WOCN Homepage


Case Study: Stewart-Treves Syndrome in Long Term Lymphedema

Dorothy Doughty, MN, RN, CWOCN, Emory University, Director: Emory University WOCNEC, 1365 Clifton Road NE, Room AT732, Atlanta, GA 30322, Bonnie Sparks-DeFriese, PT, BSN, RN, CWOCN, Emory University, Clinician/Instructor, 1365 Clifton Road NE, Room AT732, Atlanta, GA 30322, Lea Crestodina, and Rhonda Holbrook, BSN, CWOCN, Clinical Educator, Atl;anta, GA 30308.

CLINICAL PROBLEM:A 79 year old Caucasian female with a long history of lower extremity lymphedema presented to the Vascular Surgery Clinic with a raised necrotic-appearing area covering most of her anterior left lower extremity. A biopsy revealed angiosarcoma. .

PAST TREATMENT: Per chart review, past treatments for lymphedema have included H2O2, Polysporin ointment, Domeboro's Solution, lymphedema pumps, and compression stockings. Compression wraps were the current treatment.

ANGIOSARCOMA in LONG TERM LYMPHEDEMA : Angiosarcoma is a rare vascular malignancy, accounting for less than 1% of all sarcomas. Angiosarcoma that arises in an area of chronic lymphedema is known as Stewart-Treves syndrome. The prognosis is poor.

TREATMENT: After consultation with oncology, it was decided to proceed with a left above the knee amputation.

PATIENT OUTCOMES: A left above knee amputation performed in May 2005. The patient tolerated surgery well.

CONCLUSION: Although rare, angiosarcoma can occur in patients with long standing lymphedema. CLINICAL IMPLICATIONS: Patients with chronic lymphedema must be monitored for any atypical lesion, which should be promptly biopsied. LIMITATIONS: There is limited awareness of lymphedema treatment in general, with many patients untreated for years.

FINANCIAL ASSISTANCE/DISCLOSURE: No financial assistance was received for this study

REFERENCES: Breidendbach, M; Rein, D; Schmidt, T; Heindel, W; Kolhagen,H; Mallmann, P; Kurbacher, C M. Intra-arterial mitoxantrone and paclitaxel in a patient with Stewart-Treves syndrome:selection of chemotherapy by an ex vivo ATP-based chemosensitivity assay Anti-Cancer Drugs. 2000; Volume 11 (4): 269-273

Komorowski, Andrzej; Wysocki, Wojciech; Mitus, Jerzy. Angiosarcoma in a Chronically Lymphedematous Leg: An Unusual Presentation of Stewart-Treves Syndrome. The Southern Medical Journal 2003; Volume 96 (8) 807-808

See more of Case Study Poster Abstracts
See more of Case Study Abstracts

See more of The 38th Annual WOCN Society Conference (June 24 -- 28, 2006)