Atypical Presentation of Radiation-Associated Breast Angiosarcoma: A Case Report and Review of Literature

Abstract

Patient: Female, 67Final Diagnosis: Breast angiosarcomaSymptoms: Skin lesionMedication: —Clinical Procedure: SurgerySpecialty: OncologyObjective:Unusual clinical courseBackground:Radiation-associated breast angiosarcoma is a rare clinical entity that is thought to be increasing in incidence.Case Report:Here we present the case of a 67-year-old female with a history of left breast invasive ductal carcinoma who received breast conserving surgery and radiation therapy eight years ago. She then presented with a painless mild skin discoloration of the left breast that had been present for over one year. Mammograms and ultra-sounds were normal. A punch biopsy and a subsequent excisional biopsy revealed the diagnosis of angiosarcoma. The patient was treated with mastectomy and had no subsequent recurrences.Conclusions:The long-term clinical surveillance for all patients who receive breast conservation surgery is recommended and a high degree of suspicion should be exercised in view of potential atypical presentations of this disease.

Radiation‐induced angiosarcoma of the breast: A review

“…Chronic lymphedema‐associated AS and some soft tissue sarcomas such as high‐grade chondrosarcomas, epithelioid sarcomas of the proximal type, and high‐grade myxoid liposarcomas can also have amplification of this oncogene . On the other hand, amplification of myc seems to be absent in primary AS, radiation‐associated atypical vascular lesions (AVL), and in some radiation‐induced sarcomas other than AS . One study also reported gene amplification of FLT4 (encoding VEGFR3) has also been reported in 25% of secondary AS and only in association with myc amplification .…”

“…Other possible mechanisms by which radiation can induce the development of AS may be through: prolonged cellular stimulation during repair of ischemic tissues damaged by radiation ; radiation‐induced chronic lymphedema, which may stimulate tumorigenesis by the increase of the amount of vascular growth factors ; and malignant transformation of a pre‐existing benign lesion after radiation …”

“…RIAS may develop as soon as 6 months and as late as 41 years after radiotherapy (average latency of 6 years) . The latency of RIAS of the breast seems to be shorter when compared to radiation‐induced sarcomas in general, which take an average of 10‐12 years to develop after radiotherapy, and to AS associated with chronic lymphedema, which has a latency period of 10 years …”

“…The clinical features of RIAS do not differ substantially from the other two types of cutaneous AS. It usually initiates as painless blue‐red patches on the skin similar to a hematoma, developing in the previously irradiated skin area . It later progresses to red or violaceous plaques with ill‐defined nodular appearance, and eventually an ulceration (Figure ).…”

“…Therefore, the three terms are considered synonyms . Angiosarcoma can affect several organs, but the skin is one of the most frequently affected . There are essentially three different clinical types of cutaneous AS: of the scalp and face of an elderly person (idiopathic), the most common form; chronic lymphedema‐associated AS (Stewart‐Treves syndrome); and radiation‐induced angiosarcoma (RIAS), the least common .…”