A 33 year-old breast-feeding woman presented with a left breast mass for 6 months. The mass was first noticed during her pregnancy. Physical examination showed an upper inner quadrant nontender mass without skin changes or axillary lymphadenopathy. Mammography revealed a round 6-cm density with smooth borders. Ultrasound showed mixed echogenicity. Computerized tomography (CT) scan was negative elsewhere. A 14G core needle biopsy (CNB) was performed. Pathology examination reported lactational change with focal dilated vascular spaces, and recommended clinical and radiologic correlation (Fig. 1). Due to clinical suspicion the patient underwent a wide local excision (WLE) (Fig. 2). Pathology examination revealed grade III angiosarcoma with clear surgical margins (Figs 3 and 4). Tumor cells were positive for CD34, negative for human herpes virus 8 (HHV8) and epithelial membrane antigen (EMA). Review of the initial CNB revealed grade I angiosarcoma and lactational changes. Adjuvant chemotherapy and radiotherapy were implemented postoperatively. Nine months after the left WLE, patient developed two right breast Figure 2. Core biopsy: Bland-appearing vascular spaces with architecturally atypical infiltration in the fibrous stroma and adipose tissue. Lack of conspicuous cytologic atypia is a pit fall in diagnosis of low-grade angiosarcoma in core biopsy and fine-needle aspiration specimens (H&E stain, original magnification 940).Figure 1. Core biopsy: Lactational changes (left lower) and scattered vascular spaces (right upper) (H&E stain, original magnification 940).
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