Radiation‐associated angiosarcoma in the setting of breast cancer mimicking radiation dermatitis: A diagnostic pitfall

Daniels, Brianne H.; Ko, Jennifer S.; Rowe, J. Jordi; Downs‐Kelly, Erinn; Billings, Steven D.

doi:10.1111/cup.12917

Cited by 13 publications

(15 citation statements)

References 17 publications

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“…Our cohort did not exhibit this high level of recurrence with only 4 of the 13 cases having recurrences. These poor outcomes are a direct result of the difficulty in diagnosing these angiosarcomas following treatment of the primary breast carcinoma [ 21 ]. Additionally, while no study currently demonstrates it, some hypothesize that the incidence of radiation-associated angiosarcoma may increase due to the higher usage of radiation in breast conserving techniques in the treatment of breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Mutational landscape of radiation-associated angiosarcoma of the breast

et al. 2018

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PurposeRadiation-associated breast angiosarcomas are a rare complication of radiation therapy for breast carcinoma. With relatively little is known about the genetic abnormalities present in these secondary tumors, we examined genomic variation in biospecimens from radiation-associated breast angiosarcomas.Experimental DesignPatients were identified that had a previous breast cancer diagnosis, received radiation therapy, and developed angiosarcoma in the ipsilateral breast as the earlier cancer. Tumor regions were isolated from archival blocks using subsequent laser capture microdissection. Next generation sequencing was performed using a targeted panel of 160 cancer-related genes. Genomic variants were identified for mutation and trinucleotide-based mutational signature analysis.Results44 variants in 34 genes were found in more than two thirds of the cases; this included 12 variants identified as potentially deleterious. Of particular note, the BRCA1 DNA damage response pathway was highly enriched with genetic variation. In a comparison to local recurrences, 14 variants in 11 genes were present in both the primary and recurrent lesions including variants in genes associated with the DNA damage response machinery. Furthermore, the mutational signature analysis shows that a previously defined IR signature is present in almost all of the current samples characterized by predominantly C→T substitutions.ConclusionsWhile radiation-associated breast angiosarcomas are relatively uncommon, their prognosis is very poor. These data demonstrate a mutational pattern associated with genes involved in DNA repair. While important in revealing the biology behind these tumors, it may also suggest new treatment strategies that will prove successful.

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Section: Discussionmentioning

confidence: 99%

Mutational landscape of radiation-associated angiosarcoma of the breast

et al. 2018

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“…A recent study showed that a subtle histologic presentation of AS can mimic the changes seen in chronic radiation dermatitis . The single hyperchromatic cells in the background of collagen seen in some cases of well‐differentiated AS appears similar to the atypical fibroblasts scattered singly in the background of thickened collagen bundles seen in chronic radiation dermatitis.…”

Section: Introductionmentioning

confidence: 95%

Post‐radiation vascular lesions of the breast

et al. 2018

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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.

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“…The majority of studies defined MYC amplification as a ratio of MYC/CEP8 ≥ 2. 4,11,12,23,25,26,27,30,33 Six studies also defined amplification based on clustering of signals, usually >8 or 10. 23,24,26,28,29,31 Low-level MYC amplification was based on a MYC/ CEP8 ratio ≥ 2, 27 while high-level amplification was variably described as >9 copies per nucleus, 24 >21 copies, 27 or ≥9-10 signals.…”

Section: Fluorescence In Situ Hybridization and Immunohistochemistrmentioning

confidence: 99%

“…12 Udager et al quantified expression as the product of percent of cells with nuclear reactivity (0-100) and strength of expression (0-3). 34 The most commonly used dilution for anti-MYC was 1:50, 4,12,25,29,33 but some authors 26,27,28 used a dilution of 1:100 while Udager et al used a dilution of 1:25. 34 MYC expression by IHC can occur in lymphangiomas, benign or reactive endothelia, lymphocytes, and granulation tissue.…”

Section: Fluorescence In Situ Hybridization and Immunohistochemistrmentioning

confidence: 99%

“…34 Huang with radiation-dermatitis-like features, 10 of 10 cases evaluated were positive for MYC IHC. 33 MYC IHC can also highlight subtle AVL-like areas at the periphery of PRAS suggesting a utility for mapping in resections. 28 Importantly, negative MYC IHC does not exclude the diagnosis of PRAS when morphology is diagnostic, and focal weak MYC expression in less than 5% of lesional cells may be observed in AVLs and is not diagnostic of PRAS.…”

Section: Myc In Postirradiation Angiosarcoma and Atypical Vascular mentioning

confidence: 99%

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MYC gene amplification by fluorescence in situ hybridization and MYC protein expression by immunohistochemistry in the diagnosis of cutaneous angiosarcoma: Systematic review and appropriate use criteria

et al. 2020

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Background: Secondary angiosarcoma (AS) most commonly follows breast cancer and includes postirradiation AS (PRAS) and lymphedema-associated AS. The frequent amplification of MYC (8q24.21) in secondary AS and the rising incidence of PRAS and atypical vascular lesions (AVLs) have prompted interest in the diagnostic and prognostic utility of MYC in AS. Methods: Retrospective series with ≥2 cases of cutaneous AS and describing the use of fluorescence in situ hybridization (FISH) for MYC amplification or immunohistochemistry (IHC) for MYC overexpression were included. Results: Sixteen studies met inclusion criteria. Overall, 93% of cases evaluated by FISH and IHC were concordant. The sensitivity of FISH in primary AS was only 6.8%, and protein overexpression occurred without amplification in sun-damaged skin. FISH and IHC were over 78% sensitive in secondary AS but negative in over 98% of AVLs. MYC amplification and FLT4 coamplification were associated with shorter overall survival in secondary AS. Conclusion: FISH for MYC amplification and IHC for MYC overexpression are useful in distinguishing PRAS from AVLs and may also have prognostic value in secondary AS. In contrast, these methods have little diagnostic or prognostic value in primary AS and should not be used to distinguish primary AS from benign vascular neoplasms.

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Radiation‐associated angiosarcoma in the setting of breast cancer mimicking radiation dermatitis: A diagnostic pitfall

Abstract: PRAS can be very subtle and histologically mimic radiation dermatitis. Careful attention to histologic features and ancillary tests allow accurate diagnosis in subtle PRAS.

Cited by 13 publications

References 17 publications

Mutational landscape of radiation-associated angiosarcoma of the breast

Mutational landscape of radiation-associated angiosarcoma of the breast

Post‐radiation vascular lesions of the breast

MYC gene amplification by fluorescence in situ hybridization and MYC protein expression by immunohistochemistry in the diagnosis of cutaneous angiosarcoma: Systematic review and appropriate use criteria

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