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Background: Angiosarcoma of the breast is a rare form of breast malignancy. Primary breast angiosarcoma occurs sporadically primarily in young women while secondary breast angiosarcoma most frequently develops in older patients with prior history of radiation therapy or chronic lymphedema. This aggressive malignant tumor of the vascular endothelium has a high risk of local recurrence and distant metastasis and the diagnosis carries a poor prognosis.Case Description: We present a case of a 46-year-old female with a palpable left breast mass that initially masqueraded as a benign vascular lesion on core needle biopsy. After the mass began to enlarge rapidly, an excisional biopsy was performed revealing primary breast angiosarcoma and the patient was definitively managed with mastectomy. Additional surgical excision was required to achieve negative margins.Conclusions: Diagnosis of primary angiosarcoma of the breast is made difficult by an insidious clinical onset, no pathognomonic radiographic features and deceptively benign histologic appearance on biopsy. Surgical resection is often necessary to obtain sufficient tumor sampling for microscopic examination to render a final diagnosis. In young patients, a rapidly growing, highly vascular breast mass should be considered angiosarcoma until proven otherwise. Given the lack of consensus regarding systemic therapies, complete surgical resection of the tumor with mastectomy is the primary curative treatment option. A multimodal treatment approach should be considered in high-risk patients with large, advanced tumors in collaboration with a multidisciplinary care team.

Background: Inherited germline mutations in PALB2 are known to predispose patients to a higher risk of breast, ovarian and pancreatic cancer with an estimated risk of developing breast cancer in over half of all affected women by age 80 years. Current guidelines for screening patients with PALB2 mutations include annual mammograms beginning at age 30 years and consideration of breast magnetic resonance imaging (MRI) and tomosynthesis. Existing evidence regarding risk-reducing surgery with mastectomy is insufficient to make a definitive recommendation to patients. In this case series, we describe the presentation and management of 5 patients with unilateral breast cancer and PALB2 mutations. To our knowledge, this is the first reported case series discussing the role of contralateral risk-reducing mastectomy (CRRM) in breast cancer patients with PALB2 mutations. The aim of our study was to evaluate the challenges in managing breast cancer risk in patients with PALB2 pathogenic variants with illustration through real-world clinical cases and a review of the literature. Methods:In this retrospective observational study, we present 5 patients with PALB2 mutations between the ages of 29 and 61 years who were diagnosed with breast cancer and underwent surgical management of their breast cancer at our institution between November 2020 and March 2022. Through their clinical courses and a literature review, we discuss the role of CRRM in breast cancer patients with PALB2 gene mutations.Results: Out of the 5 patients, 3 patients underwent CRRM and 2 patients chose unilateral surgery for their breast cancer and active surveillance for the contralateral breast. Of the 3 patients who underwent CRRM, 1 patient experienced a surgical complication from reconstruction on the prophylactic side. None of the patients developed any recurrences with an average length of follow up of 15.4 months.Conclusions: Based on our experience and the currently available literature, CRRM in patients with a PALB2 mutation should be performed on a case-by-case basis through a shared decision-making process taking into consideration overall risk, family history, patient preference and quality of life.

Background: While praised for its benefits in treating symptoms related to menopausal changes, hormone replacement therapy (HRT) has been associated with an increased risk for hormone-dependent cancer development, particularly endometrial and breast. Few studies have elucidated the relationship between HRT cessation and hormone receptor-positive breast cancer proliferation. We report herein, to the best of our knowledge, the first case of 28.6% relative reduction in proliferation index marker Ki-67 in nodepositive hormone receptor-positive breast cancer following HRT cessation.Case Description: We report an unusual case of a 64-year-old female patient with longstanding HRT for fifteen years who underwent immediate discontinuation after diagnosis of poorly differentiated invasive ductal carcinoma. We observed a reduction in tumor grade from poorly differentiated at time of biopsy to moderately differentiated at time of surgery following cessation of HRT, as well as a reduction in the tumor proliferation index (Ki-67) from 70% to 50%. The patient has remained recurrence-free at the one-year mark postoperatively with continued follow-up.Conclusions: This case highlights potential clinical benefits associated with HRT discontinuation in the postmenopausal population with preexisting hormone-dependent cancers with high proliferation index, as well as the usefulness of Ki-67 in measuring response to aromatase inhibition in this subpopulation of patients.