Never underestimate a non‐healing extraction socket

A 73‐year‐old man presented with a history of a non‐healing socket associated with persistent pain and swelling and enlarged submandibular lymph nodes 2 months after a mandibular implant extraction. His symptoms persisted despite repeated antibiotic therapy. Biopsy from the non‐healing extraction socket and core needle biopsy (CNB) of the right level I lymph node was initially reported as a poorly differentiated carcinoma as it expressed CK7 only. Further investigation with PET‐CT imaging revealed FDG avidity above and below the diaphragm with the left axillary lymph node, the most prominent and accessible. A CNB of the left axillary lymph node revealed a high‐grade vasoformative neoplasm positive for CD31, CD34, ERG and CK7 culminating in a diagnosis of epithelioid angiosarcoma. The unusual CK7 staining prompted a re‐evaluation of the incisional biopsy from the non‐healing extraction socket and CNB of the right level I lymph node. Unexpectedly, both lesions showed similar immunohistochemical profile to the left axillary lymph node prompting a definitive diagnosis of metastatic epithelioid angiosarcoma for the non‐healing extraction socket and associated lymph node. The patient received palliative chemotherapy in view of the disseminated disease at the time of diagnosis but subsequently died of his disease. This case report raises the awareness of morphological mimics of carcinoma such as the epithelioid variants of many sarcomas and their tendency to aberrantly express cytokeratin markers. It also demonstrates the importance of clinical–radiological–pathological correlation preferably in a multidisciplinary team (MDT) setting.