Primary Breast Angiosarcoma: A Retrospective Study of 36 Cases from a Single Chinese Medical Institute with Clinicopathologic and Radiologic Correlations

Abstract

The aim of this study was to present our experience with primary breast angiosarcoma (PBA) by describing a large series of cases with an emphasis on clinicopathologic and radiologic correlations. Thirty-six cases of PBA diagnosed at our institution between 2006 and 2014 were retrospectively evaluated. All but one case occurred in women with a median age of 35.5 years. The majority of patients presented with a deeply located painless mass, whereas a minority manifested as diffuse enlargement or swelling of the breast. Magnetic resonance imaging showed poorly demarcated lesions with low signal intensity on T1-weighted images, markedly high intensity on T2-weighted images, and prolongation of enhancement upon dynamic study. Histologically, 19 cases (52.8%) were low grade, 12 cases (33.3%) were intermediate grade, and 5 cases (13.9%) were high grade. Follow-up information was available for 27 patients and revealed local recurrence and/or metastasis in 16 patients (59.3%). Five patients (18.5%) died of the disease at a median interval of 20 months. Univariate analysis showed that tumor differentiation had effect on disease-free survival (DFS) (p = 0.005) but failed to predict overall survival (OS) (p = 0.645). The treatment modality was related to OS (p = 0.042) but not DFS (p = 0.131). The Cox proportional hazards regression model suggested that tumor differentiation was an independent predictor of DFS (p = 0.015). We hypothesize that tumor differentiation may be used as a prognostic factor for this rare malignancy. Clinicopathologic and radiologic correlation may help pathologists to arrive at the correct diagnosis of PBA.

A 27‐year‐old female presented with diffuse alveolar haemorrhage due to breast angiosarcoma with lung metastasis

“…Wang et al conducted the only retrospective study that indicated angiosarcoma with pulmonary metastasis often presents with multiple pulmonary nodules and DAH. The common initial misdiagnoses included tuberculosis, auto‐immune‐related vasculitis, non‐tuberculous infectious disease, and constrictive pericarditis .…”

“…Diffuse alveolar haemorrhage (DAH) is a distinct clinicopathological syndrome characterized by the accumulation of intra‐alveolar red blood cells originating from the alveolar capillaries . DAH is associated with pulmonary capillaritis, bland pulmonary haemorrhage, diffuse alveolar damage, and miscellaneous histology . However, neoplastic diseases are not commonly considered in the differential diagnosis of DAH.…”

Primary breast angiosarcoma: a rare presentation of rare tumor – case report

“…The differential diagnosis is variable according to this grade. It includes benign haemangioma, angiomyolipoma, melanoma, undifferentiated carcinoma, stromal sarcoma and reactive spindle cell proliferative lesion [ 17 , 18 ].…”

Primary Angiosarcoma of the Breast—Series of 11 Consecutive Cases—A Single-Centre Experience

“…The age range of our study group differs from that of patients enrolled in the Wang et al study. In this study, the median age was 35.5 (17 to 68 years) 8 . Johnson et al and Nascimento et al indicate higher prevalence of pas in the right mamma 2,9 .…”