Radiation-Induced Angiosarcoma After Mastectomy and TRAM Flap Breast Reconstruction

Abstract

Radiation-induced angiosarcoma of the breast is being reported with increasing frequency as a result of the increased use of radiation therapy in conjunction with breast conservation surgery. However, this entity has not been well documented in patients undergoing mastectomy. The authors present a case of angiosarcoma occurring in a patient 6 years after undergoing mastectomy for invasive duct carcinoma with immediate transverse rectus abdominis musculocutaneous flap reconstruction followed by postoperative radiation therapy. The diagnosis of angiosarcoma was made by skin biopsy performed by the patient's reconstructive surgeon on routine follow-up examination. This is the first reported case of postradiation angiosarcoma occurring in a postmastectomy breast reconstructed with autogenous tissue and it is unusual in that the cancer invaded the musculocutaneous flap. Diagnosis and management recommendations for radiation-induced angiosarcoma are discussed.

Radiation-Induced Leiomyosarcoma after Breast Cancer Treatment and TRAM Flap Reconstruction

“…All 7 patients died within six to 36 months after RIS diagnosis [13]. Most authors did not found any evidence of benefit after chemotherapy in RIS patients [3]. …”

“…The development of secondary neoplasm is of particular importance, especially sarcomas in women previously treated with radiation therapy [2]. Case reports [3, 4] and the publications of large series of important oncology centers [5] or registers [6] is a consequence of the increasing frequency of this type of secondary neoplasms.…”

“…Leiomyosarcoma is the more prevalent sarcoma category occurring after breast cancer in the Surveillance, Epidemiology and End Result (SEER) data [5], although most published reports describe angiosarcoma as the most frequent histological entity following breast conservation and radiation therapy [3]. …”

Secondary Angiosarcoma of the Breast: Can Imaging Findings Aid in the Diagnosis?

“…Radiographic aid in the diagnosis of secondary angiosarcoma has been reported to be limited (1,6,10). We present three cases of secondary breast angiosarcoma that developed in the setting of prior breast irradiation to illustrate its various radiologic presentations and discuss how the presence of certain imaging findings might assist in recognition of these tumors.…”

Multimodality Imaging of the Reconstructed Breast

“…Although the risk of developing breast sarcoma after breast reconstruction is exceedingly rare, the prevalence of these sarcomas will increase as patients live longer due to advances in surgical and radiation therapy [38]. A few case reports have described sarcomas in the reconstructed breast [39, 40]. The imaging features of these sarcomas are similar to those of sarcomas that develop in the native breast tissue [41], with the exception of secondary angiosarcoma that tends to affect the skin [42].…”