(Kiosk 1) Angiosarcoma of the Upper Arm Post Thallium Stress Test Requiring Forequarter Amputation

Case Diagnosis: The patient is a 58-year-old male that went for a routine stress test and developed angiosarcoma in the left shoulder presenting with left arm swelling and neuropathy, approximately 6 months after exposure to high dose of radioactive material, later requiring forequarter amputation.

Case Description: A 58-year-old male patient complained of numbness, tingling and swelling on the left upper arm, sensation of increased pressure, and pain of 10 out of 10 at the clinic 6 months after receiving a thallium stress test. An MRI conducted a few months after the stress test revealed a small mass of unknown etiology in the patient’s left upper arm. Frozen section of the wall of the cyst suggested sarcoma. The patient underwent two rounds of chemotherapy, however, began to develop nerve palsies. Physical exam displayed loss of motor function and sensory sensation in his radial nerve distribution. Ulnar nerve motor function was decreased with moderate neuropathy. The patient’s median nerve was functioning normally without neuropathy. Multiple suprascapular nerve blocks along with a brachial plexus block were performed for symptomatic relief along with administration of various pain medications. Four months after initial diagnosis a forequarter amputation was performed.

Discussion: Angiosarcoma is a rare and aggressive form of cancer that develops in the cells lining the blood vessels or lymphatic vessels. Prognosis largely depends on time of diagnosis. With the patient presenting with left arm swelling, numbness, and tingling - a differential of angiosarcoma was considered and further prompt investigation confirmed, allowing for initiation of treatment.

Setting: PM&R Pain Clinic

Assessment/Results: Biopsy demonstrating sarcoma. Physical examination demonstrating LUE swelling and sensory neuropathy.

Conclusion: Angiosarcoma after high-dose radiation exposure is rare, however, should be considered in a patient developing rapidly progressive neuropathy and unilateral swelling after high-dose radiation exposure. As physiatrists it's important to recognize as treatment initiation time is significant for a better prognosis.