Angiosarcoma of the scalp – A histopathological surprise in a benign looking scalp lesion

Angiosarcoma is an uncommon malignant tumor that primarily affects older people and affects vascular endothelial cells. This tumor is quite deceptive and could be mistaken for a benign lesion based on its presentation and progression. We describe the case of a 50-year-old male who had post-traumatic left occipital edema that appeared benign on radiography and clinical examination. The index of suspicion increased due to the sudden increase in size. The excised specimen’s histomorphology revealed a cellular tumor that was mitotically active with large areas of necrosis. Vimentin, CD34, CD31, and FLI1 were all positive in the tumor cells. Clinically benign looking scalp swelling turning out a highly aggressive fatal malignancy was surprising in this case. Histopathology and evaluation by immunophenotyping remain the gold standard in timely diagnosis.