Death from hypovolemic shock caused by perforation of duodenal ulcer in a patient with angiosarcoma of the scalp.

We report a case of an 86-year-old woman with angiosarcoma on the scalp, who died from hypovolemic shock caused by perforation of a duodenal ulcer. A purple-red macule was first noticed on her left temporal scalp, and over a 1-month period this macule rapidly grew to a 6 cm purple-red indurated plaque with hematomas. The diagnosis of angiosarcoma was made based on the clinical features and histopathological finding of the lesional skin. Perilesional injections of recombinant interleukin 2 (rIL-2) were followed by surgical resection of the lesion and graft repair. However, 5 months later, new hematomas appeared and increased in number and size to cover her cheek, left temporal scalp and around the grafted area. Electron-beam radiotherapy showed only a temporary effect and the skin lesions with spontaneous severe bleeding extended rapidly again toward a wide region of the left half of the scalp and cheek. The patient died of hypovolemic shock after acute abdominal pain with intestinal hemorrhage. The surgical pathology revealed the presence of a perforated duodenal ulcer which might have been the direct cause of hypovolemic shock.