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Cozzi S, Finocchi Ghersi S, Tava F, Bardoscia L, Najafi M, Ruggieri MP, Serre AA, Roukoz C, Gutierrez Miguelez C, Lazrek A, Sardaro A, Taverna C. Radiation-Associated Angiosarcoma of the Breast: The State of the Art of a Rare and Aggressive Disease. J Pers Med 2024; 14:859. [PMID: 39202050 PMCID: PMC11355165 DOI: 10.3390/jpm14080859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Considering the increasing number of conservative surgeries (quadrantectomies) for primary breast carcinoma, especially in the early stages, often followed by adjuvant radiotherapy, the incidence of radiation-associated angiosarcoma (RAS) is expected to rise in the coming decades, and it will represent a clinical and therapeutic challenge, as limited data are available due to the rarity and heterogeneity of the disease. Though the prognosis of these patients is poor, a number of clinical and pathological factors can be evaluated to better understand the course of RAS. The aim of this systematic review is to explore the available clinical-pathological, therapeutic, and prognostic data regarding RAS to evaluate its occurrence, diagnosis, treatment, and outcomes. METHOD RAS clinical data were identified by a systematic review conducted in five different databases (Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane). Only RAS works published in English, with access to the full manuscript text, and with clear results, were considered as eligible. RESULTS We considered 52 papers comprising 319 RAS cases. The patient age at diagnosis ranged from 37 to 93 years, with most cases occurring from 5 to 10 years after breast irradiation. The most common clinical presentation was an aggressive development of macules, papules, or erythematous-violaceous skin discoloration at the site of previous radiation treatment for primary breast carcinoma. Complete surgical excision appeared to be the first-line treatment of the disease, in some cases followed by adjuvant local and/or systemic therapies. Despite different treatments, local recurrence rates ranged from 40% to 90%, leading to negative outcomes and poor prognosis for patients. CONCLUSION Although the literature is limited and the data are heterogeneous and contentious, our review aims to highlight the importance of early diagnosis, multimodal treatment, and long-term follow-up of RAS in order to limit and prevent the aggressiveness of this neoplasm.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Department, Centre Léon Bérard, 69373 Lyon, France; (A.-A.S.); (C.R.)
| | - Sebastiano Finocchi Ghersi
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.F.G.); (M.P.R.)
| | - Francesca Tava
- Pathology Unit, Azienda Sanitaria Locale, Ospedale San Giacomo, 15067 Novi Ligure, Italy; (F.T.); (C.T.)
| | - Lilia Bardoscia
- Radiation Oncology Unit, San Luca Hospital, AUSL Toscana Nord Ovest, 55100 Lucca, Italy
| | - Masoumeh Najafi
- Department of Radiation Oncology, Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran 1997667665, Iran;
| | - Maria Paola Ruggieri
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.F.G.); (M.P.R.)
| | - Anne-Agathe Serre
- Radiation Oncology Department, Centre Léon Bérard, 69373 Lyon, France; (A.-A.S.); (C.R.)
| | - Camille Roukoz
- Radiation Oncology Department, Centre Léon Bérard, 69373 Lyon, France; (A.-A.S.); (C.R.)
| | - Cristina Gutierrez Miguelez
- Brachytherapy Unit, Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Amina Lazrek
- Radiation Oncology Unit, International University Hospital Cheikh Zaid, Rabat 10000, Morocco;
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Cecilia Taverna
- Pathology Unit, Azienda Sanitaria Locale, Ospedale San Giacomo, 15067 Novi Ligure, Italy; (F.T.); (C.T.)
- Department of Health Sciences, Università del Piemonte Orientale UNIUPO, 28100 Novara, Italy
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Teng L, Yan S, Du J, Yang R, Xu P, Tao W. Clinicopathological analysis and prognostic treatment study of angiosarcoma of the breast: a SEER population-based analysis. World J Surg Oncol 2023; 21:144. [PMID: 37158932 PMCID: PMC10169469 DOI: 10.1186/s12957-023-03030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Breast angiosarcoma is a rare malignancy of endovascular origin, accounting for less than 1% of all mammary cancers. Our aim was to explore clinicopathological features and the factors associated with prognosis. METHODS We extracted information from the Surveillance, Epidemiology, and End Results Program (SEER) for all patients with breast angiosarcoma between 2004 and 2015. Chi-square analysis was used to compare the clinicopathological features in all patients. Overall survival (OS) was assessed using the Kaplan and Meier method. Univariate and multivariate analyses were performed to evaluate the factors associated with prognosis. RESULTS A total of 247 patients were included in the analyses. The median OS of patients with primary breast angiosarcoma (PBSA) and secondary breast angiosarcoma (SBAB) was 38 months and 42 months, respectively. The 1-, 3- and 5-year OS with PBSA was 80%, 39%, and 25%, respectively, and the 1-, 3- and 5-year OS with SBAB was 80%, 42%, and 34%, respectively. Multivariate analysis revealed that tumor size (p = 0.001), tumor grade (p < 0.001), tumor extension (p = 0.015), and tumor spread (p < 0.001) were statistically significant factors for OS. Partial mastectomy with radiation (HR = 0.160, 95% CI, 0.036-0.719, p = 0.016), partial mastectomy with chemotherapy (HR = 0.105, 95% CI, 0.011-1.015, p = 0.052), and partial mastectomy (HR = 0.125, 95% CI, 0.028-0.583, p = 0.007) were related to significantly better OS outcomes in primary angiosarcoma. CONCLUSION Primary breast angiosarcoma has a better clinical phenotype than secondary breast angiosarcoma. Although overall survival was not statistically significant, primary breast angiosarcoma was better than secondary breast angiosarcoma with systemic therapy. Depending on the outcome of survival, partial mastectomy is effective in treating primary breast angiosarcoma.
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Affiliation(s)
- Lizhi Teng
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, China
- The Cell Transplantation Key Laboratory of National Health Commission, Harbin, Heilongjiang, 150001, China
| | - Shuai Yan
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, China
- The Cell Transplantation Key Laboratory of National Health Commission, Harbin, Heilongjiang, 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, Heilongjiang, 150001, China
| | - Juntong Du
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, China
- The Cell Transplantation Key Laboratory of National Health Commission, Harbin, Heilongjiang, 150001, China
| | - Ru Yang
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Peng Xu
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Weiyang Tao
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, China.
- The Cell Transplantation Key Laboratory of National Health Commission, Harbin, Heilongjiang, 150001, China.
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, Heilongjiang, 150001, China.
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Tang C, Zhan C, Qin Y, Hu Q, Ai T. Primary angiosarcoma of the breast: Two case reports and brief review of the literature. Radiol Case Rep 2023; 18:1671-1675. [PMID: 36873041 PMCID: PMC9982441 DOI: 10.1016/j.radcr.2023.01.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/27/2023] Open
Abstract
Angiosarcoma is a rare but very aggressive tumor. It occurs in all organs of the body, and approximately 8% of all angiosarcomas arise in the breast. We reported 2 cases of primary breast angiosarcomas in young women. The 2 patients showed similar clinical features, but were quite different in dynamic contrast-enhanced MR imaging. The 2 patients were treated with mastectomy and axillary sentinel lymph node dissection and confirmed by post-operative pathological test. We suggested that dynamic contrast-enhanced MR imaging was the most helpful imaging tool in the diagnosis and pre-operative evaluation of the breast angiosarcoma.
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Affiliation(s)
- Caili Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, 1095 Jiefang Ave, Qiaokou District, Wuhan, Hubei 430030, China
| | - Chenao Zhan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, 1095 Jiefang Ave, Qiaokou District, Wuhan, Hubei 430030, China
| | - Yanjin Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, 1095 Jiefang Ave, Qiaokou District, Wuhan, Hubei 430030, China
| | - Qilan Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, 1095 Jiefang Ave, Qiaokou District, Wuhan, Hubei 430030, China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, 1095 Jiefang Ave, Qiaokou District, Wuhan, Hubei 430030, China
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Conti M, Morciano F, Rossati C, Gori E, Belli P, Fornasa F, Romanucci G, Rella R. Angiosarcoma of the Breast: Overview of Current Data and Multimodal Imaging Findings. J Imaging 2023; 9:jimaging9050094. [PMID: 37233313 DOI: 10.3390/jimaging9050094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Angiosarcoma of the breast is a rare breast cancer, which can arise de novo (primary breast angiosarcoma, PBA) or as a secondary malignancy (secondary breast angiosarcoma, SBA) as a result of a biological insult. In the latter case, it is usually diagnosed in patients with a previous history of radiation therapy following a conserving treatment for breast cancer. Over the years, the advances in early diagnosis and treatment of breast cancer, with increasing use of breast-conserving surgery and radiation therapy (instead of radical mastectomy), brought about an increased incidence of the secondary type. PBA and SBA have different clinical presentations and often represent a diagnostic challenge due to the nonspecific imaging findings. The purpose of this paper is to review and describe the radiological features of breast angiosarcoma, both in conventional and advanced imaging to guide radiologists in the diagnosis and management of this rare tumor.
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Affiliation(s)
- Marco Conti
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Morciano
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Claudia Rossati
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142 Verona, Italy
| | - Elisabetta Gori
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Paolo Belli
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Francesca Fornasa
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142 Verona, Italy
| | - Giovanna Romanucci
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142 Verona, Italy
| | - Rossella Rella
- UOC Diagnostica per Immagini, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy
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5
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Kuba MG, Dermawan JK, Xu B, Singer S, Plitas G, Tap WD, D’Angelo SP, Rosenbaum E, Brogi E, Antonescu CR. Histopathologic Grading Is of Prognostic Significance in Primary Angiosarcoma of Breast: Proposal of a Simplified 2-tier Grading System. Am J Surg Pathol 2023; 47:307-317. [PMID: 36376999 PMCID: PMC9974594 DOI: 10.1097/pas.0000000000001998] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite a wide spectrum of clinical presentations, including primary or secondary, most angiosarcomas are considered high grade. One exception is primary breast angiosarcoma, where historically, histologic grading has shown to predict outcome using the Rosen 3-tier system. However, more recent studies have challenged this concept suggesting that even in this specific clinical context angiosarcomas should be considered high grade. This study aimed to critically reevaluate the impact of histologic grade in a clinically uniform cohort managed at a single institution using a newly proposed grading system. Our study included 49 primary breast angiosarcomas diagnosed during 1994 to 2022 (median follow-up: 33 mo), classified as low grade (29%), intermediate grade (20%), and high grade (51%), based on mitotic count, extent of solid components, and necrosis. At last follow-up, 22% patients developed locoregional recurrences, 63% distant metastases, and 47% patients died of disease. As patients with low and intermediate-grade angiosarcomas had relatively similar outcomes, our cohort was further analyzed using a 2-tier system (low grade and high grade). Targeted-DNA next-generation sequencing (505 cancer gene panel) performed in 11 cases found KDR mutations in 78% and PIK3CA mutations in 44% of high-grade lesions. Histologic grade, by either 3-tier or 2-tier grading systems, had a strong impact on survival, with the 2-tier system being an independent predictor of disease-specific survival and overall survival. Based on 2-tier system, the 5-year overall survival was 38% for high-grade angiosarcoma and 74% for low-grade angiosarcoma. PIK3CA mutations alone or concurrent with KDR alterations were identified in angiosarcomas with worse prognosis.
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Affiliation(s)
- M Gabriela Kuba
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josephine K Dermawan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bin Xu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - George Plitas
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sandra P D’Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical Center, New York, NY
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edi Brogi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cristina R Antonescu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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6
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Kokkali S, Moreno JD, Klijanienko J, Theocharis S. Clinical and Molecular Insights of Radiation-Induced Breast Sarcomas: Is There Hope on the Horizon for Effective Treatment of This Aggressive Disease? Int J Mol Sci 2022; 23:ijms23084125. [PMID: 35456944 PMCID: PMC9029574 DOI: 10.3390/ijms23084125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Radiation-induced breast sarcomas (RIBS) are rare entities representing <1% of all primary breast malignancies, limiting most reports to small retrospective case series. They constitute a heterogeneous group of neoplasms, with high-grade angiosarcoma being the most common subtype. Other sarcoma histotypes, such as undifferentiated pleomorphic sarcoma and leiomyosarcoma, can also be identified. Radiation-induced breast angiosarcoma (RIBA) has an incidence of approximately 0.1% after breast-conserving therapy and arises mainly from the dermis of the irradiated breast. MYC gene amplification is highly indicative of secondary breast angiosarcomas. Their clinical presentation often mimics benign port-radiation lesions, leading to a delay in diagnosis and a lost window of opportunity for cure. Surgery with negative margins is the mainstay of treatment of localized RIBS. In the case of angiosarcoma, technical difficulties, including multifocality, infiltrative margins, and difficulty in assessing tumor margins, render surgical treatment quite challenging. A limited number of studies showed that adjuvant radiation therapy reduces local recurrences; therefore, it is proposed by many groups for large, high-grade tumors. Chemotherapy has been evaluated retrospectively in a small subset of patients, with some evidence supporting its use in angiosarcoma patients. Approximately half of patients with RIBA will show local recurrence. In the advanced setting, different therapeutic options are discussed in the review, including chemotherapy, antiangiogenic therapy, and immunotherapy, whereas the need for further research on molecular therapeutic targets is pointed out.
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Affiliation(s)
- Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
- Oncology Unit, 2nd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Hippocratio General Hospital of Athens, V. Sofias 114, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-6932326547
| | - Jose Duran Moreno
- Hellenic Group of Sarcoma and Rare Cancers, G. Theologou 5, 11471 Athens, Greece;
| | - Jerzy Klijanienko
- Department of Pathology, Institut Curie, 26 Rue d’Ulm, CEDEX 05, 75248 Paris, France;
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
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Guram S, Covelli AM, O’Neill AC, Shultz DB, Demicco EG, Gupta AA, Gladdy RA. Multidisciplinary Intervention in Radiation-Associated Angiosarcoma of the Breast: Patterns of Recurrence and Response to Treatment. Ann Surg Oncol 2021; 29:522-532. [DOI: 10.1245/s10434-021-10477-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
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8
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Qin X, Wu Y, Yu L, Lv Q, Xie M. Metastasis of primary breast angiosarcoma to axillary and supraclavicular lymph nodes: a rare case diagnosed using imaging data. J Int Med Res 2021; 49:3000605211002337. [PMID: 33784853 PMCID: PMC8020107 DOI: 10.1177/03000605211002337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary breast angiosarcoma (PBA) is a rare malignant tumor. PBA usually undergoes hematogenous metastasis; lymph node metastasis is very rare in such patients, and metastasis of PBA to the supraclavicular lymph nodes has not previously been reported. Here, we describe a rare case of PBA manifested by a diffuse enlargement of the left breast, with metastasis to the left axillary and bilateral supraclavicular lymph nodes. Contrast-enhanced ultrasound and positron emission tomography findings indicated a malignant lesion, whereas magnetic resonance imaging suggested a benign lesion. Core needle biopsy identified the lesion as a lymphangioma, and the histological characteristics suggested a high-grade angiosarcoma. Multimodal imaging and perfusion patterns obtained using various contrast agents can thus help to diagnose PBA.
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Affiliation(s)
- Xiaojuan Qin
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Yu
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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9
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Primary mammary angiosarcomas harbor frequent mutations in KDR and PIK3CA and show evidence of distinct pathogenesis. Mod Pathol 2020; 33:1518-1526. [PMID: 32123305 DOI: 10.1038/s41379-020-0511-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/21/2022]
Abstract
Angiosarcoma (AS) is the most frequent primary sarcoma of the breast but nevertheless remains uncommon, accounting for <0.05% of breast malignancies. Secondary mammary AS arise following radiation therapy for breast cancer, in contrast to primary AS which occur sporadically. Essentially all show aggressive clinical behavior independent of histologic grade and most are treated by mastectomy. MYC amplification is frequently identified in radiation-induced AS but only rarely in primary mammary AS (PMAS). As a heterogeneous group, AS from various anatomic sites have been shown to harbor recurrent alterations in TP53, MAP kinase pathway genes, and genes involved in angiogenic signaling including KDR (VEGFR2) and PTPRB. In part due to its rarity, the pathogenesis of PMAS has not been fully characterized. In this study, we examined the clinical, pathologic, and genomic features of ten cases of PMAS, including one patient with bilateral disease. Recurrent genomic alterations were identified in KDR (70%), PIK3CA/PIK3R1 (70%), and PTPRB (30%), each at higher frequencies than reported in AS across all sites. Six tumors harbored a KDR p.T771R hotspot mutation, and all seven KDR-mutant cases showed evidence suggestive of biallelism (four with loss of heterozygosity and three with two aberrations). Of the seven tumors with PI3K alterations, six harbored pathogenic mutations other than in the canonical PIK3CA residues which are most frequent in breast cancer. Three AS were hypermutated (≥10 mutations/megabase (Mb)); hypermutation was seen concurrent with KDR or PIK3CA mutations. The patient with bilateral disease demonstrated shared alterations, indicative of contralateral metastasis. No MYC or TP53 aberrations were detected in this series. Immunohistochemistry for VEGFR2 was unable to discriminate between KDR-mutant tumors and benign vascular lesions of the breast. These findings highlight the underrecognized frequency of KDR and PIK3CA mutation in PMAS, and a significant subset with hypermutation, suggesting a pathogenesis distinct from other AS.
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10
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O'Donnell JP, Sugrue R, McLaughlin R, McInerney NM. Multidisciplinary approach to chest wall reconstruction in primary breast angiosarcoma resection. BMJ Case Rep 2020; 13:13/5/e233156. [PMID: 32381526 DOI: 10.1136/bcr-2019-233156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Angiosarcomas account for less than 1% of primary breast cancers. Typically, they occur in young women with a low-risk personal or family history. Diagnosis, resection and reconstruction require a multidisciplinary team of breast surgeons, oncologists and plastic reconstructive surgeons. Cross-disciplinary awareness among these specialities enables dimensional patient treatment. We report a case of primary angiosarcoma of the breast in a 33-year-old woman, with no previous radiotherapy exposure, treated with a radical mastectomy and chest wall reconstruction with a deep inferior epigastric perforator (DIEP) Flap. There is a general consensus in current literature regarding the difficulty for curative treatment in angiosarcomas. There is a requirement for surgical intervention to be aggressive to ensure oncological clearance. Subsequently, the extensive reconstructive task proves a major procedure for any plastic surgeon. DIEP autologous flap chest wall reconstruction accompanying radical mastectomy can be used in efforts to eradicate risks of deep margin incomplete excision in breast angiosarcomas. This case report and review of the current literature aim to provide guidance for colleagues managing angiosarcomas and also highlight the versatility of the DIEP flap.
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Affiliation(s)
- John Phineas O'Donnell
- Department of Surgery, Galway University Hospitals, Galway, Ireland .,Plastic & Reconstructive Surgery, National University of Ireland Galway, Galway, Ireland
| | - Ryan Sugrue
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Plastic & Reconstructive Surgery, National University of Ireland Galway, Galway, Ireland
| | - Ray McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Breast & General Surgery, National University of Ireland Galway, Galway, Ireland
| | - Niall M McInerney
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Plastic & Reconstructive Surgery, National University of Ireland Galway, Galway, Ireland
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11
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Altmışdörtoğlu Ö, Gökgöz MŞ, Yalçınkaya U, Nalca Andrieu M. A Case Report of Primary Breast Angiosarcoma: Clinical Presentation and Outcome After Adjuvant Radiotherapy. Eur J Breast Health 2020; 16:290-294. [PMID: 33062971 DOI: 10.5152/ejbh.2020.4984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/30/2019] [Indexed: 11/22/2022]
Abstract
Angiosarcomas of the breast are infrequent subtypes of sarcoma that are often diagnosed after radiation therapy for primary breast cancer. Primary angiosarcomas (PAS) are rare tumors that constitute 0.04% of all malignant breast tumors. We report a case of a 40-year-old woman with a lump in the right breast and diagnosed as angiosarcoma by pathological evaluation. She underwent simple mastectomy followed by adjuvant radiation. She is alive and disease-free for 66 months although tumor size was large and one surgical margin was tumor positive. Breast angiosarcoma is often in advanced stage at diagnosis and tends to recur locally. Although surgical methods constitute the primary treatment, we believe that a multidisciplinary treatment strategy should be used in high-risk patients with large primary tumors and tumor positive margins.
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Affiliation(s)
- Özgür Altmışdörtoğlu
- Department of Radiation Oncology, Near East University School of Medicine, Nicosia, Turkish Republic of Northern Cyprus
| | | | - Ulviye Yalçınkaya
- Department of Pathology, Uludağ University School of Medicine, Bursa, Turkey
| | - Meltem Nalca Andrieu
- Department of Radiation Oncology, Near East University School of Medicine, Nicosia, Turkish Republic of Northern Cyprus
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12
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Axillary Lymph Node Dissection in Angiosarcomas of the Breast: An Asian Institutional Perspective. Sarcoma 2020; 2020:4890803. [PMID: 32300278 PMCID: PMC7136812 DOI: 10.1155/2020/4890803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/25/2020] [Indexed: 12/29/2022] Open
Abstract
Angiosarcomas of the breast (ASB) are rare, making up to less than 8% of all angiosarcomas. The surgical management for this disease continues to vary throughout centres worldwide due to the current limited evidence. We aim to examine the necessity of axillary lymph node dissection in this pathology through a retrospective study of axillary metastasis and recurrence patterns in patients treated at our institution. A retrospective review of a prospectively-maintained database was performed. All adult patients with a histologically confirmed diagnosis of ASB seen at the National Cancer Centre Singapore between 2006 and 2019 were identified. Axillary lymph node status, treatment, survival, and recurrence data were collated. Thirteen patients were identified with a confirmed diagnosis of ASB, of which there were 11 primary and 2 secondary angiosarcoma cases. Eight patients had some form of axillary lymph node dissection and 5 did not. No positive nodes were found in any examined axillary nodes despite high median number of nodes harvested (13, range 8–24). 5/13 patients had disease progression, of whom none had locoregional recurrence to the axilla. ASB continues to be rare and recurrent and presents as a challenge to treat. Axillary lymph node involvement is most likely not present in a majority of patients. Prophylactic removal is unwarranted in patients presenting without lymph node involvement due to the lack of axillary metastasis.
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13
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Ginter PS, McIntire PJ, Irshaid L, Liu YF, Shin SJ. Angiomatosis of the breast: a clinicopathological and immunophenotypical characterisation of seven cases. J Clin Pathol 2019; 72:597-602. [PMID: 31088938 DOI: 10.1136/jclinpath-2019-205821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 11/04/2022]
Abstract
AIMS Mammary angiomatosis is a rare, benign vascular lesion that morphologically mimics low-grade angiosarcoma (LGAS). To date, only occasional reports of this entity have been published, none of which included analysis by immunohistochemistry. The purpose of this study was to further characterise mammary angiomatosis by clinical, histological, and immunohistochemical means while emphasising distinguishing features from LGAS. METHODS Seven cases of primary mammary angiomatosis were evaluated. For one patient, a subsequent recurrence was also evaluated. RESULTS All patients were female with a median age at presentation of 51 years (range: 19-58 years). The most common clinical presentation was that of a palpable abnormality or mass (5/8) and the median primary tumour size was 3.1 cm (range: 2-9 cm). Of the six patients with follow-up, one developed a recurrence 6 years after initial presentation. Histologically, all cases were composed of variably sized ectatic, thin-walled vessels lined by flat normochromic endothelium diffusely infiltrating mammary stroma. Where present, lesional vessels infiltrated between and around terminal duct lobular units but not into individual intralobular stroma. Most cases (6/8) showed a combination of lymphatic-appearing and haemangiomatous-appearing vessels. Lymphatic-appearing vessels were D2-40 positive in all but one case. D2-40 was negative or weak in haemangiomatous-appearing vessels. All lesional vessels were CD31 positive. Ki-67 indices were <1% in all but one case (5%). CONCLUSIONS Mammary angiomatosis is a rare vascular lesion that shares clinical, morphological and immunohistochemical features with LGAS; however, certain key traits make the distinction possible.
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Affiliation(s)
- Paula S Ginter
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Lina Irshaid
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Yi-Fang Liu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA
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14
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Mirjolet C, Merlin JL, Truc G, Noël G, Thariat J, Domont J, Sargos P, Renard-Oldrini S, Ray-Coquard I, Liem X, Chevreau C, Lagrange JL, Mahé MA, Collin F, Bonnetain F, Bertaut A, Maingon P. RILA blood biomarker as a predictor of radiation-induced sarcoma in a matched cohort study. EBioMedicine 2019; 41:420-426. [PMID: 30827931 PMCID: PMC6442988 DOI: 10.1016/j.ebiom.2019.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Radiation-induced sarcoma (RIS) is a rare but serious event. Its occurrence has been discussed during the implementation of new radiation techniques and justified appropriate radioprotection requirements. New approaches targeting intrinsic radio-sensitivity have been described, such as radiation-induced CD8 T-lymphocyte apoptosis (RILA) able to predict late radio-induced toxicities. We studied the role of RILA as a predisposing factor for RIS as a late adverse event following radiation therapy (RT). Patients and methods In this prospective biological study, a total of 120 patients diagnosed with RIS were matched with 240 control patients with cancer other than sarcoma, for age, sex, primary tumor location and delay after radiation. RILA was prospectively assessed from blood samples using flow cytometry. Results Three hundred and forty-seven patients were analyzed (118 RIS patients and 229 matched control patients). A majority (74%) were initially treated by RT for breast cancer. The mean RT dose was comparable with a similar mean (± standard deviation) for RIS (53.7 ± 16.0 Gy) and control patients (57.1 ± 15.1 Gy) (p = .053). Median RILA values were significantly lower in RIS than in control patients with respectively 18.5% [5.5–55.7] and 22.3% [3.8–52.2] (p = .0008). Thus, patients with a RILA >21.3% are less likely to develop RIS (p < .0001, OR: 0.358, 95%CI [0.221–0.599]. Conclusion RILA is a promising indicator to predict an individual risk of developing RIS. Our results should be followed up and compared with molecular and genomic testing in order to better identify patients at risk. A dedicated strategy could be developed to define and inform high-risk patients who require a specific approach for primary tumor treatment and long term follow-up.
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Affiliation(s)
- C Mirjolet
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - J L Merlin
- Department of Biopathology, Université de Lorraine, CNRS UMR 7039 CRAN, Institut de Cancérologie de Lorraine, Nancy, France
| | - G Truc
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - G Noël
- Department of Radiation Oncology, Paul Strauss Center, Strasbourg, France
| | - J Thariat
- Department of Radiation Oncology, Antoine Lacassagne center, Nice, France; Department of Radiation Oncology, François Baclesse Center, Caen, France
| | - J Domont
- Department of Oncology, Gustave Roussy, Villejuif, France
| | - P Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - S Renard-Oldrini
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, NANCY, France
| | - I Ray-Coquard
- Department of Radiation Oncology, Léon Berard Center, Université Claude Bernard, Lyon, France
| | - X Liem
- Department of Radiation Oncology, Oscar Lambret Center, Lille, France
| | - C Chevreau
- Department of Radiation Oncology, IUCT Oncopole, Toulouse, France
| | - J L Lagrange
- Department of Radiation Oncology, Henri Mondor Hospital, Créteil, France
| | - M A Mahé
- Department of Radiation Oncology, ICO René Gauducheau, Saint Herblain, France
| | - F Collin
- Department of Biopathology, Georges François Leclerc Cancer Center, Dijon, France
| | - F Bonnetain
- Department of Statistics, Georges François Leclerc Cancer Center, Dijon, France
| | - A Bertaut
- Department of Statistics, Georges François Leclerc Cancer Center, Dijon, France
| | - P Maingon
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France; Department of Radiation Oncology, Sorbonne Université, GHU La Pitié Salpêtrière Charles Foix, Paris, France.
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15
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Abstract
Breast angiosarcoma is a rare and aggressive tumor. The role of F-FDG PET/CT in breast angiosarcoma is poorly known. We report a series of 13 lesions in 11 patients with histologically proven primary or secondary breast angiosarcoma who underwent FDG PET/CT at the initial assessment in our institution. All breast lesions showed FDG avidity. Visually and statistically, we observed a significant difference of SUVmax uptake foci between primary and secondary breast angiosarcoma (Wilcoxon test P < 0.0046) and a significantly poorer prognosis for high SUVmax than those with low SUVmax (P = 0.049) regardless of primary or secondary origins.
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16
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Yoga A, Lyapichev KA, Baek D, Gomez-Fernandez CR. Hemangioma of a Male Breast: Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1425-1429. [PMID: 30498190 PMCID: PMC6287655 DOI: 10.12659/ajcr.911842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Male breast hemangioma is a rare benign neoplasm that is usually excised for definitive diagnosis. CASE REPORT In our case report, we present a male octogenarian with multiple comorbidities who presented with a large palpable mass in his right breast. The diagnostic imaging studies were suggestive of a benign tumor, with a BI-RADS (Breast Imaging Reporting and Data System) score of 3. Subsequent core needle biopsies were diagnostic of benign hemangioma. The patient was managed with observation due to his comorbidities. Benign vascular tumors in the male breast are exceptionally rare, and in our review of the literature we found only 14 previously published cases. Historically, fine needle aspiration has been found to be unreliable in making a definitive diagnosis and surgical excision has been the standard treatment. CONCLUSIONS Recent studies and our case report indicate that core needle biopsy may be a reliable diagnostic tool and observation is a possible option for hemangiomas in male patients who cannot undergo surgery.
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Affiliation(s)
- Arthy Yoga
- Department of Breast Surgery, Texas Oncology, Houston, TX, USA.,Division of Breast Surgery, Department of Surgery, Bethesda Health System, Boynton Beach, FL, USA
| | - Kirill A Lyapichev
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL, USA.,Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Donghwa Baek
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL, USA.,Department of Pathology and Genomic Medicine, Methodist Hospital, Houston, TX, USA
| | - Carmen R Gomez-Fernandez
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, Miami, FL, USA
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17
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Horisawa N, Adachi Y, Sawaki M, Hattori M, Yoshimura A, Gondo N, Kotani H, Kataoka A, Sugino K, Mori M, Terada M, Ozaki Y, Iwata H. A case of radiation-associated angiosarcoma after breast cancer. Surg Case Rep 2018; 4:131. [PMID: 30406473 PMCID: PMC6221852 DOI: 10.1186/s40792-018-0538-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/29/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Radiation-associated angiosarcoma (RAAS) is a rare subtype of secondary angiosarcoma that is characterized by rapid proliferation and extensive tissue infiltration. Although various treatments for RAAS (such as surgery, chemotherapy, and radiation therapy) have been reported, there is no consensus as to which approach is the best. CASE PRESENTATION A 76-year-old woman presented with right breast cancer (T1N0M0, stage I) 9 years ago. She had undergone breast-conserving surgery and sentinel lymph node biopsy and was receiving adjuvant chemotherapy and radiation therapy for the malignancy. Six years after presenting with the tumor, she developed pigmented skin and was diagnosed with a RAAS; this angiosarcoma recurred three times within 2 years. The angiosarcoma was resected each of the three times, after which adjuvant radiation therapy was performed. At 76 years old, the patient developed a new mass on her chest skin in the vicinity of the scar. Angiosarcoma was diagnosed following a pathology report, which resulted in a second diagnosis of recurrent RAAS again since the diagnostic criteria were met. After extensive resection of the irradiated area, the patient has remained free of angiosarcoma for the last 3 years. CONCLUSION Resection of the entire irradiated field is critical for successful treatment of RAAS.
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Affiliation(s)
- Nanae Horisawa
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Yayoi Adachi
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Naomi Gondo
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Ayumi Kataoka
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Kayoko Sugino
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Makiko Mori
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Mitsuo Terada
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Yuri Ozaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
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18
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Ronen S, Ivan D, Torres-Cabala CA, Curry JL, Tetzlaff MT, Aung PP, Nagarajan P, Suster S, Prieto VG. Post-radiation vascular lesions of the breast. J Cutan Pathol 2018; 46:52-58. [DOI: 10.1111/cup.13363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/03/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shira Ronen
- Department of Pathology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Doina Ivan
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | | | - Jonathan L. Curry
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | - Michael T. Tetzlaff
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | - Phyu P. Aung
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | | | - Saul Suster
- Department of Pathology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Victor G. Prieto
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
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19
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Mella JR, Ross KM, Li GZ, Pomahac B, Raut CP, Orgill DP. Cutaneous Breast Radiation-associated Angiosarcoma: Anterior Chest Wall Reconstruction Options Following Extra-radical Resection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1938. [PMID: 30349797 PMCID: PMC6191213 DOI: 10.1097/gox.0000000000001938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/18/2018] [Indexed: 11/25/2022]
Abstract
Background Radiation-associated angiosarcoma (RAAS) of the breast is a rare complication following breast irradiation with high rates of recurrence and death. To improve survival, we have advocated for an extra-radical resection where the entire irradiated skin and subcutaneous tissue is excised. This results in very large chest defects for which we describe our reconstructive experience. Methods We performed a retrospective review of patients diagnosed with RAAS and treated with extra-radical resection followed by immediate reconstruction between 1999 and 2017. We analyzed reconstructive options, complications rates, length of stay, and operative times. Results Extra-radical resections were performed in 35 patients. We reconstructed these large defects with abdominal advancement flaps with split-thickness skin grafting in 25 patients and added a pedicled latissimus dorsi or omental flap in the 10 other patients. Skin grafts took well over the irradiated pectoralis major muscle with a median take rate of over 90%. Average operative times were 150 minutes for those treated with an abdominal advancement flap and skin grafting with a median length of stay of 5 days for all patients. Conclusion Large anterior chest soft-tissue defects caused by extra-radical resections leaves defects too large to be covered by traditional breast reconstruction flaps. Abdominal advancement, latissimus dorsi muscle, and omental flaps along with skin grafts can be safely performed while leaving other traditional options open for future breast reconstruction.
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Affiliation(s)
- Juan R Mella
- Department of Plastic Surgery, Lahey Clinic, Burlington, Mass.,Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Kimberly M Ross
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - George Z Li
- Division of Surgical Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Mass
| | - Bohdan Pomahac
- Division of Plastic Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Mass
| | - Chandrajit P Raut
- Division of Surgical Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Mass.,Center for Sarcoma and Bone Oncology, Dana Farber Cancer Institute, Boston, Mass
| | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Mass
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20
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Abstract
RATIONALE As a very rare vascular tumor, breast angiosarcoma (AS) can be divided into primary and second breast AS. However, the latter is slightly more commonly detected in clinical practice. Radiation post mastectomy is the common cause for the secondary breast AS, and although there are other reasons, it is still quite rare. In the present study, we reported a rare case of breast AS and summarized the relevant literatures so that to conduce to diagnose AS. PATIENT CONCERNS A 50-year-old female with a history of right breast neoplasm was treated with repeat lumpectomy for 4 times during 8 years. DIAGNOSES Mammogram and ultrasound examination demonstrated a possible malignancy (BIRADS-4B and BI-RADS-4C, respectively). Immunohistochemically positive for endothelial markers CD31, CD34, ERG, and FVIII-R-Ag. INTERVENTIONS The patient underwent a right mastectomy with sentinel lymph node biopsy by our multidisciplinary team and no other therapy was given postsurgery. OUTCOMES The patient had no recurrence after 3 months. LESSONS Based on our findings, we concluded that repeated resection might be a risk factor for the breast AS, especially for a gradual pathological evolution from benign to malignant. This case showed a very rare cause for angiomatosis of breast, and the patient had a successful outcome after a simple mastectomy.
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21
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O'Connor SM, Wobker SE, Cardona DM, Eward W, Esther RJ, Dodd LG. Iatrogenic lesions of soft tissue and bone. Semin Diagn Pathol 2017; 35:208-217. [PMID: 29110897 DOI: 10.1053/j.semdp.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S M O'Connor
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States
| | - S E Wobker
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States
| | - D M Cardona
- Department of Pathology, Duke University, Durham, NC, United States
| | - W Eward
- Division of Oncology, Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - R J Esther
- Department of Orthopaedic Surgery, University of North Carolina Chapel Hill, United States
| | - L G Dodd
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States.
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22
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Wang L, Lao IW, Yu L, Wang J. Clinicopathological features and prognostic factors in angiosarcoma: A retrospective analysis of 200 patients from a single Chinese medical institute. Oncol Lett 2017; 14:5370-5378. [PMID: 29113171 PMCID: PMC5656021 DOI: 10.3892/ol.2017.6892] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/23/2017] [Indexed: 12/20/2022] Open
Abstract
Angiosarcoma is a rare soft tissue sarcoma, and the data about its clinicopathological features and prognostic factors are limited. The purpose of the present study was to report a large series of angiosarcoma at a single institution. Clinical data from 200 cases of angiosarcoma from the Shanghai Cancer Center (Shanghai, China) between March 2006 and March 2014 were retrospectively analyzed. The study population included 97 males and 103 females with ages between 4 and 91 years (median, 53 years). According to the tumor location, 200 cases were divided into 4 groups: i) Tumors involving the head and neck; ii) breast; iii) viscera (including internal organs and bone); and iv) soft tissue (including trunk and extremities). Of the 113 patients with follow-up data, 46 patients succumbed to the disease with a median interval of 10 months. Tumor recurrence/metastasis was identified in 66 patients with a median interval of 4 months. The disease-free survival (DFS) rate at 5-years was 19.3% and the overall survival (OS) rate at 5-years was 40.8%. Site of tumor origin, size (≥5 cm) and histological differentiation influenced DFS (P=0.032, 0.038 and <0.001, respectively), and OS (P<0.001, 0.008 and <0.001, respectively) rates. Age (<65 years) and multimodal treatment correlated with improved OS (P=0.003 and <0.001, respectively). Tumor differentiation and treatment modality were identified to be independent determinants of OS (P<0.001 and 0.038, respectively). Tumor recurrence/metastasis was an independent predictor of DFS (P<0.001). The prognosis of angiosarcoma is poor and the mortality rate is high. The site of tumor origin, size, histological differentiation, age, treatment modality and tumor recurrence/metastasis are all significant prognostic factors. In the present study, multimodal treatment may improve the clinical outcome of patients with angiosarcoma.
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Affiliation(s)
- Lei Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, P.R. China
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, P.R. China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, P.R. China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, P.R. China
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23
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Lim A, Preda C, Stone J, Lambrianides AL. Cutaneous angiosarcoma: a rare complication post-male breast cancer radiotherapy. ANZ J Surg 2017. [PMID: 28643893 DOI: 10.1111/ans.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Aaron Lim
- Department of Surgery, Redcliffe Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Corina Preda
- Department of Surgery, Redcliffe Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason Stone
- Department of Cytopathology, QML Pathology, Brisbane, Queensland, Australia
| | - Andreas L Lambrianides
- Department of Surgery, Redcliffe Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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24
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Abstract
Vascular lesions of the breast comprise a heterogeneous group that includes a variety of benign, atypical, and malignant lesions. The presentation of these lesions ranges from those that are microscopic and discovered incidentally, to large tumors that may extensively involve the breast parenchyma and skin. In addition, some non-vascular breast lesions have features that may mimic those of vascular lesions and need to be distinguished from them in order to avoid an erroneous diagnosis. In this review, we discuss the spectrum of vascular lesions of the breast with particular emphasis on those lesions of greatest clinical importance, angiosarcoma and atypical vascular lesions. We also discuss lesions that may be mistaken for vascular lesions.
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Affiliation(s)
- Gabrielle M Baker
- (a)Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Stuart J Schnitt
- (b)Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.
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25
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Banks J, Ives C, Potter S, Holcombe C. The BRASS (BReast Angiosarcoma Surveillance Study): Protocol for a retrospective multicentre cohort study to evaluate the management and outcomes of angiosarcoma of the breast and chest wall. Int J Surg Protoc 2017; 5:5-10. [PMID: 31851741 PMCID: PMC6913564 DOI: 10.1016/j.isjp.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/17/2017] [Accepted: 05/21/2017] [Indexed: 01/05/2023] Open
Abstract
•Multicentre retrospective study involving breast and plastic units across the UK.•Will produce valuable data regarding management and outcomes.•Will inform decision making and help shape a future definitive study.
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Affiliation(s)
- Jenny Banks
- Breast Unit, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
- Breast Unit, Torbay and South Devon NHS Foundation Trust, Newton Road, Torquay Devon TQ2 7AA, UK
| | - Charlotte Ives
- Breast Unit, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
- Breast Unit, Torbay and South Devon NHS Foundation Trust, Newton Road, Torquay Devon TQ2 7AA, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP, UK
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26
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Vascular tumours of the breast: a comprehensive review with focus on diagnostic challenges encountered in the core biopsy setting. Pathology 2016; 49:197-214. [PMID: 28049578 DOI: 10.1016/j.pathol.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/04/2016] [Accepted: 11/06/2016] [Indexed: 12/20/2022]
Abstract
Vascular proliferations of the breast comprise a spectrum of benign and malignant lesions. In limited samples, such as core needle biopsies (CNB), these lesions may be difficult to distinguish due to significant overlap in morphological features. As the treatment and prognosis of these entities vary widely, it is important for pathologists to consider a complete differential diagnosis and correctly synthesise histological features, results of adjunctive immunohistochemical studies, and pertinent clinical and imaging information, to render an accurate diagnosis in such limited samples. The diagnostic pitfalls of under- or overdiagnosis of vascular lesions sampled in CNB will also be discussed.
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Wang L, Lao IW, Yu L, Yang W, Wang J. Primary Breast Angiosarcoma: A Retrospective Study of 36 Cases from a Single Chinese Medical Institute with Clinicopathologic and Radiologic Correlations. Breast J 2016; 23:282-291. [PMID: 27933680 DOI: 10.1111/tbj.12731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this study was to present our experience with primary breast angiosarcoma (PBA) by describing a large series of cases with an emphasis on clinicopathologic and radiologic correlations. Thirty-six cases of PBA diagnosed at our institution between 2006 and 2014 were retrospectively evaluated. All but one case occurred in women with a median age of 35.5 years. The majority of patients presented with a deeply located painless mass, whereas a minority manifested as diffuse enlargement or swelling of the breast. Magnetic resonance imaging showed poorly demarcated lesions with low signal intensity on T1-weighted images, markedly high intensity on T2-weighted images, and prolongation of enhancement upon dynamic study. Histologically, 19 cases (52.8%) were low grade, 12 cases (33.3%) were intermediate grade, and 5 cases (13.9%) were high grade. Follow-up information was available for 27 patients and revealed local recurrence and/or metastasis in 16 patients (59.3%). Five patients (18.5%) died of the disease at a median interval of 20 months. Univariate analysis showed that tumor differentiation had effect on disease-free survival (DFS) (p = 0.005) but failed to predict overall survival (OS) (p = 0.645). The treatment modality was related to OS (p = 0.042) but not DFS (p = 0.131). The Cox proportional hazards regression model suggested that tumor differentiation was an independent predictor of DFS (p = 0.015). We hypothesize that tumor differentiation may be used as a prognostic factor for this rare malignancy. Clinicopathologic and radiologic correlation may help pathologists to arrive at the correct diagnosis of PBA.
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Affiliation(s)
- Lei Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Hu QC, Mei X, Feng Y, Ma JL, Yang ZZ, Shao ZM, Yu XL, Guo XM. Management experiences of primary angiosarcoma of breast: a retrospective study from single institute in the People's Republic of China. Onco Targets Ther 2015; 8:3237-43. [PMID: 26604790 PMCID: PMC4640151 DOI: 10.2147/ott.s92769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Primary angiosarcoma of breast (PAOB) is a rare and highly aggressive malignancy. There is no general agreement on optimal treatments or prognostic factors for this orphan disease. The objective of this study was to investigate the clinicopathologic features and management experiences of PAOB. Methods We performed a retrospective review of medical and pathologic records of 17 consecutive patients diagnosed with PAOB between January 2000 and February 2014 at FuDan University Shanghai Cancer Center. We evaluated the clinical characteristics, multimodality treatments, and associated clinical outcomes. Results A total of 16 patients were included in this retrospective study (median age at PAOB presentation 33.5 years, range: 19–56 years). Palpable tumor with or without breast skin ecchymosis presented as the most common initial symptom. All patients underwent surgery with curative intent. Median disease-free survival and overall survival (OS) were 9 months and 13.6 months, respectively. One-year and 3-year disease-free survival rates were 43.8% and 6.3%, with OS rates of 93.8% and 78.1%, respectively. High histologic grade indicated poorer OS by univariate analysis (P=0.01). However, neither adjuvant chemotherapy nor radiotherapy contributed to clinical outcomes in our series. Conclusion PAOB is considered as an infrequent breast neoplasm with aggressive characteristics. Histologic grade and early metastasis (within 12 months after diagnosis) are associated with poor prognosis. Regardless of grade, additional benefit was not observed with adjuvant therapy.
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Affiliation(s)
- Qun-Chao Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China ; Department of Radiation Oncology, Suzhou Municipal Hospital, Suzhou, People's Republic of China
| | - Xin Mei
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yan Feng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Jin-Li Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Zhao-Zhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Zhi-Min Shao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China ; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xiao-Li Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Xiao-Mao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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Masai K, Kinoshita T, Jimbo K, Asaga S, Hojo T. Clinicopathological features of breast angiosarcoma. Breast Cancer 2015; 23:718-23. [DOI: 10.1007/s12282-015-0630-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/23/2015] [Indexed: 11/24/2022]
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Hillenbrand T, Menge F, Hohenberger P, Kasper B. Primary and secondary angiosarcomas: a comparative single-center analysis. Clin Sarcoma Res 2015; 5:14. [PMID: 26413264 PMCID: PMC4582641 DOI: 10.1186/s13569-015-0028-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/14/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Angiosarcomas (AS) are rare vascular malignancies. They are subdivided into primary (PAS) and secondary angiosarcomas (SAS). The objective was to compare the characteristics of AS subtypes. METHODS Eighteen PAS and ten SAS patients treated at our institution between 2004 and 2012 were included in this study. RESULTS Median age of PAS and SAS patients was 52.9 and 64.2 years, respectively (p = 0.1448). The percentage of women was 27.8% for PAS, but 80.0% for SAS (p = 0.0163). While PAS occurred throughout the body, the majority of SAS arose from the breast (p = 0.0012). All SAS were radiation-induced with a median latency of 7.7 years. The majority of patients with PAS and SAS underwent surgery as primary or recurrence treatment (p > 0.95). Local recurrence was developed by 27.8% of PAS and 50.0% of SAS (p = 0.4119). 61.1% of PAS metastasized, but only 40.0% of SAS (p = 0.4328). Median overall survival for PAS and SAS was 19 and 57 months, respectively (p = 0.2306). CONCLUSION Radical surgery remains the mainstay of both primary and recurrence treatment. SAS show a high local recurrence rate, while PAS tend towards developing early metastases. Overall, prognosis is poor for both groups.
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Affiliation(s)
- Thorsten Hillenbrand
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Franka Menge
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Peter Hohenberger
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Fraga-Guedes C, André S, Mastropasqua MG, Botteri E, Toesca A, Rocha RM, Peradze N, Rotmensz N, Viale G, Veronesi P, Gobbi H. Angiosarcoma and atypical vascular lesions of the breast: diagnostic and prognostic role of MYC gene amplification and protein expression. Breast Cancer Res Treat 2015; 151:131-40. [DOI: 10.1007/s10549-015-3379-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 04/09/2015] [Indexed: 12/29/2022]
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Clinicopathological and immunohistochemical study of 30 cases of post-radiation atypical vascular lesion of the breast. Breast Cancer Res Treat 2014; 146:347-54. [DOI: 10.1007/s10549-014-3020-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 05/31/2014] [Indexed: 01/02/2023]
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Pandey M, Martin MG. Primary Angiosarcoma of the Breast: A Case Report and Review of Literature. World J Oncol 2014; 5:144-148. [PMID: 29147394 PMCID: PMC5649819 DOI: 10.14740/wjon809w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2014] [Indexed: 11/11/2022] Open
Abstract
Angiosarcoma of the breast (ASB) is a rare but aggressive tumor with very poor prognosis. It is important to recognize this tumor early and to distinguish between primary and secondary ASB. While mammograms frequently miss these lesions, ultrasound and MRI show promise as imaging modalities. In spite of characteristic features described on pathology, misdiagnosis is common, with over 35% tumors initially thought to be benign. We present the case of a 32-year-old woman with a history of bilateral reduction mammoplasty who presented with a non-tender lump in her right breast. After repeated aspirations and biopsies, a diagnosis of primary ASB was made. She underwent bilateral simple mastectomies followed by adjuvant chemo-therapy and radiation. While surgery is the mainstay of treatment, roles of radiation and chemo-therapy are still evolving; we review the literature and discuss the decision pathways for diagnosis and management of this rare tumor.
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Affiliation(s)
- Manjari Pandey
- University of Tennessee Health Science Center and West Cancer Center, Memphis, Tennessee, USA
| | - Mike G Martin
- University of Tennessee Health Science Center and West Cancer Center, Memphis, Tennessee, USA
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Crowley TP, Sainsbury DCG, Crowley DM, Milner RH, Ragbir M. The surgical management of angiosarcoma of the breast—a single institution experience. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0972-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Treatment and prognostic factors of radiation-associated angiosarcoma (RAAS) after primary breast cancer: a systematic review. Eur J Cancer 2014; 50:1779-1788. [PMID: 24731859 DOI: 10.1016/j.ejca.2014.03.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/28/2014] [Accepted: 03/01/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Radiation-associated angiosarcoma (RAAS) of the breast is a rare, aggressive disease. The incidence is increasing with the prolonged survival of women irradiated for primary breast cancer. Surgery is the current treatment of choice. Prognosis is poor. This review aims to evaluate all publications on primary treatment of RAAS to identify prognostic factors and evaluate treatment modalities. METHODS Databases were searched for articles with published individual patient data on prognostic factors, treatment and follow-up of patients with RAAS. A regression analysis was performed to test the prognostic values of age, interval between primary treatment and RAAS, tumour size and grade on the local recurrence-free interval (LRFI) and overall survival (OS). The effects of treatment modalities surgery, radiation (with or without hyperthermia) and chemotherapy or combinations were evaluated. RESULTS 74 articles were included, representing data on 222 patients. In these patients, the 5-year OS was 43% and 5-year LRFI was 32%. Tumour size and age were significant prognostic factors on LRFI and OS. Of all patients, 68% received surgery alone, 17% surgery and reirradiation and 6% surgery with chemotherapy. The remaining 9% received primary treatments without surgery. Surgery with radiotherapy had a better 5-year LRFI of 57% compared to 34% for surgery alone (p=0.008). The value of other treatment modalities could not be assessed. CONCLUSIONS This systematic review confirms the poor prognosis of RAAS. Tumour size and age were of prognostic value. The addition of reirradiation to surgery in the treatment of RAAS appears to enhance local control.
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Angiosarcoma of the Breast with Solitary Metastasis to the Ovary during Pregnancy: An Uncommon Pattern of Metastatic Disease. Case Rep Oncol Med 2014; 2013:209610. [PMID: 24383023 PMCID: PMC3870644 DOI: 10.1155/2013/209610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/12/2013] [Indexed: 12/29/2022] Open
Abstract
Primary de novo angiosarcoma of the breast is an uncommon, aggressive neoplasm. Here, we present a case of a young woman who initially developed primary angiosarcoma of the breast, and subsequently angiosarcoma of the ovary during pregnancy two years later. Only two confirmed primary angiosarcomas of the breast metastasizing specifically to the ovary have been described in the literature. However, all previous cases had ovarian metastases at presentation or shortly after initial diagnosis. This case is unusual as it occurred after a relatively long interval, and apparently developed during pregnancy. We discuss this rare phenomenon, as well as the possible factors contributing to the recurrence.
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Sporadic versus Radiation-Associated Angiosarcoma: A Comparative Clinicopathologic and Molecular Analysis of 48 Cases. Sarcoma 2013; 2013:798403. [PMID: 24082817 PMCID: PMC3776386 DOI: 10.1155/2013/798403] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/22/2013] [Accepted: 07/30/2013] [Indexed: 11/19/2022] Open
Abstract
Angiosarcomas are aggressive tumors of vascular endothelial origin, occurring sporadically or in association with prior radiotherapy. We compared clinicopathologic and biologic features of sporadic angiosarcomas (SA) and radiation-associated angiosarcomas (RAA). Methods. From a University of Michigan institutional database, 37 SA and 11 RAA were identified. Tissue microarrays were stained for p53, Ki-67, and hTERT. DNA was evaluated for TP53 and ATM mutations. Results. Mean latency between radiotherapy and diagnosis of RAA was 11.9 years: 6.7 years for breast RAA versus 20.9 years for nonbreast RAA (P = 0.148). Survival after diagnosis did not significantly differ between SA and RAA (P = 0.590). Patients with nonbreast RAA had shorter overall survival than patients with breast RAA (P = 0.03). The majority of SA (86.5%) and RAA (77.8%) were classified as high-grade sarcomas (P = 0.609). RAA were more likely to have well-defined vasoformative areas (55.6% versus 27%, P = 0.127). Most breast SA were parenchymal in origin (80%), while most breast RAA were cutaneous in origin (80%). TMA analysis showed p53 overexpression in 25.7% of SA and 0% RAA, high Ki-67 in 35.3% of SA and 44.4% RAA, and hTERT expression in 100% of SA and RAA. TP53 mutations were detected in 13.5% of SA and 11.1% RAA. ATM mutations were not detected in either SA or RAA. Conclusions. SA and RAA are similar in histology, immunohistochemical markers, and DNA mutation profiles and share similar prognosis. Breast RAA have a shorter latency period compared to nonbreast RAA and a significantly longer survival.
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Effect of a combined surgery, re-irradiation and hyperthermia therapy on local control rate in radio-induced angiosarcoma of the chest wall. Strahlenther Onkol 2013; 189:387-93. [PMID: 23549781 DOI: 10.1007/s00066-013-0316-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 01/16/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE Radiation-induced angiosarcoma (RAS) of the chest wall/breast has a poor prognosis due to the high percentage of local failures. The efficacy and side effects of re-irradiation plus hyperthermia (reRT + HT) treatment alone or in combination with surgery were assessed in RAS patients. PATIENTS AND METHODS RAS was diagnosed in 23 breast cancer patients and 1 patient with melanoma. These patients had previously undergone breast conserving therapy (BCT, n = 18), mastectomy with irradiation (n=5) or axillary lymph node dissection with irradiation (n = 1). Treatment consisted of surgery followed by reRT + HT (n = 8), reRT + HT followed by surgery (n = 3) or reRT + HT alone (n = 13). Patients received a mean radiation dose of 35 Gy (32-54 Gy) and 3-6 hyperthermia treatments (mean 4). Hyperthermia was given once or twice a week following radiotherapy (RT). RESULTS The median latency interval between previous radiation and diagnosis of RAS was 106 months (range 45-212 months). Following reRT + HT, the complete response (CR) rate was 56 %. In the subgroup of patients receiving surgery, the 3-month, 1- and 3-year actuarial local control (LC) rates were 91, 46 and 46 %, respectively. In the subgroup of patients without surgery, the rates were 54, 32 and 22 %, respectively. Late grade 4 RT toxicity was seen in 2 patients. CONCLUSION The present study shows that reRT + HT treatment--either alone or combined with surgery--improves LC rates in patients with RAS.
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