Vascular proliferations of the skin after radiation therapy for breast cancer: Clinicopathologic analysis of a series in favor of a benign process

Abstract

BACKGROUND. Cutaneous vascular proliferations that occur in the field of prior radiotherapy include angiosarcoma and small, cutaneous lesions with a pseudosarcomatous pattern that previously were reported as atypical vascular lesions or benign lymphangiomatous papules. METHODS. The objective of this study was to investigate the clinicopathologic features and outcomes of 56 radiation‐induced vascular proliferations that occurred in 36 patients who received previous treatment for breast carcinoma. Data from all patients were retrieved from the files of the French Sarcoma Group. Immunostaining with D2.40 antibody was performed in 24 lesions. RESULTS. All patients (median age, 52 years) had received external radiotherapy. Small papules developed within the field of prior radiotherapy (median latency interval, 66 months). Microscopically, the lesions were relatively well circumscribed, and they were located mostly in the superficial/middermis. They were composed of dilated or irregular‐jagged vascular channels that were lined by a single layer of bland endothelial cells, and they demonstrated either a predominately lymphangioendothelioma‐like or lymphangioma/lymphangioma circumscriptum‐like growth pattern. Micropapillary tufts were common findings. Ten lesions showed additional cytologic and/or architectural atypia. Twenty of 24 lesions showed D2.40 positivity. Follow‐up information was available for 31 patients (median follow‐up, 48 months): Five women developed new cutaneous lesions, and 1 woman had spontaneous regression of her lesions. None of the patients developed cutaneous angiosarcoma. Five patients were lost to follow‐up. CONCLUSIONS. Although vascular proliferations in irradiated skin may mimic angiosarcoma morphologically, the large majority of these lesions showed a benign clinical outcome. Despite relatively limited follow‐up, the current results indicate the benign nature of these vascular proliferations. Cancer 2007. © 2007 American Cancer Society.

Postradiation cutaneous angiosarcoma after treatment of breast carcinoma is characterized by MYC amplification in contrast to atypical vascular lesions after radiotherapy and control cases: clinicopathological, immunohistochemical and molecular analysis of 66 cases

“…8 Recently, a larger series of 56 radiation-induced vascular lesions arising in 36 patients has been reported. 9 The vascular neoplasms have been described as relatively well-circumscribed, mainly intradermal lesions with micropapillary tufts and architectural and/or cytologic atypia in 10 cases. Of the patients with follow-up information, five patients developed new vascular lesions in the same area, and of the 10 patients with lesions showing atypical histological features two developed local recurrences.…”

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

“…Atypical vascular lesions are defined as vascular proliferations developing in the radiation field that by definition follow a benign course [2,5]. 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].…”

“…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.…”

Early Onset Post-Radiation Cutaneous Angiosarcoma of the Breast with Features of Atypical-Vascular Lesion: A Diagnostic Pitfall and Its Biologic Significance

“…Radiation-associated angiosarcomas occur with a median latency period of 5 -6 years after breast radiation, and have a poor prognosis, with aggressive local behavior and substantial metastatic potential [2] [8]. AVLs have a similar or slightly shorter latency period, varying from 3.5 -5.5 years, depending on the series, but with a greater fraction of cases presenting within 1 -2 years of therapy [4] [7]- [10]. Because of its generally benign clinical behavior, AVL may be excised more conservatively, whereas radiation-associated angiosarcoma may both recur locally and metastasize even following wide excision.…”