Primary Breast Angiosarcoma: Avoiding a Common Trap

Abstract

Background. Primary breast angiosarcoma is a rare entity. Case. Initial diagnosis was a benign hemangioma at core biopsy. Wide local excision was performed, with positive margins. Pathology after surgery reported a moderately differentiated angiosarcoma. Tumor was finally treated using mastectomy and radiations. She developed a second angiosarcoma in contralateral breast, with an initial diagnosis on core biopsy of an atypical vascular lesion and was again treated using mastectomy and radiations. She developed bones and lung metastases. Conclusion. Primary breast angiosarcoma is a rare entity often difficult to diagnose on core biopsy, and a benign differential diagnosis is frequent. A highly vascular breast mass should always be considered malignant until proven otherwise. Surgical treatment seems to be the best course of action. There is a lack of data proving efficacy of adjuvant chemotherapy and radiation therapy.

Primary angiosarcoma of the breast: A case report

“…Primary angiosarcomas represent only 20% of all breast angiosarcomas 1 . However, angiosarcoma arises in the breast more often than in any other organ 4,5 .…”

“…Often, this tumour covers an area of more than 4 cm 1,4,7 . For this reason, distant metastases are frequent 1,8 . This tumour may present with blue or purple discoloration of the skin 4 .…”

“…Three grades of angiosarcoma are described, depending on the tumour differentiation. Low-grade or Type I tumours consist of anastomosing vascular channels that proliferate diffusely in Grade I must be distinguished from benign lesions such as haemangioma, especially on biopsy, and Grade III from metaplastic carcinoma, fibrosarcoma and reactive spindle cell proliferative lesion 1,9 . Complete excision and sufficient sampling of the tumour are often necessary to perform diagnosis accurately.…”

“…Primary breast sarcomas (PBA) are rare and aggressive malignant tumours 1,2 . Barring phyllodes tumours, they account for less than 0.1% of all malignant tumours of the breast 3 .…”

“…These neoplasms arise from vascular endothelial cells 4,5 . They can occur de novo (primary) or, more commonly, as a consequence of breast carcinoma treatment (secondary) 1 . In this article, we will discuss only primary angiosarcomas.…”