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Dong X, Song D, Ma J, Sun J, Wang X. Massive malignant phyllodes tumor accompanied by anemia and ulceration in the breast: A case report. Clin Case Rep 2024; 12:e9096. [PMID: 38887305 PMCID: PMC11180603 DOI: 10.1002/ccr3.9096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/24/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
Large malignant breast phyllodes tumors are uncommon in clinical settings. Here, we report such a case to provide a reference for clinical work. A 48-year-old woman identified a lump in her right breast, which eventually grew up to 25 cm × 10 cm and began to rapidly bleed and ulcerate within 3 months. The patient had visible signs of anemia and significant emaciation as a result of the tumor's wasting effect and the protracted course of the disease. The patient underwent a modified radical mastectomy on the right breast. The pathology results obtained after surgery revealed a malignant phyllodes tumor. No adjuvant therapy, such as chemotherapy or radiation, was administered. The patient had no symptoms of tumor recurrence and complications from the surgery after a follow-up of 9 months.
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Affiliation(s)
- Xiaoxiao Dong
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
| | - Dong Song
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
| | - Jinxiu Ma
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
| | - Jian Sun
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
| | - Xiaozhen Wang
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
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2
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Conti M, Morciano F, Rossati C, Gori E, Belli P, Fornasa F, Romanucci G, Rella R. Angiosarcoma of the Breast: Overview of Current Data and Multimodal Imaging Findings. J Imaging 2023; 9:jimaging9050094. [PMID: 37233313 DOI: 10.3390/jimaging9050094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Angiosarcoma of the breast is a rare breast cancer, which can arise de novo (primary breast angiosarcoma, PBA) or as a secondary malignancy (secondary breast angiosarcoma, SBA) as a result of a biological insult. In the latter case, it is usually diagnosed in patients with a previous history of radiation therapy following a conserving treatment for breast cancer. Over the years, the advances in early diagnosis and treatment of breast cancer, with increasing use of breast-conserving surgery and radiation therapy (instead of radical mastectomy), brought about an increased incidence of the secondary type. PBA and SBA have different clinical presentations and often represent a diagnostic challenge due to the nonspecific imaging findings. The purpose of this paper is to review and describe the radiological features of breast angiosarcoma, both in conventional and advanced imaging to guide radiologists in the diagnosis and management of this rare tumor.
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Affiliation(s)
- Marco Conti
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Morciano
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Claudia Rossati
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142 Verona, Italy
| | - Elisabetta Gori
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Paolo Belli
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Francesca Fornasa
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142 Verona, Italy
| | - Giovanna Romanucci
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37142 Verona, Italy
| | - Rossella Rella
- UOC Diagnostica per Immagini, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy
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3
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Yang J, Dong A, Nian S, Peng Y, Zuo C. FDG PET/CT in a Case of Primary Angiosarcoma of the Kidney. Clin Nucl Med 2023; 48:370-372. [PMID: 36716457 DOI: 10.1097/rlu.0000000000004586] [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: 01/31/2023]
Abstract
ABSTRACT Primary angiosarcoma of the kidney is a rare aggressive malignancy. We describe MRI and FDG PET/CT findings in a case of primary renal angiosarcoma with hepatic, pulmonary, and bony metastases. The large primary tumor showed extensive necrosis and increased FDG uptake in the nonnecrotic components. Multiple metastatic lesions in the liver, lung, and bones were detected by FDG PET/CT. Most of the hepatic metastases seen on MRI were missed on FDG PET/CT due to low FDG avidity.
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Affiliation(s)
- Jian Yang
- From the Departments of Nuclear Medicine
| | | | | | - Yonghan Peng
- Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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4
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Wang P, Li F. Primary Hepatic Angiosarcoma Having FDG Uptake at the Similar Level of the Normal Liver Parenchyma. Clin Nucl Med 2022; 47:e649-e650. [PMID: 35777981 DOI: 10.1097/rlu.0000000000004270] [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
ABSTRACT Primary hepatic angiosarcoma is a rare but aggressive malignancy. A 60-year-old woman presented with multiple liver lesions with progressive enhancement detected with multiphasic CT. FDG PET did not show any FDG-avid lesions, and the uptake of hepatic lesions was similar to that of the normal liver parenchyma. Subsequently, pathological examination revealed hepatic angiosarcoma.
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5
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Gonzalez TV, Sae-Kho TM, Robinson SI, Hieken TJ, Folpe AL, Broski SM, Degnim AC, Glazebrook KN. Radiation-associated angiosarcoma of the breast with initial presentation as non-mass enhancement on MRI. Radiol Case Rep 2022; 17:3624-3629. [PMID: 35923341 PMCID: PMC9340125 DOI: 10.1016/j.radcr.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Radiation-associated angiosarcoma of the breast (RAASB) is a rare and aggressive malignancy occurring after radiation therapy as part of breast cancer treatment. RAASB usually presents several years after prior radiation and typically involves the skin with or without involvement of the parenchyma. Most RAASB are detected as cutaneous changes on physical exam. Herein, we present a unique case of a clinically occult RAASB diagnosed as non-mass enhancement on annual surveillance breast MRI.
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6
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Dejanovic D, Specht L, Czyzewska D, Kiil Berthelsen A, Loft A. Response Evaluation Following Radiation Therapy With 18F-FDG PET/CT: Common Variants of Radiation-Induced Changes and Potential Pitfalls. Semin Nucl Med 2022; 52:681-706. [PMID: 35835618 DOI: 10.1053/j.semnuclmed.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Radiation therapy (RT) is one of the cornerstones in cancer treatment and approximately half of all patients will receive some form of RT during the course of their cancer management. Response evaluation after RT and follow-up imaging with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can be complicated by RT-induced acute, chronic or consequential effects. There is a general consensus that 18F-FDG PET/CT for response evaluation should be delayed for 12 weeks after completing RT to minimize the risk of false-positive findings. Radiation-induced late side effects in normal tissue can take years to develop and eventually cause symptoms that on imaging can potentially mimic recurrent disease. Imaging findings in radiation induced injuries depend on the normal tissue included in the irradiated volume and the radiation therapy regime including the total dose delivered, dose per fraction and treatment schedule. The intent for radiation therapy should be taken in consideration when evaluating the response on imaging, that is palliative vs curative or neoadjuvant vs adjuvant RT. Imaging findings can further be distorted by altered anatomy and sequelae following surgery within the radiation field. An awareness of common PET/CT-induced changes/injuries is essential when interpreting 18F-FDG PET/CT as well as obtaining a complete medical history, as patients are occasionally scanned for an unrelated cause to previously RT treated malignancy. In addition, secondary malignancies due to carcinogenic effects of radiation exposure in long-term cancer survivors should not be overlooked. 18F-FDG PET/CT can be very useful in response evaluation and follow-up in patients treated with RT, however, variants and pitfalls are common and it is important to remember that radiation-induced injury is often a diagnosis of exclusion.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Choudhury S, Shah S, Shet T, Agrawal A, Purandare N, Puranik A, Rangarajan V. Comparison of 68Ga-FAPI PET and 18F-FDG PET Findings in a Patient With Bilateral Breast Cancer of 2 Different Histopathologies. Clin Nucl Med 2022; 47:e696-e697. [PMID: 35695729 DOI: 10.1097/rlu.0000000000004308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We present the findings of 18F-FDG PET and 68Ga-fibroblast activation protein PET scans done in a case of bilateral breast carcinoma with 2 different histopathology, left breast tubulolobular carcinoma and right breast invasive breast carcinoma of no special type.
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Affiliation(s)
- Sayak Choudhury
- From the Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre Advanced Centre for Treatment, Research, and Education in Cancer
| | - Sneha Shah
- Departments of Nuclear Medicine and Molecular Imaging
| | - Tanuja Shet
- Pathology, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai, India
| | - Archi Agrawal
- Departments of Nuclear Medicine and Molecular Imaging
| | | | - Ameya Puranik
- Departments of Nuclear Medicine and Molecular Imaging
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8
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Positive FAPI PET/CT in a Bilateral Mammary Angiosarcoma Patient With Less Impressive FDG PET/CT Images. Clin Nucl Med 2022; 47:648-650. [PMID: 35143460 DOI: 10.1097/rlu.0000000000004089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Bilateral primary angiosarcoma of the breast is an extremely rare disease. We describe a case with bilateral angiosarcoma of the breast well visualized on 68Ga-FAPI PET/CT in a 30-year-old woman with a history of right breast-conserving surgery. However, the lesions are less impressive on 18F-FDG PET/CT. No additional findings including lymph node and distant metastases were noted. The patient underwent bilateral mastectomy, and histopathology revealed well-differentiated angiosarcoma that involved bilateral breast parenchyma and the left nipple. Our case illustrates that 68Ga-FAPI PET/CT can be more sensitive in detecting well-differentiated angiosarcoma of the breast.
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Zhang J, Yu Z, Dong A, Zhu Y. FDG-Avid Sclerosing Adenosis of the Breast Mimicking Malignancy. Clin Nucl Med 2022; 47:192-194. [PMID: 34319965 DOI: 10.1097/rlu.0000000000003849] [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: 11/26/2022]
Abstract
ABSTRACT Sclerosing adenosis is a common benign proliferative disorder of the breast. We describe FDG PET/CT findings in a case of sclerosing adenosis showing focal intense FDG uptake mimicking malignancy. This case indicates that sclerosing adenosis should be included in the differential diagnosis of focal breast FDG accumulation along with malignant and nonmalignant conditions.
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Affiliation(s)
- Jian Zhang
- From the Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University
| | - Zhongfei Yu
- From the Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yuzhao Zhu
- From the Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University
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10
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Kim J, Jung HK, Kim W. Angiosarcoma of the Breast and Spleen: A Case Report with Imaging and Pathologic Findings. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1310-1314. [PMID: 36238393 PMCID: PMC9432375 DOI: 10.3348/jksr.2020.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 12/04/2022]
Abstract
Angiosarcoma of the breast is a rare malignant sarcoma of endovascular origin that presents with various radiological findings. We encountered a case of angiosarcoma of the breast presenting as an irregular indistinct hyperechoic mass on ultrasonography, with a large single angiosarcoma of the spleen in a previously healthy 36-year-old female. Herein, we report the imaging and pathologic findings and review the literature.
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11
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Tripathy S, Rastogi S, Prakash S, Arun Raj ST, Sagar S, Shamim SA. Solitary Subcutaneous Tissue Metastasis as Recurrence in a Case of Primary Angiosarcoma of Breast: Findings on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography. Indian J Nucl Med 2021; 36:210-211. [PMID: 34385799 PMCID: PMC8320824 DOI: 10.4103/ijnm.ijnm_84_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 11/04/2022] Open
Abstract
Primary angiosarcomas of the breast are rare tumors, with a fatal outcome. We present a rare case of an operated primary angiosarcoma of the right breast in a 20-year-old female who showed disease recurrence in the right posterior arm subcutaneous tissue on 18F-fluorodeoxyglucose positron emission tomography-computed tomography after 1 year of surgery without any other visceral metastasis.
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Affiliation(s)
- Sarthak Tripathy
- Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sneha Prakash
- Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sambit Sagar
- Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
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12
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18F-FDG PET/CT Findings in a Patient With Primary Mucinous Cystadenocarcinoma of the Breast. Clin Nucl Med 2019; 45:159-160. [DOI: 10.1097/rlu.0000000000002902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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