Introduction: Breast conserving surgery with radiotherapy has replaced mastectomy as the standard care for earlystage breast cancer in the last few decades. Angiosarcoma (AS) arising in the irradiated breast after breastconserving therapy (BCT) is being reported in the literature with increasing frequency. In our study, we have reviewed cases of breast AS at our institution that have occurred in the last two years; we report the clinical presentation, histopathology and their management outcome and have performed a thorough literature review for this condition.
Method: Patients with angiosarcoma of breast in patients who had breast cancer surgery followed by radiation were identified during the breast multi-disciplinary meeting in a single breast screening unit from 2013-2015. Literature search of electronic databases via Pub Med and the search engines Google/Google Scholar were used. Emphasis on keywords with the varying combination of the search terms ‘breast’, ‘angiosarcoma’, ‘radiotherapy’, ‘trauma’, ‘secondary’, ‘primary’, ‘metastasis’ was performed.
Results: Case 1: A 59-year-old female developed BAS 8 years following breast-conserving surgery and radiotherapy (BCS and RT). Microscopically, irregular dissecting vascular channels lined by pleomorphic, mitotically active cells are seen. Immunohistochemistry revealed that tumour cells express CD34 with weak, minimal expression of Factor VIII. Patient then proceeded to having a radical mastectomy and latissimus dorsi flap. Patient is currently alive. Case 2: A 56-year-old female developed right BAS 3 months following a normal mammogram. Right breast was wholly bruised and discolored. New 18 mm mass suspicious of malignancy (MRI4) was seen on MRI. Patient previously had BCS and RT 5 years prior. Case 3: A 79-year-old female with angiosarcoma over 15 years after BCS and RT.
Conclusion: We conclude that with increasing use of radiotherapy for breast conserving surgery will result in a growing number of cases of secondary angiosarcoma for which early detection is important and requires a high index of clinical and pathological suspicion. Patient education is the key and they need to be advised to remain vigilant of any skin changes for early detection and prompt treatment for this condition.
Omar Ashour and Tarannum Fasih