Angiosarcoma After Breast Conservation: Diagnostic Pitfalls

The Breast Care and Imaging Center of Orange County, Irvine, CA 92604, USA.
Clinical Breast Cancer (Impact Factor: 2.11). 03/2008; 8(1):94-6. DOI: 10.3816/CBC.2008.n.009
Source: PubMed


Angiosarcomas are aggressive tumors of endovascular origin. Although angiosarcomas are relatively rare, they are being reported with increasing frequency in patients who have previously undergone breast conserving therapy. The initial clinical presentation of angiosarcomas after breast irradiation is often similar to the presentation of recurrent breast carcinomas. In addition, the histologic and cytologic appearance of posttreatment angiosarcomas can be highly suggestive of recurrent breast carcinoma. Immunohistochemical stains are often required to make an accurate distinction between the 2 entities. An accurate diagnosis is essential, because prognosis and treatment are different for each condition. An early and accurate diagnosis is aided by a high index of suspicion by clinician and pathologist. Herein, a case history is presented that underscores the pitfalls in attempting to achieve an accurate diagnosis.

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    ABSTRACT: Angiosarcoma of the breast is a rare and very aggressive tumors originated from endothelial cells lining blood vessels. We report a case of a 55-year-old postmenopausal female with a primary breast angiosarcoma diagnosed just a one year after radical hysterectomy and radiation therapy due to endometrial cancer. The patient initially presented with postmenopausal bleeding. Cytology and biopsy of the endometrium were performed and endometrial adenosquamous carcinoma was diagnosed followed by radical hysterectomy and postoperative local radiatiotherapy (50 Gy). One year later patient presented with a great painful tumorous mass in the right breast. Physical examination revealed an oval tumor, located in upper and outer quadrant of the right breast, around 15 cm in diameter. Mammography and ultrasonography were performed. The angiosarcoma of the breast was confirmed by biopsy. The patient underwent radical mastectomy. Histopathology proved the diagnosis of angiosarcoma (high-grade, numerous mitoses over 10/10 HPF, necrosis, “blood lakes”, infiltrative borders). Differential diagnosis of a breast angiosarcoma should be considered in all painful breast tumours no mather the time and the location of the previous radiation treatment even if benign characteristics of these masses have been detected by mammography and breast ultrasound.
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    ABSTRACT: Angiosarcomas of the breast (ASB) are rare, representing <1% of breast malignancies. They can develop as a primary or secondary malignancy, also called post-radiation angiosarcoma. The aim of the this study is to discuss diagnosis, treatment, and outcome of primary and secondary ASB patients, diagnosed and treated in a single institution, over a 10-year period and to further compare the two conditions. We retrieved 28 consecutive cases of ASB, diagnosed from 1999 to 2009 at the European Institute of Oncology. Clinical and pathologic findings and survival analyses were performed. Of the 28 cases (27 women and 1 man), eight were primary breast angiosarcomas (PBA) and 20 were secondary breast angiosarcomas (SBA). Median follow-up was 23 months (range 1-112 months). Type of treatment (conservative or radical surgery) did not affect survival in both types of angiosarcomas. The clinical course observed was characterized by a high rate of local recurrence rather than distant metastasis or death from disease. There was a correlation between histological grade and prognosis of angiosarcomas with high-grade tumors presenting worse prognosis. SBA had a poorer prognosis compared to PBA. Our data indicate that primary and secondary ASB are distinct clinical and pathological features. SBA showed worse prognosis and was more often diagnosed in the study period compared to PBA. Physicians who care for patients who have been treated with radiation must be aware of its potential to induce angiosarcoma and stay vigilant in its detection.
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    ABSTRACT: Radiation-induced angiosarcomas are uncommon adverse sequelae related to treatment of tumors. Early diagnosis and treatment are key to successful management. The purpose of this case study is to describe the clinical characteristics of radiation-induced angiosarcomas. We retrospectively reviewed the medical literature using PubMed, searching the terms angiosarcoma, breast, post, radiation, and treatment. Patient reports and previous reviews of the subject were critically assessed and the salient features are presented. Approximately one hundred patients have been diagnosed with radiation-induced angiosarcomas. The condition presents within the radiation field, approximately six years after initial treatment. We describe the dramatic efficacious response of our patient's angiosarcoma to adjuvant chemotherapy both preoperatively (gemcitabine and docetaxel) and postoperatively (gemcitabine and docetaxel followed by ifosfamide and adriamycin). We recommend that new skin lesions within or adjacent to radiation ports should be considered for biopsy. Also, for lesions that are larger, ill-defined, or both, several sites should be sampled to ensure an accurate diagnosis and to prevent the possibility of a false negative interpretation.
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