Diffuse Dermal Angiomatosis of the Breast

Abstract

Background: Diffuse dermal angiomatosis is rare and usually considered a variant of reactive angioendotheliomatosis. It generally involves the extremities of patients with severe vascular disease and other comorbidities. Two patients with breast involvement have been described; however, neither had a relevant medical history or a vaso-occlusive disorder, but both had large pendulous breasts, and 1 was positive for IgM anticardiolipin and antinuclear antibodies.Observations: A 53-year-old woman had a reticulated, erythematous plaque with superficial ulceration and underlying tender nodules on her left breast. She had a history of cardiovascular disease and was a heavy smoker. Biopsy of the lesion showed diffuse proliferation of additional endothelial cells and small bland vessels within the pap-illary and upper reticular dermis. Angiography showed almost complete occlusion of the subclavian artery proximally. Diffuse dermal angiomatosis was diagnosed. With isotretinoin therapy, the lesions improved. One month later, after percutaneous subclavian arterial revascularization, the lesion resolved completely. A literature review suggested that a history of heavy smoking, in addition to a history of vascular disease, may be important in the pathogenesis of diffuse dermal angiomatosis.Conclusions: Clinical acumen is crucial to diagnose diffuse angiomatosis of the breast. Appropriate treatment to alleviate hypoxia may improve the patient's condition.

Diffuse dermal angiomatosis of the breast: Clinicopathologic study of 5 patients

“…12 Breast involvement has been thought rare; however, our review of the literature identified breast involvement in 5 of 14 previously reported cases. 2,7,8,10,11 DDA is usually bilateral, most commonly affecting large pendulous breasts, as in our 5 patients. The addition of our cases makes the breast the most common location (10 of 19 reported cases).…”

“…8,9 Isotretinoin has been partially successful in resolving 2 cases affecting the breast; however, 1 patient later required stent placement in the proximal subclavian artery for resolution of signs and symptoms. 7,11 Although it is still early in the treatment course of our patient 4, she responded well after 1 month on isotretinoin. The antiangiogenic effects of isotretinoin may explain the improvement in symptoms.…”

Diffuse Dermal Angiomatosis of the Breasts: A Case Series of 8 Patients

“…8 Furthermore, there are reports of DDA presenting after or worsening with weight gain. 1,3,4,8 In the series, we saw a trend of greater BMI among symptomatic patients compared to asymptomatic patients. Higher BMI would likely result in larger pendulous breasts, a risk factor for DDA of breasts.…”

Severe atherosclerosis and a bewildering reticulated rash

“…In several case reports of DDA secondary to atherosclerotic disease, revascularization resulted in the resolution of skin lesions . Unfortunately, our patient was unsuitable for stenting or bypass due to the extensive nature of her disease.…”