Postradiation vascular proliferations: an increasing problem

Abstract

The occurrence of cutaneous vascular lesions is a rare but well-documented complication of radiation treatment and may be associated with significant morbidity as well as mortality. The overall incidence is low but appears to be rising due to a change in the prevailing treatment of breast carcinoma with increased use of radiation in the setting of breast-conserving therapy for stage 1 and 2 disease. The spectrum of postradiation vascular lesions is wide and ranges from atypical vascular lesions with reportedly benign clinical behaviour to frank cutaneous angiosarcoma. There is, however, significant clinical as well as histological overlap. It is frequently difficult to classify these postradiation vascular lesions accurately and they create an emerging diagnostic and therapeutic challenge to both pathologists and clinicians. Experience with these vascular lesions is very limited, and this article aims to provide an overview of our current understanding and concept of radiation-associated vascular lesions with focus on their clinical and histological presentation as well as behaviour and treatment.

Post-radiation Atypical Vascular Lesion/Angiosarcoma Arising in the Larynx

“…Some propose that AVL and AS exist along a continuum rather than representing two distinct entities [3]. Our lesion seems to fall along this continuum and cannot be easily categorized as an AVL or an AS.…”

“…Infiltration into the subcutis, papillary endothelial hyperplasia, significant cytologic atypia with prominent nucleoli, and mitotic figures are defining characteristics AS. Also, AS are not well-demarcated as compared to AVLs that tend to be well-circumscribed [3,9].…”

“…Most of the publications describing AVLs comes from breast literature and have been referred to by various different names such as benign lymphangiomatous papules, lymphangioma circumscriptum, acquired lymphangioma, and cutaneous lymphangiectasia [3,[9][10][11]. They have a typical post radiation median interval of 3 years and association with radiation dosages of 40-60 gray [2].…”

“…Atypical vascular lesions as described in the breast literature are usually \ 5 mm multifocal papules with red to brown discoloration [3] that histologically are well-circumscribed lesions, located in the mid to superficial dermis, comprised of anastomosing vessels lined by a single layer of endothelial cells. Some have divided the histologic patterns seen in breast AVLs into two histologic subtypes [11].…”

“…Atypical vascular lesions (AVL) and angiosarcomas (AS) are lesions known to arise after radiation therapy [1][2][3][4][5][6][7][8][9][10][11][12]. They are most commonly described in the breast region status post radiation for breast carcinoma.…”