High-Grade Cutaneous Angiosarcoma of the Breast 8.5 Years after Radiotherapy

Abstract

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.

Radiation-induced breast angiosarcoma: a case report

“…When tumour size increases, ulcers or oedema may appear. Other symptoms such as pain are uncommon [2]. Growth is explosive in high grade tumours and more insidious in low grade tumours.…”

“…Radiographically, the finding of skin thickening by mammography or nuclear magnetic resonance (MRI), or the appearance of skin lesions that enhance the contrast in the MRI may raise the suspicion of this secondary tumour lesion [2]. …”

“…Breast angiosarcomas following radiotherapy are a rare entity of which the incidence is estimated at 0.05% for all breast cancers [2], and its diagnostic criteria include a history of radiotherapy and a latency period of 5–10 years following radiotherapy [3]. The prognosis is poor with a high rate of relapse and an increased tendency to metastasise [4].…”

“…Often the initial diagnosis of this entity is complex given its relatively anodyne nature and usually being present in the form of typically multifocal reddish-purple papular skin lesions [2]. Because of the low incidence of this tumour, there is a limited number of studies regarding its optimal therapeutic management [3].…”

MRI findings of radiation‐associated angiosarcoma of the breast (RAS)

“…Much is unknown about imaging findings of radiation‐associated sarcomas (RAS) in the breast, as the current radiology literature on RAS is in the form of case reports and pictorial reviews, many of which describe both primary and secondary breast angiosarcoma cases, or do not pathologically differentiate these entities . Given the potential use of breast magnetic resonance imaging (MRI) in the follow‐up of women with a personal history of breast cancer, in addition to the nonspecific findings of conventional mammography and sonography, the initial MRI findings of secondary angiosarcoma may be useful in early detection.…”