010;39:1305-8. DOI: https://doi.org/10.1016/j.lpm.2010.06.017

Ruocco V, Schwartz RA, Ruocco E. Lymphedema: an immunologically vulnerable site for development of neoplasms. J Am Acad Dermatol 2002;47:124-7. DOI: https://doi.org/10.1067/mjd.2002.120909

Shon W, Ida CM, Boland-Froemming JM, Rose PS, Folpe A. Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five cases and review of the literature. J Cutan Pathol 2011;38:560-4. DOI: https://doi.org/10.1111/j.1600-0560.2011.01703.x

Schwartz RA. Stewart-Treves syndrome. In: Demis DJ, ed. Clinical dermatology. 16th ed. Philadelphia, PA: Harper and Row Inc; 1989. pp. 1-6.

McConnell EM, Haslam P. Angiosarcoma in post-mastectomy lymphedema; a report of five cases and review of the literature. Br J Surg 1959;46:322-32. DOI: https://doi.org/10.1002/bjs.18004619804

Sharma A, Schwartz RA. Stewart-Treves syndrome: pathogenesis and management. J Am Acad Dermatol 2012;67:1342-8. DOI: https://doi.org/10.1016/j.jaad.2012.04.028

Jensen MR, Friberg L, Karlsmark T, Bulow J. (18)F-FDG PET/CT in a rare case of Stewart-Treves syndrome: future implications and diagnostic considerations. Lymphat Res Biol 2011;9:61-4. DOI: https://doi.org/10.1089/lrb.2010.0025

Wang LL, Cui LF, Gao Y, Jiang ZC. Clinicopathologic features of Stewart-Treves syndrome. Int J Clin Exp Pathol 2019;12:680-8.

Grobmyer SR, Daly JM, Glotzbach RE, Grobmyer AJ. Role of surgery in the management of postmastectomy extremity angiosarcoma (Stewart-Treves syndrome). J Surg Oncol 2000;73:182-8. DOI: https://doi.org/10.1002/(SICI)1096-9098(200003)73:3<182::AID-JSO14>3.0.CO;2-N

Malhaire JP, Labat JP, Simon H, et al. One case of Stewart-Treves syndrome successfully treated at two years by chemotherapy and radiation therapy in a 73-year-old woman. Acta Oncol 1997;36:442-3. DOI: https://doi.org/10.3109/02841869709001296

Koca S, Beşiroğlu M, Özçelik M, et al. Pazopanib for metastatic soft-tissue sarcoma: a multicenter retrospective study. J Oncol Pharm Pract 2020;27:541-6. DOI: https://doi.org/10.1177/1078155220924075

Yamada M, Osada SI, Toyoshima A, et al. Prevention of tumor progression in Stewart-Treves syndrome with a low dose of pazopanib. J Dermatol 2019;46:e263-5. DOI: https://doi.org/10.1111/1346-8138.14807

Hayashi M, Makino T, Mori N, et al. Effectiveness of pazopanib for local and lung metastases in Stewart-Treves syndrome. Eur J Dermatol 2020;30:68-9.

Di Prazza, A., Dominguez, L. J., Badalamenti, G., & Barbagallo, M. (2023). Stewart-Treves syndrome: a case report of lymphedema-related angiosarcoma. Geriatric Care, 8(3). https://doi.org/10.4081/gc.2022.11065

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