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Pancsa T, Pósfai B, Schubert A, Almási S, Papp E, Chien YCC, Kálmán E, Kovács KA, Kulka J, Varga L, Cserni G, Kuthi L. TRPS1 expression in breast angiosarcoma. Virchows Arch 2024:10.1007/s00428-024-03852-2. [PMID: 38902365 DOI: 10.1007/s00428-024-03852-2] [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: 02/14/2024] [Revised: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
Angiosarcoma (AS) of the breast, a rare mesenchymal neoplasm, exhibits distinct forms based on etiological and genetic features. While cases with typical clinical presentation and morphology allow for a straightforward diagnosis, challenges arise when clinical data are scarce, diagnostic material is limited, or morphological characteristics overlap with other tumors, including undifferentiated carcinomas. The trichorhinophalangeal syndrome protein 1 (TRPS1), once regarded as highly specific for breast carcinomas, now faces doubts regarding its reliability. This study explores TRPS1 expression in breast AS. Our investigation revealed that 60% of AS cases displayed TRPS1 labeling, contrasting with the 40% lacking expression. Scoring by four independent readers established a consensus, designating 12/35 ASs as unequivocally TRPS1-positive. However, uncertainty surrounded nine further cases due to a lack of reader agreement (being substantial as reflected by a kappa value of 0.76). These findings challenge the perceived specificity of TRPS1, shedding light on its presence in a noteworthy proportion of breast ASs. Consequently, the study underscores the importance of a comprehensive approach in evaluating breast ASs and expands the range of entities within the differential diagnosis associated with TRPS1 labeling.
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Affiliation(s)
- Tamás Pancsa
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Boglárka Pósfai
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anna Schubert
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Szintia Almási
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Eszter Papp
- Department of Surgical and Molecular Pathology, Tumor Pathology Center, National Institute of Oncology, Budapest, Hungary
| | - Yi-Che Chang Chien
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Endre Kálmán
- Department of Pathology, Faculty of Medicine and Clinical Center, University of Pécs, Pécs, Hungary
| | - Kristóf Attila Kovács
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Linda Varga
- Department of Oncotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Levente Kuthi
- Department of Surgical and Molecular Pathology, Tumor Pathology Center, National Institute of Oncology, Budapest, Hungary.
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary.
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2
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Plaza JA, Sangueza OP, Giubellino A, Gru AA, Kaffenberger B, Wakely PE, Sangueza MJ. Angiosarcoma-like Kaposi Sarcoma: A Distinctive Histomorphologic Variant Representing an Important Diagnostic Pitfall. Am J Surg Pathol 2022; 46:1732-1738. [PMID: 35948518 DOI: 10.1097/pas.0000000000001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Kaposi sarcoma (KS) is a rare low-grade angioproliferative neoplasm associated with human herpesvirus 8 (HHV-8) infection with multiple clinical subtypes and varying histopathologic patterns. Histologically, many different variants of KS have been reported, yet all can be difficult to recognize and must be differentiated from other vascular tumors. In this report, we studied fourteen cases of a newly described variant of KS reminiscent of a well-differentiated angiosarcoma (angiosarcoma-like KS). All cases showed a diffuse, ill-defined infiltrative dermal-based lesion composed of numerous anastomosing vascular channels of varying caliber lined by a single layer of endothelium with minimal pleomorphism. The vascular proliferation ramified through the dermis and dissected the collagen bundles along with infiltration into the subcutaneous fat and around skin appendages. All cases showed expression of vascular markers (CD31, CD34, and ERG) and were positive for HHV-8. None showed the classic histopathology associated with KS. Without clinical guidance these tumors can be difficult to recognize as KS, creating significant diagnostic challenges. Our study expands on a rare histologic variant of KS that ought to be considered in the differential diagnosis of any cutaneous well-differentiated angiosarcoma. Awareness of this variant of KS is of important for proper diagnosis and management of these patients; thus, careful attention to the histomorphology and clinical history can help lead the pathologist to the correct diagnosis.
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Affiliation(s)
- Jose A Plaza
- Department of Pathology and Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
| | - Omar P Sangueza
- Department of Pathology and Dermatology, Wake Forest Baptist Health, Winston-Salem, NC
| | | | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Benjamin Kaffenberger
- Department of Pathology and Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
| | - Paul E Wakely
- Department of Pathology and Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
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3
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Russell DH, Montgomery EA, Susnik B. Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management. Adv Anat Pathol 2022; 29:309-323. [PMID: 35838633 DOI: 10.1097/pap.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Spindle cell proliferations of the breast are a heterogeneous group of lesions ranging from benign or reactive lesions to aggressive malignant neoplasms. Diagnosis on core biopsy can be particularly challenging as lesions displaying different lineages associated with variable outcomes share overlapping morphologies (scar vs. fibromatosis-like metaplastic carcinoma) whereas individual entities can exhibit a large variety of appearances (myofibroblastoma). In this review, lesions are grouped into lineage, when possible, including those showing fibroblastic/myofibroblastic differentiation, ranging from entities that require no additional management, such as scar and nodular fasciitis, to those with unpredictable clinical outcomes such as fibromatosis and solitary fibrous tumor or locally aggressive behavior such as dermatofibrosarcoma protuberans. The review of low-grade vascular lesions includes atypical vascular lesion and low-grade angiosarcoma. Also discussed are various adipocytic lesions ranging from lipoma to liposarcoma, and rare smooth muscle and neural entities more commonly encountered in locations outside the breast, such as leiomyoma, neurofibroma, schwannoma, or granular cell tumor. Optimal histological evaluation of these entities merges clinical and radiologic data with morphology and ancillary testing. We present our approach to immunohistochemical and other ancillary testing and highlight issues in pathology correlation with imaging. Recent updates in the management of breast spindle cell lesions are addressed. In a well-sampled lesion with radiographic concordance, the core biopsy diagnosis reliably guides management and we advocate the inclusion of management recommendations in the pathology report. Precise characterization using up to date guidelines is important to identify a subset of patients who may safely avoid unnecessary surgical procedures. A multidisciplinary approach with close collaboration with our clinical colleagues is emphasized.
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Affiliation(s)
- Daniel H Russell
- Departments of Pathology University of Miami Hospital and Jackson Health Systems, Miami, FL
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4
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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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5
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[Acquired progressive lymphangioma in a 13-year-old boy]. Hautarzt 2021; 72:610-614. [PMID: 33205257 DOI: 10.1007/s00105-020-04728-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Acquired tumors of lymphatic vessels are rare. Clinically, progressive lymphangioma usually appears as circumscribed plaques of small to medium size. In contrast, our case of a 13-year-old boy demonstrates a case of progressive lymphangioma with a solitary large indurated plaque. No extracutaneous manifestation was found. Systemic therapy with corticosteroids and methotrexate resulted in an improvement of the patient's condition. Dependent on clinical course and appearance of the disease, therapy with mTOR inhibitors may be considered as a therapeutic option.
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6
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Wollina U, Schönlebe J, Koch A, Tirant M, Cardoso JC, Karadag AS. Atypical vascular proliferations of the neck. Wien Med Wochenschr 2020; 171:57-60. [PMID: 32757107 DOI: 10.1007/s10354-020-00774-x] [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: 05/10/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
Atypical vascular proliferations (AVP) are a late complication after radiotherapy. Most cases have been reported in female breast cancer patients on the chest wall. These lesions are mostly of the lymphatic type. Herein, we report a blood vascular-type AVP in a male on the neck 60 years after radiotherapy for a benign hemangioma, which makes this case exceptional. We removed the whole chronic radiodermatitis surgically. Histopathology excluded vascular malignancies but confirmed AVP. We discuss the differential diagnoses and treatment.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstraße 41, 01067, Dresden, Germany.
| | - Jacqueline Schönlebe
- Institute of Pathology "Georg Schmorl", Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, 01067, Dresden, Germany
| | - André Koch
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstraße 41, 01067, Dresden, Germany
| | - Michael Tirant
- Department of Dermatology, Hanoi Medical University, Hanoi, Viet Nam
| | - José C Cardoso
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ayşe Serap Karadag
- Department of Dermatology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
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7
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Hoyle JM, Layfield LJ, Crim J. The lipid-poor hemangioma: an investigation into the behavior of the "atypical" hemangioma. Skeletal Radiol 2020; 49:93-100. [PMID: 31250038 DOI: 10.1007/s00256-019-03257-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Most vertebral hemangiomas contain high signal intensity on T1-weighted MRI images. Atypical vertebral hemangiomas, which are defined as showing low-signal intensity on T1-weighted images, have been described as lesions which are prone to aggressive behavior. This study was performed to assess behavior of atypical hemangiomas. MATERIALS AND METHODS Thoracic and lumbar spine MRI reports for the year 2012 were reviewed for diagnosis of atypical hemangioma. Images were reviewed by two independent observers, and cases which showed atypical vertebral hemangioma, and had imaging or clinical follow-up, were included in our study. RESULTS Thirty atypical hemangiomas which had follow-up data were identified out of 2784 thoracic and lumbar MR examinations performed during 2012 at a single institution. Imaging follow-up was available for 23 lesions (mean follow-up 32 months), while there was clinical follow-up for the remaining seven lesions (mean 43.6 months). Twenty-two lesions were stable on imaging, while one demonstrated significant growth over approximately 6 years, developing MRI signal characteristics of a typical hemangioma. Eleven lesions had CT scans showing typical features of hemangioma. Two of the index lesions could not be identified on follow-up CT examinations, which showed normal-appearing spines. The remaining seven lesions were followed clinically; none of the patients reported symptoms in the region of the index lesions. CONCLUSIONS Atypical hemangiomas are uncommon lesions. The cases in our population did not show aggressive behavior. A more appropriate designation for these lesions may be lipid-poor hemangioma, to distinguish them from aggressive hemangiomas.
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Affiliation(s)
- J M Hoyle
- University of Missouri at Columbia, 1 Hospital Dr., Columbia, MO, 65212, USA
| | - L J Layfield
- University of Missouri at Columbia, 1 Hospital Dr., Columbia, MO, 65212, USA
| | - J Crim
- University of Missouri at Columbia, 1 Hospital Dr., Columbia, MO, 65212, USA.
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8
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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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9
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A Painful Firm Plaque on the Midback of a 53-Year-Old Woman: Answer. Am J Dermatopathol 2018; 40:621-622. [PMID: 30028761 DOI: 10.1097/dad.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Abstract
Examination of the rectum by pathologists is instrumental in the management of patients affected by rectal carcinoma. That role includes evaluation of multiple gross and microscopic features that convey prognostic implications. The analysis is based on the authors' experience handling rectal specimens along with review of the pertinent literature in these areas: margins of excision, quality of the mesorectum, diligence and techniques to sample lymph nodes, tumor budding, grading of residual amount of carcinoma after preoperative therapy, vascular/perineural invasion, and staging the tumor. Pathologists must communicate the findings in a clear manner. Evaluation of margins and completeness of mesorectum are markers of the quality of surgical excision. The number of lymph nodes obtained and examined is dependent in great part on the diligence of the pathologist finding them in the mesenteric adipose tissue. There are grades for budding and response to prior chemoradiation therapy. The location of vascular invasion (extramural vs. intramural) may predict aggressive behavior. Pathologists proactively are to choose sections of tumor for molecular testing. Meticulous macro- and microscopic evaluation of specimens for rectal carcinoma by pathologist is needed to determine an accurate assessment of staging and other prognostic factors. The modern pathologists play a pivotal part in the care and management of patients suffering from rectal adenocarcinoma. That role goes from the initial histological diagnosis to the gross and microscopic examination of the excised specimens. Based on that examination pathologists issue statements that not only evaluate the quality of the surgical procedure, but also through the application of molecular tests they give light on prognostic factors and information for therapeutic purposes.
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Affiliation(s)
- Mariana Berho
- Department of Pathology, Cleveland Clinic Florida, Weston, FL, USA -
| | - Pablo A Bejarano
- Department of Pathology, Cleveland Clinic Florida, Weston, FL, USA
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11
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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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12
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Abstract
Accurate diagnosis of cutaneous malignant vascular tumors, including angiosarcoma and epithelioid hemangioendothelioma, is critical for determination of appropriate clinical management and prognosis. Although there have been significant advances in understanding genetic aspects of cutaneous vascular biology, differential diagnosis of malignant vascular tumor involving skin and superficial soft tissue is a frequent source of difficulty. This brief overview highlights the clinicopathologic features of primary and secondary cutaneous angiosarcoma and epithelioid hemangioendothelioma and also provides a short summary of newer molecular data.
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Affiliation(s)
- Wonwoo Shon
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 8612, Los Angeles, CA 90048, USA.
| | - Steven D Billings
- Department of Pathology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, L25, Cleveland, OH 44195, USA
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13
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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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14
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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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15
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Feng X, Tian L, Zhang Z, Yu Y, Cheng J, Gong Y, Li CY, Huang Q. Caspase 3 in dying tumor cells mediates post-irradiation angiogenesis. Oncotarget 2016; 6:32353-67. [PMID: 26431328 PMCID: PMC4741698 DOI: 10.18632/oncotarget.5898] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/17/2015] [Indexed: 12/30/2022] Open
Abstract
Cytotoxic radiotherapy unfavorably induces tumor cells to generate various proangiogenic substances, promoting post-irradiation angiogenesis (PIA), which is one of major causes of radiotherapy failure. Though several studies have reported some mechanisms behind PIA, they have not yet described the beginning proangiogenic motivator buried in the irradiated microenvironment. In this work, we revealed that dying tumor cells induced by irradiation prompted PIA via a caspase 3 dependent mechanism. Proteolytic inactivation of caspase 3 in dying tumor cells by transducing a dominant-negative version weakened proangiogenic effects in vitro and in vivo. In addition, inhibition of caspase 3 activity suppressed tumor angiogenesis and tumorigenesis in xenograft mouse model. Importantly, we identified vascular endothelial growth factor (VEGF)-A as a downstream proangiogenic factor regulated by caspase 3 possibly through Akt signaling. Collectively, these findings indicated that besides acting as a key executioner in apoptosis, caspase 3 in dying tumor cells may play a central role in driving proangiogenic response after irradiation. Thus, radiotherapy in combination with caspase 3 inhibitors may be a novel promising therapeutic strategy to reduce tumor recurrence due to restrained PIA.
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Affiliation(s)
- Xiao Feng
- The Comprehensive Cancer Center and Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Tian
- Experimental Research Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengxiang Zhang
- The Comprehensive Cancer Center and Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Yu
- The Comprehensive Cancer Center and Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Cheng
- The Comprehensive Cancer Center and Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanping Gong
- The Comprehensive Cancer Center and Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuan-Yuan Li
- The Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Qian Huang
- The Comprehensive Cancer Center and Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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16
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Cheah AL, Billings SD, Rowe JJ. Mesenchymal tumours of the breast and their mimics: a review with approach to diagnosis. Pathology 2016; 48:406-24. [DOI: 10.1016/j.pathol.2016.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 12/16/2022]
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17
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Kak I, Salama S, Gohla G, Naqvi A, Alowami S. A Case of Patch Stage of Kaposi's Sarcoma and Discussion of the Differential Diagnosis. Rare Tumors 2016; 8:6123. [PMID: 27134709 PMCID: PMC4827646 DOI: 10.4081/rt.2016.6123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/16/2015] [Accepted: 11/28/2015] [Indexed: 12/03/2022] Open
Abstract
A 55 year old HIV positive male had a skin lesion biopsy which showed atypical vascular proliferation within the superficial and deep dermis with mild atypia of lining endothelial cells. A sparse lymphoplasmacytic infiltrate surrounding the irregular vascular channels was noted. Immunohistochemistry highlighted the atypical blood vessels with the vascular markers CD31, CD34 and Factor VIII. The differential diagnosis included unusual vascular or lymphatic proliferations, stasis dermatitis, kaposiform hemangioendothelioma, progressive lymphangioma and angiosarcoma with focal Kaposi’s sarcoma features. Characteristic human herpes virus-8 positive staining helped support the diagnosis of patch stage of Kaposi’s sarcoma. Herein, we discuss the case findings, differential diagnosis and characteristic histological findings associated with the patch stage of Kaposi’s sarcoma which can be an elusive diagnosis.
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Affiliation(s)
- Ipshita Kak
- Department of Pathology and Molecular Medicine, McMaster University , Hamilton, ON, Canada
| | - Samih Salama
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Gabriella Gohla
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Asghar Naqvi
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Salem Alowami
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
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18
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Llamas-Velasco M, Angulo J, Durán R, Fraitag S, Kutzner H, Requena L. Hemangioma with dabskoid features: a rare histopathologic variant of acquired hemangioma. J Cutan Pathol 2015; 43:258-62. [DOI: 10.1111/cup.12621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/21/2015] [Accepted: 09/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mar Llamas-Velasco
- Department of Dermatology; Hospital Universitario de la Princesa; Madrid Spain
| | - Jorge Angulo
- Department of Dermatology; Fundación Jiménez Díaz; Madrid Spain
| | - Rafael Durán
- Department of Pathology; Hospital de Elda; Alicante Spain
| | - Silvie Fraitag
- Service d'Anatomie et Cytologie Pathologiques; CHU Paris - Hôpital Necker; Paris France
| | - Heinz Kutzner
- Department of Dermatopathology; Dermatohistopathologisches Gemeinschaftslabor; Friedrichshafen Germany
| | - Luis Requena
- Department of Dermatology; Fundación Jiménez Díaz; Madrid Spain
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19
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Lin G, Doyle LA. An update on the application of newly described immunohistochemical markers in soft tissue pathology. Arch Pathol Lab Med 2015; 139:106-21. [PMID: 25549147 DOI: 10.5858/arpa.2014-0488-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT During the last 5 to 10 years, significant progress has been made in the molecular characterization of soft tissue tumors, predominantly with the identification of recurrent translocations or amplification of certain genes in different tumor types. Alongside this, translational efforts have identified many novel and diagnostically useful immunohistochemical markers for many of these tumor types. OBJECTIVE This article reviews a select group of recently described immunohistochemical markers of particular use in the evaluation of mesenchymal neoplasms; the underlying biology of the protein product, practical utility, and limitations of each marker are discussed in detail. DATA SOURCES Literature review, authors' research data, and personal practice experience serve as sources. CONCLUSIONS There are many diagnostically useful immunohistochemical markers to help confirm the diagnosis of many different soft tissue tumor types, some of which have reduced the need for additional, and more costly, studies, such as fluorescence in situ hybridization. However, no one marker is 100% specific for a given tumor, and knowledge of potential pitfalls and overlap in patterns of staining among other tumor types is crucial to ensure the appropriate application of these markers in clinical practice.
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Affiliation(s)
- George Lin
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Dr Lin); and the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Doyle)
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The utility of MYC and FLT4 in the diagnosis and treatment of postradiation atypical vascular lesion and angiosarcoma of the breast. Hum Pathol 2015; 46:868-75. [PMID: 25864386 DOI: 10.1016/j.humpath.2015.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/17/2015] [Accepted: 02/26/2015] [Indexed: 01/06/2023]
Abstract
Atypical vascular lesions (AVLs) and angiosarcomas (ASs) are well-recognized complications of radiotherapy for breast cancer. Early diagnosis may be challenging, particularly on small biopsies, and the treatment options are limited. Recently, MYC and sometimes FLT4 gene amplification has been reported in AS, but not in AVL, and FLT4 may be a target for therapy. We evaluated the MYC/FLT4 status in AVL and AS by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), determined its utility in differentiating these 2 entities in small biopsies, and ascertained the value of FLT4 as a potential marker for targeted therapy. Thirty-five vascular neoplasms were reviewed from 21 breast cancer patients who received radiotherapy (AVL, n = 18; AS, n = 17). MYC expression by IHC and/or gene amplification by FISH were identified in 13 (77%) of 17 ASs, but none of the AVL cases. Four patients had biopsies with follow-up excisions, of which 1 showed the morphology of an AVL on biopsy and AS on excision, both positive for MYC. Of 17 ASs, 3 (18%) showed strong and diffuse 3+ cytoplasmic FLT4 staining by IHC and FLT4 gene amplification by FISH. All 3 cases were coamplified for the MYC gene. Focal and weak FLT4 cytoplasmic immunoreactivity was present in 2 (12%) of 17 AVL cases and 12 (70%) of 17 AS cases. Although MYC is a valuable ancillary tool in distinguishing AS from AVL, FLT4 IHC may be used to screen for patients with FLT4 gene amplification who might benefit from targeted therapy, as only diffuse strong FLT4 immunoreactivity correlated with FLT4 gene amplification.
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21
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Berho M, Bejarano PA. Judging pathological assessment in cancer specimens. J Surg Oncol 2014; 110:543-50. [PMID: 25132357 DOI: 10.1002/jso.23738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/08/2014] [Indexed: 11/08/2022]
Abstract
The pathologist plays a critical role in the multidisciplinary team in charge of treating cancer patients, as many of the therapeutic decisions rely on the information conveyed through the pathology reports. The task of the pathologist includes not only an accurate assessment of pathological T and N categories, but also the evaluation of other indicators of prognosis including quality of surgery, margins of resection, as well as additional histopathological and molecular markers that influence prognosis and could predict response to therapy.
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Affiliation(s)
- Mariana Berho
- Department of Pathology and Laboratory Medicine, Cleveland Clinic Florida
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22
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Kaffenberger BH, Zuo RC, Gru A, Plotner AN, Sweeney SA, Devine SM, Hymes SR, Cowen EW. Graft-versus-host disease-associated angiomatosis: a clinicopathologically distinct entity. J Am Acad Dermatol 2014; 71:745-53. [PMID: 24993601 DOI: 10.1016/j.jaad.2014.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/26/2014] [Accepted: 05/12/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic graft-versus-host disease (GVHD) may present with various cutaneous manifestations. Isolated case reports describe eruptive angiomas in this setting. OBJECTIVE We sought to provide a clinical and pathologic description of vascular proliferations in patients with GVHD. METHODS Cases of documented GVHD associated with vascular proliferations were collected from the National Institutes of Health, Ohio State University, and MD Anderson Cancer Center. RESULTS Eleven patients with a diagnosis of GVHD who developed vascular proliferations were identified. All patients manifested sclerotic type chronic GVHD of the skin. Vascular lesions were first documented a median of 44 months after transplantation and occurred primarily on the lower extremities or trunk. Histopathology revealed anastomosing networks of thin-walled vascular proliferations in a vague lobular growth pattern, with overlying epidermal acanthosis, peripheral collarette, ulceration, and disorganized fibroblast-rich and fibrotic stroma. Improvement was noted in 1 patient treated with propranolol and sirolimus and 1 patient with electrocautery. LIMITATIONS Given the retrospective nature of the study, the overall incidence of vascular lesions in patients with GVHD is unknown. Histopathology was present for review on only 3 of 11 patients. CONCLUSION The phenomenon of vascular lesions appears to be relatively specific for sclerotic type chronic GVHD when compared with other fibrosing diseases. We propose the term "graft-versus-host disease-associated angiomatosis" to describe this entity.
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Affiliation(s)
| | - Rena C Zuo
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alejandro Gru
- Division of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Dermatopathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alisha N Plotner
- Division of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sarah A Sweeney
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven M Devine
- Division of Blood and Marrow Transplantation, Ohio State University James Cancer Hospital, Columbus, Ohio
| | - Sharon R Hymes
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edward W Cowen
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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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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Mudaliar KM, Borrowdale R, Mehrotra S. Post-radiation atypical vascular lesion/angiosarcoma arising in the larynx. Head Neck Pathol 2013; 8:359-63. [PMID: 24310944 PMCID: PMC4126914 DOI: 10.1007/s12105-013-0511-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/26/2013] [Indexed: 11/26/2022]
Abstract
Atypical vascular lesions (AVL) and angiosarcomas (AS) are lesions known to arise after radiation therapy. These lesions can show overlap in both their gross and histologic pictures, and distinction between the two can be extremely challenging at times. They are known most commonly to arise in the breast region after radiation therapy. We present the first unique case of post-radiation AVL/AS arising in the larynx of a 51 year old woman, occurring 8 years after she received radiation for tonsillar squamous cell carcinoma.
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Affiliation(s)
- K M Mudaliar
- Department of Pathology, Loyola University Medical Center, Loyola University Chicago, Building #110, Rm #2242, 2160 S. First Avenue, Maywood, IL, 60153, USA,
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25
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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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26
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Abstract
This article provides an update on vascular neoplasms. New immunohistochemical markers for the diagnosis of vascular neoplasms tumor 1, infantile hemangiomas, myopericytomas, perivascular epithelial cell tumors, acquired elastotic hemangiomas, vascular proliferations in radiated skin, and new histopathologic variants of AIDS-related Kaposi sarcoma are explored.
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Affiliation(s)
- Omar P Sangüeza
- Department of Pathology, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA.
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27
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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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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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Mentzel T, Schildhaus HU, Palmedo G, Büttner R, Kutzner H. Postradiation cutaneous angiosarcoma after treatment of breast carcinoma is characterized by MYC amplification in contrast to atypical vascular lesions after radiotherapy and control cases: clinicopathological, immunohistochemical and molecular analysis of 66 cases. Mod Pathol 2012; 25:75-85. [PMID: 21909081 DOI: 10.1038/modpathol.2011.134] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Postradiation cutaneous vascular lesions after treatment of breast carcinoma comprise a heterogeneous group of benign, atypical, and malignant lesions and are best regarded as points along a morphological spectrum. We analyzed a series of cutaneous angiosarcomas after treatment of breast cancer in comparison with control cases and cases of atypical vascular lesions with special emphasis on the expression and amplification of MYC. The 66 cases were divided into control cases (5), cases in which a slight vascular proliferation was seen after radiotherapy of breast cancer (12), cases of atypical vascular lesions after radiotherapy (16), cases of postradiation cutaneous angiosarcomas (25), and cases of angiosarcomas of skin and soft tissues unrelated to radiotherapy (8). None of the control cases (2 M, 3 F, 20-76 years), of cases showing slight vascular proliferation, dermal fibrosis and inflammation after radiotherapy of breast cancer (12 F, 48-79 years), of cases of atypical vascular lesions after radiotherapy (16 F, 29-81 years), and of cases of angiosarcomas of skin and soft tissues unrelated to radiotherapy (3 M, 5 F, 25-92 years) showed an amplification of MYC by FISH analysis. In striking contrast, in all cases of postradiation cutaneous angiosarcomas (25 F, 46-95 years), MYC amplification was found by FISH analysis in a variable number of counted nuclei. Immunohistochemically, strong positive nuclear staining for MYC and prox-1 was seen in cases of postradiation cutaneous angiosarcoma, whereas control cases and cases of atypical vascular proliferation after radiotherapy were negative for MYC, and stained only focally positive for prox-1 in a number of cases. In conclusion, the presence of MYC amplification represents an important additional diagnostic tool in the distinction of postradiation cutaneous angiosarcomas from atypical vascular lesions after radiotherapy. Immunohistochemical stainings for MYC are useful for mapping of these lesions and for careful tumor margin control.
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Affiliation(s)
- T Mentzel
- Dermatopathologie Bodensee, Friedrichshafen, Germany.
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Santi R, Cetica V, Franchi A, Pepi M, Cesinaro AM, Miracco C, Paglierani M, De Giorgi V, Delfino C, Difonzo EM, Pimpinelli N, Bianchi S, Sardi I, Santucci M, Massi D. Tumour suppressor gene TP53 mutations in atypical vascular lesions of breast skin following radiotherapy. Histopathology 2011; 58:455-66. [PMID: 21323968 DOI: 10.1111/j.1365-2559.2011.03770.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS Atypical vascular lesions (AVL) occurring at the site of radiotherapy represent an uncommon but well-documented complication in the setting of breast-conserving therapy for breast carcinoma. Although the biological behaviour of AVL has been regarded as benign, it has been suggested that AVL may represent a precursor of angiosarcoma. A better understanding of the biology of AVL is essential in order to assess appropriate patient management. The aim of the present study was to investigate alterations of tumour suppressor gene TP53 in a series of radiation-induced AVL and angiosarcomas (AS). METHODS AND RESULTS Direct sequencing analysis of the TP53 gene showed the presence of at least one variation in 10 of 12 (83.3%) AVL and in seven of eight (87.5%) AS. The most common alteration in both categories was the P72R polymorphism in exon 4. One angiosarcoma sample carried a pathogenetically relevant disruptive mutation c.592delG, a frameshift deletion in exon 6, causing a premature stop codon. CONCLUSIONS The presence of TP53 alterations suggests that its mutational inactivation may be implicated in the pathogenesis of radiation-associated vascular proliferations. The common mutational pathway suggested by our data supports the hypothesis that AVL and AS are biologically related entities, most probably representing the extremes of a morphological continuum.
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Affiliation(s)
- Raffaella Santi
- Division of Pathological Anatomy, Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy.
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Mandrell J, Mehta S, McClure S. Atypical vascular lesion of the breast. J Am Acad Dermatol 2010; 63:337-40. [DOI: 10.1016/j.jaad.2009.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/06/2009] [Accepted: 08/06/2009] [Indexed: 10/19/2022]
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Ivan D, Prieto VG. Histopathology of inflammatory skin disease in oncological patients. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mpdhp.2009.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Acquired cutaneous lymphangiectasia with mesothelial cells reflux in a patient with cirrhotic ascites. Am J Dermatopathol 2008; 30:140-4. [PMID: 18360117 DOI: 10.1097/dad.0b013e31816373ad] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A previously undescribed case of acquired cutaneous lymphangiectasias on the abdomen in a patient with cirrhotic ascites where peritoneal mesothelial cells refluxed in the skin is discussed. A 56-year-old man previously submitted to liver transplantation presented with vesiculobullous lesions on the developed as his cirrhotic ascites progressed. Histology showed dilated lymphatic channels in the upper dermis lined by a single, discontinuous layer of flattened, monomorphous endothelial cells with endoluminal papillary projections. In the deep reticular dermis, we observed irregular thin- often jagged-walled vascular channels lined by a single layer of bland endothelial cells, dissecting the collagen bundles. Vessels in the lumen were medium to large bizarre-shaped polygonal cells with abundant eosinophilic cytoplasm and hyperchromatic and irregular nuclei, arranged in small clusters or as solitary units, focally in close contact with the endothelial lining or free floating within vessel cavities. Immunohistochemistry indicated atypical intraluminal cells to be positive for calretinin, a specific marker for mesothelial cells. Pathophysiologic mechanisms and problems of differential diagnosis of this unique clinicopathologic entity are discussed.
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Abstract
This review evaluates changes in vascular nomenclature particularly in the category of vascular tumours of intermediate malignancy that includes the various haemangioendotheliomas, Kaposi's sarcoma and giant cell angioblastoma. Recently described entities in this category, including the latter tumour and composite haemangioendothelioma, are described. Several newly characterized vascular tumours not included in recent classifications of vascular tumours are also summarized. These include acquired elastotic haemangioma, symplastic haemangioma, cutaneous epithelioid angiomatous nodule and cutaneovisceral angiomatosis with thrombocytopenia. The newly introduced clinical classification of congenital haemangiomas into non-involuting and rapidly involuting variants and radiation-induced atypical vascular lesions are also reviewed.
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Affiliation(s)
- S G N Goh
- St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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40
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Martín-González T, Sanz-Trelles A, del Boz J, Samaniego E. Pápulas y placas linfangiomatosas benignas postradioterapia. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Martín-González T, Sanz-Trelles A, del Boz J, Samaniego E. Benign Lymphangiomatous Papules and Plaques After Radiotherapy. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mattoch IW, Robbins JB, Kempson RL, Kohler S. Post-radiotherapy vascular proliferations in mammary skin: A clinicopathologic study of 11 cases. J Am Acad Dermatol 2007; 57:126-33. [PMID: 17572278 DOI: 10.1016/j.jaad.2006.10.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 08/31/2006] [Accepted: 10/01/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Post-radiotherapy atypical vascular lesions (AVL) in mammary skin show significant clinical and histopathologic overlap with well-differentiated angiosarcoma (AS) and pose a considerable diagnostic and managerial challenge when encountered. OBJECTIVE We review Stanford's experience with diagnosing AVL and formulate a clinicopathologic approach to these lesions. METHODS We performed a clinicopathologic study on 11 cases that were initially diagnosed as AVL and examined whether there are specific clinical or histopathologic features that delineate AVLs from well-differentiated AS. RESULTS Clinically, all patients were women with a mean age of 68.1 years, had a history of infiltrating breast carcinoma, and were treated by excision with postoperative radiation therapy. All lesions were located in mammary skin within the prior radiation field. The clinical presentation included erythema, telangiectasias, papules, plaques, and nodules. All patients were diagnosed with AVL on initial biopsy. Six patients showed no recurrence or progression of disease following incomplete excision with no further therapy (3/6) or re-excision with negative margins (3/6). The remaining 5 patients were shown to have AS in the re-excision specimen. The patients diagnosed with AS were older and had a shorter interval from radiation as compared to those who did not experience an adverse outcome. Histologically, all initial biopsy specimens were transected and were characterized by complex, anastomosing vascular proliferations with dilated spaces. Each case was morphologically evaluated according to the AVL criteria of Fineberg and Rosen. Three cases met all of the criteria for AVL, and these patients showed no progression of disease. The remaining cases met most but not all diagnostic criteria for AVL and showed some features of AS, but fell short of a definitive diagnosis of AS, including the 5 cases that were subsequently diagnosed as angiosarcoma. LIMITATIONS This retrospective study utilized a small number of cases from a single consultation service; therefore, some inherent selection bias may exist. CONCLUSION We could not identify unequivocal clinical or histologic criteria that allows for a sharp separation between AVL and AS. Dermatologists and pathologists need to be aware of the overlap between AVL and well-differentiated AS and all patients who receive a diagnosis of AVL should undergo complete excision with close clinical follow-up and biopsy of any new lesions.
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Gengler C, Coindre JM, Leroux A, Trassard M, Ranchère-Vince D, Valo I, Michels JJ, Guillou L. Vascular proliferations of the skin after radiation therapy for breast cancer: Clinicopathologic analysis of a series in favor of a benign process. Cancer 2007; 109:1584-98. [PMID: 17357996 DOI: 10.1002/cncr.22586] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cutaneous vascular proliferations that occur in the field of prior radiotherapy include angiosarcoma and small, cutaneous lesions with a pseudosarcomatous pattern that previously were reported as atypical vascular lesions or benign lymphangiomatous papules. METHODS The objective of this study was to investigate the clinicopathologic features and outcomes of 56 radiation-induced vascular proliferations that occurred in 36 patients who received previous treatment for breast carcinoma. Data from all patients were retrieved from the files of the French Sarcoma Group. Immunostaining with D2.40 antibody was performed in 24 lesions. RESULTS All patients (median age, 52 years) had received external radiotherapy. Small papules developed within the field of prior radiotherapy (median latency interval, 66 months). Microscopically, the lesions were relatively well circumscribed, and they were located mostly in the superficial/middermis. They were composed of dilated or irregular-jagged vascular channels that were lined by a single layer of bland endothelial cells, and they demonstrated either a predominately lymphangioendothelioma-like or lymphangioma/lymphangioma circumscriptum-like growth pattern. Micropapillary tufts were common findings. Ten lesions showed additional cytologic and/or architectural atypia. Twenty of 24 lesions showed D2.40 positivity. Follow-up information was available for 31 patients (median follow-up, 48 months): Five women developed new cutaneous lesions, and 1 woman had spontaneous regression of her lesions. None of the patients developed cutaneous angiosarcoma. Five patients were lost to follow-up. CONCLUSIONS Although vascular proliferations in irradiated skin may mimic angiosarcoma morphologically, the large majority of these lesions showed a benign clinical outcome. Despite relatively limited follow-up, the current results indicate the benign nature of these vascular proliferations.
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Affiliation(s)
- Carole Gengler
- Department of Pathology, University Institute of Pathology, Lausanne, Switzerland.
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Bodet D, Rodríguez-Cano L, Bartralot R, Mollet J, Medina A, Heras C, Bassas P, Huguet P, García-Patos V. Benign lymphangiomatous papules of the skin associated with ovarian fibroma. J Am Acad Dermatol 2007; 56:S41-4. [PMID: 17097370 DOI: 10.1016/j.jaad.2006.05.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 04/11/2006] [Accepted: 05/24/2006] [Indexed: 10/24/2022]
Abstract
Benign lymphangiomatous papules of the skin are considered reactive lymphatic proliferations either caused by disruption of the lymphatic flow or tissue damage produced by operation or radiation therapy. We report a 72-year-old woman with umbilical papules and vesicle-like lesions that led to the diagnosis of a large ovarian fibroma. Histologic study revealed dilated lymphatic spaces manifesting an anastomosing and branched pattern in the papillary and reticular dermis dissecting collagen bundles. The vessels were lined by plump endothelial cells with foci of intravascular papillary endothelial cell hyperplasia. After the ovarian fibroma was removed by laparotomy, umbilical lesions almost disappeared, leaving small flesh-colored papules. A periumbilical dermatosis may herald certain intra-abdominal diseases including those of neoplastic derivation. A heightened awareness of this association may lead to an early diagnosis with a potential for improved patient outcome. Benign lymphangiomatous papules have not been previously described in association with an untreated tumor, without previous operation or radiotherapy. This case advocates for disruption of the lymphatic drainage as the probable pathogenetic mechanism.
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Affiliation(s)
- Domingo Bodet
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
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Abstract
The occurrence of cutaneous vascular lesions is a rare but well-documented complication of radiation treatment and may be associated with significant morbidity as well as mortality. The overall incidence is low but appears to be rising due to a change in the prevailing treatment of breast carcinoma with increased use of radiation in the setting of breast-conserving therapy for stage 1 and 2 disease. The spectrum of postradiation vascular lesions is wide and ranges from atypical vascular lesions with reportedly benign clinical behaviour to frank cutaneous angiosarcoma. There is, however, significant clinical as well as histological overlap. It is frequently difficult to classify these postradiation vascular lesions accurately and they create an emerging diagnostic and therapeutic challenge to both pathologists and clinicians. Experience with these vascular lesions is very limited, and this article aims to provide an overview of our current understanding and concept of radiation-associated vascular lesions with focus on their clinical and histological presentation as well as behaviour and treatment.
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Affiliation(s)
- T Brenn
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Peramiquel L, Barnadas MA, Sancho J, Curell R, Alonso MC, Fuentes MJ, Pernas S, Gómez A, Alomar A. [Angiosarcoma in an irradiated breast: a case description]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 96:602-6. [PMID: 16476306 DOI: 10.1016/s0001-7310(05)73144-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Post-radiotherapy cutaneous angiosarcomas have been described in different locations, including the breast. We present a case of cutaneous angiosarcoma of the breast, diagnosed 6 years after a carcinoma of the breast had been treated with radiation. The patient was a 44-year-old female with a history of ductal carcinoma (CA) of the right breast treated with tumorectomy, axillary lymphadenectomy, chemotherapy (FEC) and radiotherapy, who 6 years later presented with a violaceous, indurated plaque with a satellite nodule on the same breast. The histology of the skin biopsies showed angiomatous proliferation throughout the entire dermis, with no cellular atypia. Considering the patient's symptoms, history and the changes observed via mammography, it was decided to completely excise the lesion followed by a simple mastectomy, with the diagnosis of angiosarcoma being confirmed. The patient was later treated with paclitaxel, and the disease was apparently controlled. Despite this fact, two years and one month later, the angiosarcoma recurred on the internal area of the mastectomy scar. The patient was treated with paclitaxel, and surgical excision of the lesion area was once again performed. This complication usually appears 5-10 years after treatment with radiotherapy, so angiosarcoma should be ruled out if any angiomatous lesions later appear on skin that had been irradiated.
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Affiliation(s)
- Laura Peramiquel
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Clarke LE, Julian KG, Clarke JT, Ioffreda MD. Reactive Angioendotheliomatosis in Association with a Well-Differentiated Angiosarcoma. Am J Dermatopathol 2005; 27:422-7. [PMID: 16148413 DOI: 10.1097/01.dad.0000159214.70183.0d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 55-year-old white female with a complex medical history including mixed connective tissue disease and peripheral vascular disease developed a group of red-purple papules on her proximal medial thigh that was followed, five months later, by the development of a large violaceous patch. She reported a history of radiation to this site (for melanoma) during her childhood. She was admitted to the hospital with a presumptive diagnosis of cellulitis, but failed to respond to antibiotics. A biopsy was performed and demonstrated a well-differentiated angiosarcoma arising in conjunction with reactive angioendotheliomatosis. Excision of the lesion was performed, and fifteen months of follow-up have shown no recurrence or metastasis.
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Affiliation(s)
- Loren E Clarke
- Department of Pathology, The Penn State College of Medicine/Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
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Di Tommaso L, Rosai J. The Capillary Lobule: A Deceptively Benign Feature of Post-Radiation Angiosarcoma of the Skin. Am J Dermatopathol 2005; 27:301-5. [PMID: 16121049 DOI: 10.1097/01.dad.0000163572.18673.8d] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Three cases are presented of a proliferative vascular lesion of the skin developing in the chest wall of women who had received radiation therapy for breast carcinoma. All 3 lesions were characterized microscopically by the presence of the so-called capillary lobule, a formation generally regarded as a sign of benignancy but that in this setting proved to be a forerunner or indicator of angiosarcoma (malignant hemangioendothelioma). Therefore, the detection of capillary lobules in irradiated skin ought to be regarded with great suspicion, and other morphologic signs suggestive of angiosarcoma should be sought in the specimen.
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Affiliation(s)
- Luca Di Tommaso
- Department of Pathology, University of Milan Medical School, Rozzano, Italy.
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