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Kapoor MM, Yoon EC, Yang WT, Patel MM. Breast Angiosarcoma: Imaging Features With Histopathologic Correlation. JOURNAL OF BREAST IMAGING 2023; 5:329-338. [PMID: 38416884 DOI: 10.1093/jbi/wbac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Indexed: 03/01/2024]
Abstract
Breast angiosarcoma is a rare malignancy of endothelial origin that can be categorized as primary angiosarcoma (PAS) or secondary angiosarcoma (SAS) based on etiology. Primary angiosarcoma typically affects younger women with no known risk factors, whereas SAS of the breast typically develops in older women who have undergone breast cancer treatment. There are two types of SAS, one that develops in the setting of chronic lymphedema and one that develops as a radiation-associated neoplasm after breast-conserving therapy (BCT). Clinically, PAS often presents as a palpable mass that may be rapidly growing, whereas SAS presents with skin changes such as erythematous plaques or nodules or with areas of skin discoloration. Mammographically, the appearance of PAS can be nonspecific and may be obscured by the dense tissue that is characteristic of the young patient population it typically affects. Cases of mammographically occult PAS have been visible at US and MRI. Mammography and US have been found to be less sensitive than MRI for the diagnosis of secondary radiation-associated angiosarcoma. Angiosarcomas, both PAS and SAS, are graded, depending on degree of differentiation, as low, intermediate, or high grade. Endothelial markers such as ERG and CD31 immunohistochemical stains are used to support the diagnosis of angiosarcomas. In this article, we review the clinical presentation, imaging findings, associated histopathology, and treatment of primary and secondary breast angiosarcoma.
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Affiliation(s)
- Megha M Kapoor
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
| | - Esther C Yoon
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA
| | - Wei T Yang
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
| | - Miral M Patel
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
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Soto-García D, Batalla A, Gonzalez-Sixto B, Rodríguez-Jato Q, Alvarez C, Flórez Á. Atypical Vascular Lesions After Radiotherapy: A Case Series. Am J Dermatopathol 2022; 44:390-393. [PMID: 35120033 DOI: 10.1097/dad.0000000000002069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diego Soto-García
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain
| | - Ana Batalla
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain
| | - Beatriz Gonzalez-Sixto
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain
| | - Queila Rodríguez-Jato
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain
| | - Carlos Alvarez
- Department of Pathology, University Hospital of Pontevedra, Pontevedra, Spain
| | - Ángeles Flórez
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain
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Humeda Y, Beasley J. Multiple purple papules of the breast in a patient with a history of breast cancer – a clinicopathological challenge. Int J Dermatol 2020; 59:1217-1218. [DOI: 10.1111/ijd.14859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/11/2020] [Accepted: 02/28/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Yasmine Humeda
- Vital Dermatology Florida State University College of Medicine Pensacola FL USA
| | - Jenna Beasley
- Vital Dermatology Florida State University College of Medicine Pensacola FL USA
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Bonilla CE, Perez Lugo LM, Vallejo Yepes C, Osma Charris HR. Atypical Vascular Proliferation Secondary to Radiotherapy in a Patient With a History of Synovial Sarcoma. Cureus 2020; 12:e10179. [PMID: 33029459 PMCID: PMC7529495 DOI: 10.7759/cureus.10179] [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: 11/17/2022] Open
Abstract
We present the case of a 21-year-old male patient with a history of monophasic synovial sarcoma in his left thigh, which was treated with surgical resection, radiotherapy, and chemotherapy with mesna, doxorubicin, and Ifosfamide (MAI protocol). Approximately six years after the end of the oncological treatment, he presented a nodular, polypoid lesion in the left popliteal region, which was painless and fast growing. Ultimately, the biopsy was consistent with atypical vascular proliferation (AVP). Vascular lesions after radiotherapy include a wide spectrum of pathologies that range from benign lesions such as AVP to malignant ones with very poor prognosis such as angiosarcoma, the distinction between one and the other can be difficult, being the determination rearrangement or amplification of gene c-myc, a key to make an accurate diagnosis in case of doubt.
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Zhong CS, Raut CP, Glynn RJ, Nambudiri VE. Characteristics of atypical postradiation vascular proliferation: A retrospective review of 193 patients. J Am Acad Dermatol 2019; 83:1447-1450. [PMID: 31669437 DOI: 10.1016/j.jaad.2019.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/23/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Connie S Zhong
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Cutaneous Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Chandrajit P Raut
- Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Sarcoma and Bone Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Robert J Glynn
- Harvard Medical School, Boston, Massachusetts; Division of Biostatistics, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vinod E Nambudiri
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Cutaneous Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.
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Patrushev AV, Belousova IE, Gorislavskaya TA, Suharev AV, Samtsov AV. BENIGN LYMPHANGIOENDOTHELIOMA. VESTNIK DERMATOLOGII I VENEROLOGII 2018. [DOI: 10.25208/0042-4609-2018-94-1-91-96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors describe modern data relating to the definition, clinical, pathological and immunohistochemical features of a rare vascular tumor — benign lymphangioendothelioma. The problems of differential diagnosis with Kaposi’s sarcoma and angiosarcoma are discussed. This is the first description of this tumorin domestic literature.
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Gonzalez-Ericsson PI, Estrada MV, Al-Rohil R, Sanders ME. Post-irradiation morphoea of the breast: a case report and review of the literature. Histopathology 2017; 72:342-350. [DOI: 10.1111/his.13343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Paula I Gonzalez-Ericsson
- Breast Cancer Research Program; Vanderbilt-Ingram Cancer Center; Vanderbilt University Medical Center; Nashville TN USA
| | - Monica V Estrada
- Department of Pathology; School of Medicine; University of California; San Diego CA USA
| | - Rami Al-Rohil
- Department of Pathology; Vanderbilt University Medical Center; Nashville TN USA
| | - Melinda E Sanders
- Breast Cancer Research Program; Vanderbilt-Ingram Cancer Center; Vanderbilt University Medical Center; Nashville TN USA
- Department of Pathology; Vanderbilt University Medical Center; Nashville TN USA
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Stolnicu S, Moldovan C, Podoleanu C, Georgescu R. Mesenchymal tumors and tumor-like lesions of the breast: a contemporary approach review. Ann Pathol 2014; 35:15-31. [PMID: 25533916 DOI: 10.1016/j.annpat.2014.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022]
Abstract
The classification of the breast tumors has been revised and recently published in 2012 in the WHO blue book. Contrary to the epithelial tumors in the breast, mesenchymal tumors are rare and the classification for benign and malignant tumors is based on the same criteria in both categories, since no other specific diagnostic criteria, which would have an impact on prognosis, exist to date. The present review deals with minor changes mirroring the recent developments in the benign mesenchymal tumors (new additions are nodular fasciitis and atypical vascular lesions, while the haemangiopericytoma is removed) focusing especially on criteria to diagnose sarcomas, which represent a wide spectrum including very difficult lesions. The majority of sarcomas of the breast arise as a component of a malignant phyllodes tumor, while the pure forms are very rare. When a pure primary sarcoma of the breast is diagnosed, pathologists are encouraged to categorize the lesion according to the type of differentiation and to provide to the clinicians all the important prognostic parameters for the best treatment choice.
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Affiliation(s)
- Simona Stolnicu
- Department of Pathology, University of Medicine, Tirgu Mures, Romania
| | - Cosmin Moldovan
- Department of Histology, University of Medicine, Tirgu Mures, Romania
| | | | - Rares Georgescu
- Department of Surgery, University of Medicine, Tirgu Mures, Romania
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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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Tan PH, Ellis IO. Myoepithelial and epithelial-myoepithelial, mesenchymal and fibroepithelial breast lesions: updates from the WHO Classification of Tumours of the Breast 2012. J Clin Pathol 2013; 66:465-70. [PMID: 23533258 DOI: 10.1136/jclinpath-2012-201078] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the 4th edition of the WHO Classification of Tumours of the Breast, myoepithelial lesions are retitled myoepithelial and epithelial-myoepithelial lesions in order to better reflect the dual participation of luminal and myoepithelial compartments in some key entities. Malignant myoepithelioma, described as a section within the chapter on myoepithelial lesions in the 3rd edition, is recognised in the 4th edition as part of metaplastic carcinoma. Adenomyoepithelioma with malignancy is categorised in terms of the cellular component undergoing malignant transformation. The list of antibodies that can be used for identifying myoepithelial cells is updated. Among mesenchymal lesions, new additions are nodular fasciitis and atypical vascular lesions, while the haemangiopericytoma is removed. The 3rd edition stated that pathological prediction of behaviour of phyllodes tumours is difficult in the individual case. In the 4th edition, some progress has been made in prioritisation and weighting of histological parameters that can potentially estimate probability of recurrence. The WHO Working Group advocates leaning towards a diagnosis of fibroadenoma in cases where there is histological uncertainty in distinction from a benign phyllodes tumour, or adopting the neutral term 'benign fibroepithelial neoplasm', as the clinical behaviour of fibroadenoma overlaps with that of benign phyllodes tumour. The 3rd edition terminology of 'periductal stromal sarcoma' is revised to 'periductal stromal tumour', akin to the widespread consensus to avoid the use of the term 'cystosarcoma' in the context of phyllodes tumours.
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Affiliation(s)
- Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore
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Fisher C. Unusual myoid, perivascular, and postradiation lesions, with emphasis on atypical vascular lesion, postradiation cutaneous angiosarcoma, myoepithelial tumors, myopericytoma, and perivascular epithelioid cell tumor. Semin Diagn Pathol 2013; 30:73-84. [PMID: 23327731 DOI: 10.1053/j.semdp.2012.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In recent years, a number of new soft tissue tumor entities have been described that occur in the skin only, or that also occur in other sites but form clinically and pathologically distinct subsets when arising in the skin and subcutaneous tissue. These include a variety of mesenchymal lineages and have variable malignant potential, although superficial malignant soft tissue tumors generally have a more favorable outcome than their more deeply located counterparts. This article reviews the clinical and pathologic features and differential diagnoses of atypical vascular lesion, postradiation cutaneous angiosarcoma, myoepithelioma, myopericytoma, and perivascular epithelioid cell tumor.
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Affiliation(s)
- Cyril Fisher
- Department of Histopathology, Royal Marsden Hospital, London, UK.
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Postmastectomy-postirradiation atypical vascular lesion of the skin: report of 2 cases. Case Rep Pathol 2012; 2012:710318. [PMID: 23050180 PMCID: PMC3461290 DOI: 10.1155/2012/710318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 08/20/2012] [Indexed: 11/18/2022] Open
Abstract
The spectrum of vascular lesions developing in breast or chest wall skin following lumpectomy or mastectomy and radiation is wide and ranges from atypical vascular lesions with a benign clinical behaviour to frankly malignant, angiosarcoma ranging histologically from well to poorly differentiated variety. Postmastectomy-postirradiation atypical vascular lesions (AVLs) are rare and develop in the skin adjacent to the mastectomy scar. About hundred cases have been reported in the literature so far. AVLs have also been reported in patients after breast conservation surgery within the breast parenchyma or in the skin around the scar. The incidence appears to be rising. The exact reason for this is not known. The newer modalities of radiation therapy may be contributory to the pathogenesis. More studies have to be done in this area to prove the causal relationship. We are reporting the cases of 2 patients with carcinoma of breast who developed postmastectomy-postirradiation atypical vascular lesions. The cases were received in our department within a 6-month period.
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Widespread atypical vascular lesions of the skin after whole-body electron beam therapy: expanding the clinical spectrum. Am J Dermatopathol 2012; 35:e11-5. [PMID: 22935890 DOI: 10.1097/dad.0b013e318268175c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atypical vascular lesion of the skin is an uncommon usually benign condition, thus far reported almost exclusively from mammary skin after radiotherapy for carcinoma of the breast. Some clinical and histological overlap exists with early angiosarcoma, which can also occur on irradiated skin. The lesions are divided into vascular and lymphatic types, the first representing a higher risk for development of angiosarcoma and the latter being more common. This article reports a rare case of widespread, progressive, vascular-type atypical vascular lesion after repeated whole-body electron beam irradiation administered as treatment for mycosis fungoides.
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Armengot-Carbó M, Roca-Estellés M, Quecedo-Estébanez E, Gimeno-Carpio E. Angiosarcoma of the Skin After Breast Cancer Radiotherapy. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bae SY, Choi MY, Cho DH, Lee JE, Nam SJ, Yang JH. Large clinical experience of primary angiosarcoma of the breast in a single Korean medical institute. World J Surg 2012; 35:2417-21. [PMID: 21882024 DOI: 10.1007/s00268-011-1225-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Angiosarcoma of the breast is rare. The purpose of the present study was to evaluate the clinicopathologic characteristics and the clinical outcomes of patients with primary breast angiosarcoma. METHODS We analyzed the clinicopathologic factors of patients with angiosarcoma of the breast treated between 1997 and 2010 at the Samsung Medical Center. We reviewed the related demographic data, preoperative imaging studies, method of histologic confirmation, tumor size, histologic grades, status of hormonal receptors, treatment modality, and survival data. RESULTS Nine women with angiosarcoma of the breast were identified. The median age of patients with primary angiosarcoma of the breast at diagnosis was 31 years (range: 19-63 years), and the median tumor size was 9.0 cm (range: 3.5-10.7 cm). Seven patients (77.7%) died within a median follow-up of 46.7 months (range: 3.9-63.3 months), and all deaths were directly attributed to angiosarcoma. Overall, the median time from diagnosis of angiosarcoma to death was 46.8 months (range: 8.21-63.3 months). The 5 year overall survival with angiosarcoma was 42.9%. CONCLUSIONS Primary angiosarcoma of the breast is a rare malignancy with a poor prognosis, even with complete resection. Chemotherapy and radiation therapy have limited value as treatments to date. Total mastectomy appears to be the most appropriate and beneficial treatment. More aggressive surgical management should be considered, and future clinical research should explore the most appropriate adjuvant therapy in the treatment of angiosarcoma.
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Affiliation(s)
- Soo Youn Bae
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Republic of Korea
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Armengot-Carbó M, Roca-Estellés MJ, Quecedo-Estébanez E, Gimeno-Carpio E. [Angiosarcoma of the skin after breast cancer radiotherapy]. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:557-9. [PMID: 22465258 DOI: 10.1016/j.ad.2011.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 09/29/2011] [Accepted: 10/09/2011] [Indexed: 10/28/2022] Open
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Karkouche R, Carbonnelle-Puscian A, Rivet J, Fraitag S, Moulonguet I, Carlotti A, Havard S, Vérola O, Cavelier-Balloy B. [Post-radiation atypical vascular lesions and angiosarcoma: 11 cases]. Ann Dermatol Venereol 2012; 139:109-17. [PMID: 22325749 DOI: 10.1016/j.annder.2011.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/11/2011] [Accepted: 11/04/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Post-radiation atypical vascular lesions of the skin display clinical and morphological overlap with well-differentiated angiosarcomas, and correct diagnosis may be difficult. PATIENTS AND METHODS We studied clinical, histological and immuno-histochemical aspects (CD31, CD34, D2-40 and VEGFR-3) of eight post-radiation atypical vascular lesions comparatively with three post-radiation angiosarcomas. RESULTS All patients were female and received radiation therapy for breast carcinoma. On average, atypical vascular lesions occurred 4.3 years after radiation therapy and presented as small papulonodules or erythematous plaques. The clinical course after simple excision was benign. Histologically, they were relatively circumscribed lesions and showed slit-like vessels dissecting dermal collagen in all cases. On average, angiosarcomas occurred 5 years after radiation therapy and presented as more extensive lesions with a more aggressive clinical course. The lesions showed histological overlap with atypical vascular lesions, but were poorly circumscribed, with deeper invasion, cytological atypia and mitosis. Although the immuno-histochemical profiles were similar, expression of VEGFR-3 was greater in two cases of angiosarcoma. CONCLUSION Post-radiation atypical vascular lesions are benign lesions that display clinical, histological and immuno-phenotypic overlap with well-differentiated angiosarcoma, and diagnosis requires good clinicopathological correlation. VEGFR-3 may be useful for differential diagnosis, as well as amplification of the MYC gene.
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Affiliation(s)
- R Karkouche
- Service d'anatomie et cytologie pathologiques, université Paris-Descartes, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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