Justice for Diagnostic Delay: A $25 Million Medical Malpractice Verdict and the Dangers of Mismanaged Angiosarcoma

This post of the Baltimore Medical Malpractice Lawyer Blog highlights a significant medical malpractice verdict. A jury recently sent a powerful message regarding the standard of care in oncology and diagnostic imaging. The jury awarded $25 million in a medical malpractice case to an angiosarcoma patient. They found that doctors repeatedly failed to timely diagnose the rare and aggressive form of cancer.

This case serves as a sobering reminder about “benign” assumptions and communication breakdowns within a medical system. They can lead to catastrophic, life-altering outcomes for patients.

The Medical Malpractice Case: A Three-Year Failure to Act on Angiosarcoma

The plaintiff’s ordeal began when he first sought evaluation for a persistent lump in the breast area. Despite the ongoing presence of the mass, the initial clinical assessment dismissed it as benign. Notably, the medical providers did not order imaging at that time to confirm the diagnosis.

The failure to diagnose was not the result of a single oversight, but rather a multi-year chain of errors:

• Ignored Recommendations: At one point, a radiologist specifically recommended additional diagnostic testing for the patient. However, the medical providers did not take any further steps, and never told the patient that the recommendation existed.
• Misinterpreted Biopsies: When the medical providers eventually biopsied the mass, they mischaracterized the results as noncancerous. This provided a false sense of security that further delayed life-saving intervention.
• The Devastating Discovery: By three years later, the mass recurred and new symptoms emerged. Subsequent testing revealed advanced angiosarcoma that had already metastasized, or spread, including a large tumor in the patient’s liver.

The medical providers who later reviewed the earlier biopsy samples confirmed that cancer had, in fact, been present years prior. The defense argued the disease might have been terminal regardless of the timing. However, the jury disagreed, finding that the failures in diagnosis, follow-up, and informed consent directly caused the patient significant harm.

Understanding Angiosarcoma and Medical Malpractice

To better understand how this cancer behaves and why the diagnostic failures in the $25 million verdict were so critical, it is helpful to look at the specific anatomy involved.

The Anatomy of Angiosarcoma: Blood Vessels and Lymphatics

Angiosarcoma is unique because it does not originate in an organ’s functional cells (like lung or liver cells), but rather in the endothelium.

The Endothelial Lining

The endothelium is a thin layer of simple squamous cells that lines the interior surface of the entire circulatory system, from the heart to the smallest capillaries.

• Structure: Think of the endothelium as the “wallpaper” of your blood vessels. It acts as a gatekeeper, controlling the passage of fluids, nutrients, and white blood cells between the blood and the surrounding tissue.
• Vascular System: Because blood vessels permeate almost every square inch of the human body, angiosarcoma can technically manifest in any anatomical location.
• Lymphatic System: This cancer also arises in the lining of lymph vessels, which transport lymph fluid and are a key part of the immune system.

Common Anatomical Sites

While it can appear anywhere, certain anatomical regions are more frequently involved:

• The Dermis and Hypodermis: The most common form is cutaneous (skin) angiosarcoma, often appearing on the scalp or face of older patients.
• Breast Tissue: As seen in the recent verdict, the breast area is a significant site for this cancer. It can occur as a primary tumor or a secondary complication following radiation for breast cancer.
• Deep Soft Tissue: It can grow within the muscles of the limbs or the trunk.
• Visceral Organs: The liver, spleen, and heart are the most common internal organs affected. In the case mentioned, the cancer eventually spread to form a large tumor in the patient’s liver.

Anatomy of Angiosarcoma and Metastasis in Medical Malpractice

The anatomy of the disease is also why it spreads so efficiently. Because the cancer originates inside the vessels, malignant cells have immediate access to the body’s transport systems.

• Hematogenous Spread: Cancer cells break off and travel through the bloodstream.
• Lymphatic Spread: Cells move through the lymph nodes to distant sites.

In this case, the anatomy played a tragic role. The persistent lump in the breast area remained undiagnosed for years, giving the malignant endothelial cells a direct “highway” to migrate to the liver, where the advanced stage of the disease was finally discovered. Understanding that this cancer is literally part of the circulatory system underscores why a “wait and see” approach for a persistent mass is a dangerous breach of the medical standard of care.

Causes and Risk Factors

While many cases of angiosarcoma occur sporadically without a clear cause, there are several well-documented risk factors:

• Radiation Therapy: Patients who have received radiation for other cancers (such as breast cancer) are at an increased risk of developing angiosarcoma in the treated area, often 5 to 10 years later.
• Chronic Lymphedema: Long-term swelling of the limbs, often after lymph node removal, can trigger the development of these tumors (a condition known as Stewart-Treves syndrome).
• Chemical Exposure: Exposure to certain industrial chemicals, such as vinyl chloride, arsenic, or thorium dioxide, has been linked specifically to angiosarcoma of the liver.
• Genetic Factors: Certain rare genetic syndromes, like Neurofibromatosis type 1, may slightly increase susceptibility.

Symptoms to Watch For

Angiosarcoma is often a “great masquerader,” frequently mistaken for bruises or benign fatty tumors (lipomas). Symptoms include:

• A purple or blue-black lesion on the skin that resembles a bruise but does not heal.
• A soft-tissue lump that may be painful or painless, often increasing in size.
• Lesions that bleed easily when bumped or scratched.
• In advanced cases, symptoms like weight loss, fatigue, or abdominal pain if the condition involves the liver.

The Diagnostic Path

As highlighted by the recent medical malpractice litigation, a clinical exam alone is often insufficient to rule out an angiosarcoma malignancy. If a lump is persistent or growing, specific medical providers and tools are required for an accurate diagnosis.

Who to See

If you notice a suspicious growth, you should initially consult a Dermatologist(for skin-based lesions) or a General Surgeon. However, if there is any suspicion of a sarcoma, you should be referred to a Surgical Oncologist or a specialized Sarcoma Center. These specialists have the expertise to distinguish between common fatty growths and rare vascular malignancies.

Tools and Equipment

• Advanced Imaging: MRI is the preferred tool for evaluating soft tissue masses, as it provides high contrast between different types of tissue. Medical providers often use CT scans and PET scans are to see if the cancer has spread to organs like the lungs or liver.
• Core Needle Biopsy: This is the most critical step. A doctor uses a specialized needle to remove a small cylinder of tissue.
• Histopathology: A pathologist examines the tissue under a microscope. To confirm angiosarcoma, they use Immunohistochemistry (IHC). This uses antibodies to detect specific markers (like CD31 or CD34) that prove the cells originated from blood vessels.

Angiosarcoma Treatment and Prognosis, and Medical Malpractice

The complexity of angiosarcoma requires a multidisciplinary team, typically including a Medical Oncologist, a Radiation Oncologist, and a Surgical Oncologist.

Treatment Modalities

1. Surgery: The goal is the complete removal of the tumor with “wide negative margins,” meaning no cancer cells are found at the edge of the removed tissue.
2. Radiation Therapy: This is often used before surgery to shrink the tumor or after surgery to kill any microscopic cells left behind, reducing the risk of recurrence.
3. Chemotherapy: For aggressive or metastatic cases, drugs such as paclitaxel or doxorubicin are used to slow the spread of the disease.
4. Targeted Therapy& Immunotherapy: In recent years, newer treatments that target the growth signals of blood vessels (anti-angiogenic drugs) have shown promise.

Prognosis

The prognosis for angiosarcoma depends heavily on the timing of the diagnosis. When caught early and treated with radical surgery, the chances of survival are significantly higher. However, because it is so aggressive, the overall five-year survival rate is generally between 20% and 35%. When medical providers misdiagnose or delay a diagnosis by years—as happened in this case—the cancer often reaches a stage where a “cure” is no longer possible. Treatment then shifts toward extending life and managing symptoms.

Final Thoughts on Angiosarcoma Medical Malpractice

The $25 million verdict is more than just a financial award. It is a reminder that patients deserve transparency and diligence. When a radiologist recommends a follow-up, the medical providers must share that information. When medical providers perform a biopsy, they must interpret it with the highest degree of accuracy.

If you or a loved one are facing a persistent medical issue that your providers are “dismissing”, do not hesitate to seek a second opinion. In the world of oncology, time is the most valuable resource a patient has.

If you have experienced a delay in diagnosis of cancer, and that delay has caused the cancer to reach stage 4 by spreading to other organs, then contact the Kopec Law Firm now.

You can read about other Blog posts on Verdicts involving misdiagnosis of a number of different types of cancers.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.