Post‐radiation vascular lesions of the breast

Abstract

Post‐radiation vascular lesions are a rare complication most commonly seen in patients previously treated for breast cancer. The main two entities include angiosarcoma (AS), which are malignant tumors that have a poor prognosis, and atypical vascular lesions (AVL), which typically behave in a benign manner and only rarely progress to angiosarcoma. The overall incidence of these lesions is low, but it appears to be increasing. Histopathologic distinction of AVL and AS is essential due to different clinical outcomes and treatment. However, due to the occasional existence of overlapping clinical and histopathologic features, it may be sometimes difficult to render a definite diagnosis, particularly in small biopsies. Ancillary techniques are, in general, of little help for separating the borderland cases but, in some instances, immunohistochemical study (IHC) for Ki67 and IHC or fluorescence in situ hybridization analysis for MYC may help in the diagnosis of angiosarcoma. Herein we discuss the clinical characteristics, histopathologic features, management strategies, and outcome of these lesions, with special emphasis on their differential diagnosis.

Epithelioid angiosarcoma of the small intestine presenting with intractable gastrointestinal bleeding: An uncommon tumor with diagnostic challenge and poor prognosis

“…Commonly involved sites include the head and neck skin in the older population and the breast, usually in association with radiation therapy for breast cancer. [11] AS has also been reported to occur at sites of or adjacent to endovascular and bypass grafts. [12,13] There is an increased incidence in those with prior radiation therapy, appreciable vinyl chloride or arsenic exposure, or prolonged lymphedema, usually as a sequela to axillary lymph node dissection for breast cancer.…”

Multiple purple papules of the breast in a patient with a history of breast cancer – a clinicopathological challenge

“…Cutaneous lesions classically develop within 3–6 years and may clinically present with erythema, telangiectasia, purpuric papules, nodules, or plaques, similar to AS. The pathogenesis is believed to arise from lymphatic obstruction causing dilatation of superficial vascular channels following radiotherapy or surgery 2 …”

Educational Case: Radiation-Associated Angiosarcoma in Patients With Breast Cancer

“…Radiation-associated angiosarcomas arise in the dermis of the exposed area after a latency period of 5 to 6 years. 4 They clinically present as dark red or violaceous skin lesions.…”