A 70-year-old woman was diagnosed with a moderately differentiated invasive lobular breast carcinoma (pT3, pN1 biii (2/14), M0, ER negative, PR negative) and underwent tumor excision of the left upper outer lobe and lymph node excision of the left axilla 8.5 years ago, followed by re-surgery of the breast 1 month after the first operation because of microscopic residual tumor. The second surgery was followed by four chemotherapy cycles with doxorubicin and cyclophosphamide. Adjuvant percutaneous radiotherapy was performed in fractions of 2 Gy with a total dose of 50 Gy of the left breast and with a total dose of 56 Gy of the left axillar region.Eight years after the initial presentation, the patient noted a skin discoloration that she referred to minor trauma to the breast. Five months later, the patient was seen for routine checkup and physical examination revealed a blue-reddish-colored induration of the skin located at the lower outer and inner quadrant of her left breast, measuring 16 9 7 cm (6.3 9 2.8 inches; Fig. 1).The patients routine mammogram revealed a progressive circular thickening of the skin when compared to previous mammograms (last time performed 1 year before), showing no skin abnormalities. Breast tissue postlumpectomy showed no evidence of tumor recurrence (Fig. 2).Magnetic resonance imaging (MRI) of the left breast demonstrated-in correlation with the mammogram-a circular edematous thickening of the skin. After intravenous (i. v.) injection of contrast medium (CM), heterogeneous enhancement of the cutis was seen, without any infiltration of subcutaneous or breast tissue ( Fig. 3-transversal T1 fat-suppressed post i. v. CM). There was no evidence of local tumor recurrence in the breast tissue by MRI.Tumor biopsy was performed and subsequent histologic analysis confirmed the diagnosis of angiosarcoma in all specimens, based on the vasoformative features on light microscopy and on immunoreactivity for Figure 1. Erythematous lesion affecting the lower medial and lateral quadrant of the left breast.
Well-reduced extra-articular physeal fractures of the proximal phalanges can be effectively treated using functional-conservative casts. Although children may need a functional forearm cast, a LuCa is adequate in compliant adolescents.Level of Evidence The level of evidence for the study is Level II (therapeutic studies).
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