Stewart-Treves Syndrome: A Case Report

Year 2021, , 34 - 36, 11.06.2021

Cosmin Florescu , Christine Ahn

https://doi.org/10.33706/jemcr.795113

Abstract

A 68 year old female with Stewart Treves Syndrome was evaluated in the Emergency Department. Patient was resuscitated in the Emergency Department and admitted to the Intensive Care Unit. The following day, she suffered a stroke and was placed on comfort care measures after palliative care discussion with family. She died three days after admission. This article discusses Stewart Treves Syndrome, a rare form of angiosarcoma that occurs with chronic lymphedema after radical mastectomy with lymph node dissection. It presents with purplish cutaneous nodules or reddish blue macules that enlarge. The mortality rate is high and survival is low. Emergency physicians should be aware of this rare, but highly lethal, malignant syndrome. A patient with history of breast cancer and radiation therapy who presents with an enlarging red-purple plaque should be admitted or referred to oncology or plastic surgery for immediate biopsy.

Keywords

Stewart-Treves Syndrome, Lymphangiosarcoma, Breast cancer, Malignant sarcoma, Elephantiasis chirurgica

Supporting Institution

Stony Brook University Hospital Department of Emergency Medicine

References

• 1. Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Stewart, F W and Treves, N. 1948 May, Cancer, pp. 1(1):64-81.
• 2. Stewart-Treves Syndrome [Updated 2020 Jan 29). Murgia, R D and Gross, G P. Treasure Island, FL : StatPearls, 2020 Jan.
• 3. Stewart-Treves syndrome. Pol Merkur Lekarski. Komorowski, A L, Kysocki, W M and Mitus, J. 2004 May, pp. 16(95)493-4.
• 4. Post-mastectomy lymphangiosarcoma (Stewart-Treves syndrome): report of two long-term survivals. Kaufmann, T, Chu, F and Kaufman, R. 1991 Sep, pp. 64(765):857-860.
• 5. Lymphangiosarcoma (Stewart-Treves syndrome) in postmastectomy patients. Chung, K C, Kim, H J and Jeffers, L L. 2000 Nov, Journal of Hand Surgery, pp. 25(6):1163-8.
• 6. Stewart-Treves syndrome. Radiology Case Reports. Gottlieb, Roy, et al. 2012, pp. Volume 7, Issue 4.
• 7. Cutaneous angiosarcoma of the lower leg. Scholtz, J, Mishra, M M and Simman, R. 2018 Oct, Cutis, pp. 102(4):E8-E11.
• 8. Clinicopathologic features of Stewart-Treves syndrome. Wang, L L, et al. 2019 Mar, Int J Clin Exp Pathol, pp. 1:12(3):680-688.
• 9. Primary and secondary breast angiosarcoma: a single center report and a meta-analysis. Abdou, Y, et al. 2019 Dec, Breast Cancer Res Treat, pp. 178(3):523-533.
• 10. Angiosarcoma outcomes and prognostic factors: a 25-year single institution experience. Buehler, D, et al. 2014 Oct, in Oncol, pp. 37(5):473-9.