Delayed diagnosis of radiation – associated cutaneous angiosarcoma

Abstract

Angiosarcoma is most frequently occurring in patients treated for a previous cancer with radiation therapy. Our aim was to measure the time between the first signs found by the patient and the first biopsy, and the time before the final diagnosis of radiation-associated angiosarcoma (RAAS) and to analyse the reasons for delayed diagnosis. Four patients met the inclusion criteria. Three had cutaneous RAAS and one had suprapubic cutaneous RAAS after treatment for cancer. The intervals between the first cutaneous sign recorded by the patient and the diagnosis of RAAS were 9 to 37 months. The initial diagnosis by the non-specialist pathologist was a benign vascular lesion. Review of the initial biopsy was consistent with RAAS in 3 cases and with AVL in 1 case. Clinicians should alert pathogists when a vascular lesion is larger than 5 mm in the context of irradiated skin. Histology review by an expert should be recommended.

Radiation‐induced cutaneous angiosarcoma of the abdomen in a patient with cervical cancer: A case report

“…CA shows an extremely poor prognosis, and the reported overall 5‐year survival rate is low, ranging from 12% to 34% (median survival 18–28 months) . Radiation‐associated CAs are a common complication of radiotherapy in breast and gynecologic cancer patients . The mean latency time between radiotherapy and the development of sarcoma is 10 years on average, and the incidence rate tends to increase with radiotherapy doses above 60 Gy .…”

“…Atypical vascular lesion (AVL), a benign vascular lesion, can occur at sites previously exposed to radiation and may show similar clinical and histopathological features to CAs. In addition, long‐term follow‐up is necessary because AVL can progress to angiosarcoma . Other malignant and borderline vascular neoplasms, such as Kaposi sarcoma (KS) and hemangioendothelioma, also need to be differentiated from CAs .…”

“…In summary, given the poor prognosis of CAs, it is important to achieve early detection through long‐term follow‐up observations and to provide appropriate treatment, including chemotherapy, for advanced CAs …”

“…This suggests an association between angiosarcoma and female hormonal factors. Diagnosis of CAs can be made by history and skin biopsy, but early recognition is difficult due to the long latency period of 10 years on average and slow, progressive development . Despite aggressive treatment, such as a combination of surgery and radiotherapy, CAs have an extremely poor prognosis and high local recurrence and metastatic tendencies .…”

Dermatoscopic and ultra‐high frequency ultrasound evaluation in cutaneous postradiation angiosarcoma

“…1 The diagnosis of cAS may be difficult also for the pathologists and the tumour may be misdiagnosed as a benign vascular lesion. 2 Dermatoscopy [3][4][5][6][7][8][9] and ultrasonography [9][10] in cAS may allow clinicians to perform an early diagnosis. Dermatoscopy may show the presence of bluish, reddish or yellowish areas, white lines or veils, white follicular outlets, different vascular pattern, or pink-purple 'steam-like areas'.…”