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Nwachukwu CT, Henrichsen T. Radiation-associated breast angiosarcoma after strut-adjusted volume implant brachytherapy. Radiol Case Rep 2024; 19:3888-3894. [PMID: 39040825 PMCID: PMC11261268 DOI: 10.1016/j.radcr.2024.05.081] [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: 05/04/2024] [Accepted: 05/26/2024] [Indexed: 07/24/2024] Open
Abstract
Angiosarcoma is a rare malignancy that may classically occur in the post-treatment breast. Radiation and post-treatment edema have been identified in the literature as causative risk factors. Modern treatment innovations have provided patients with more targeted radiation therapy and more conservative surgical options, which may individually limit exposure to these risk factors. Advanced treatment options are also able to provide superior cosmetic outcomes that can positively impact patient quality of life. Despite the ability for modern treatment options to mitigate post-treatment morbidities, there is still long-term risk to the patient of developing treatment-related pathologies, such as breast angiosarcoma. Here we present a patient who underwent lumpectomy and received targeted brachytherapy through a strut-adjusted volume implant device to her lumpectomy site. Her initial post-treatment course was mildly complicated by localized breast lymphedema, which resolved and left the patient with favorable cosmetic results. She developed treatment-associated breast angiosarcoma after initial breast conservation therapy was completed approximately 6 and a half years prior. Her presenting physical exam and imaging findings are portrayed with a comprehensive discussion of the commonly described presenting clinical features and imaging findings of breast angiosarcoma. Factors related to radiation treatment planning and use of the strut-adjusted volume implant device are also discussed. Comparisons between primary and secondary breast angiosarcoma are made, and a review of treatment options is given.
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Affiliation(s)
- Chidi T. Nwachukwu
- Mayo Clinic Department of Radiology, 200 First St. SW, Rochester, MN 55905, USA
| | - Tara Henrichsen
- Mayo Clinic Department of Radiology, 200 First St. SW, Rochester, MN 55905, USA
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Hashimoto K, Nishimura S, Ito T, Kakinoki R, Goto K. Total management of hemangiopericytoma/solitary fibrous tumor of the buttock: A case report. Medicine (Baltimore) 2024; 103:e39044. [PMID: 39029055 DOI: 10.1097/md.0000000000039044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Solitary fibrous tumors can manifest at various anatomical sites, predominantly occurring at extrapleural sites with a peak incidence between 40 and 70 years. SFT necessitates long-term follow-up owing to its tumor characteristics. However, comprehensive reports covering the period from initial diagnosis to the patient's demise are lacking. Herein, we present a case of a malignant SFT of the buttocks that was treated at our hospital from the time of initial diagnosis to the end of life, with a literature review. METHODS A 54-year-old woman had a T1 low-to-isobaric and T2 isobaric-to-hyperintense mass in the psoas muscle on magnetic resonance imaging, diagnosed as an SFT. Wide excision was performed, followed by postoperative radiotherapy and chemotherapy. Multiple lung metastases were treated, while bone metastases appeared in the left femur. Multiple spinal metastases developed, causing respiratory distress due to pleural effusion. Best support care was initiated; however, a thrombus appeared in the inferior vena cava. Despite anticoagulant therapy, the patient died 11 years and 6 months after the initial surgery. Herein, marginal resection resulted in a relatively short operative time and average blood loss. The radiotherapy dose was 66 Gy; no complications occurred, and local recurrence was prevented. Tumor arthroplasty was performed to stabilize the affected limbs, and the patient required careful follow-up. RESULTS Despite the poor prognosis, the patient survived >11 years after surgery and had a favorable outcome. CONCLUSION Long-term monitoring for potential complications remains necessary.
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Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
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Yang Y, Dong Y, Wu J, Li J, Wang Z, Ma Y. Primary Angiosarcoma of the Breast Diagnosed on Core Needle Biopsy: A Diagnostic Challenge. Int J Surg Pathol 2024; 32:368-373. [PMID: 37231624 DOI: 10.1177/10668969231176011] [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] [Indexed: 05/27/2023]
Abstract
Primary angiosarcoma of the breast is very rare and difficult to pathologically diagnose especially on core needle biopsy. Only 11 cases of breast primary angiosarcoma diagnosed on core needle biopsy have been reported in English literature of last 5 years. We reported a case of primary angiosarcoma of the breast diagnosed on core needle biopsy and summarized the useful morphological clues in literature which prompted the diagnosis of angiosarcoma. A 50-year-old woman presented with a palpable mass in her left breast for a year. She never received breast surgery or radiotherapy before. Microscopically, the core needle biopsy specimen displayed interanastomosing vascular spaces that dissected through the mammary stroma and adipose tissue. The vascular channels were mostly lined by a single layer of endothelial cells with a mild degree of nuclear atypia, whereas focally, the endothelia were multilayered, with tufting and formation of glomerulus-like structures. CD31, CD34, and ERG immunochemical stain highlighted the endothelial cells lining on the vascular spaces. The Ki67 index was about 10%, and MYC was negative. Primary angiosarcomas have significant overlaps of morphological features with benign and borderline vascular lesions. Anastomosing vascular spaces, cytologic atypia, endothelial mitotic activity, infiltration of glandular parenchyma, elevated Ki-67, and high cellularity are all useful clues to diagnose angiosarcomas. Among them, anastomosing vascular spaces with infiltrated growth pattern especially invasion into the breast intralobular stroma and adipose tissue was the most common character of angiosarcomas which alert the possibility of malignancy in core needle biopsy. However, an accurate diagnosis demands integration of various histological clues and multidisciplinary discussion.
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Affiliation(s)
- Ying Yang
- Department of Pathology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuan Dong
- Department of Breast Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian'e Wu
- Department of Pathology, Anning First People's Hospital, Kunming, China
| | - Jun Li
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhiyuan Wang
- Department of Pathology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yun Ma
- Department of Breast Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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An R, Men XJ, Ni XH, Wang WT, Wang CL. Angiosarcoma of the breast: A review. Heliyon 2024; 10:e24413. [PMID: 38318005 PMCID: PMC10839862 DOI: 10.1016/j.heliyon.2024.e24413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Breast angiosarcoma is a rare and highly aggressive malignancy with a poor prognosis. It can occur spontaneously or be associated with factors such as radiation therapy or chronic lymphedema. The etiology and pathogenesis of this disease are still unclear, the clinical symptoms and imaging findings lack specificity, and the pathological morphology is diverse, which is easy to be confused with other diseases. There is no clear guideline for surgical treatment. Although the optimal surgical approach remains unclear, the ultimate goal is surgical excision with optimal margins, which remains the primary method of treatment. In clinical practice, the choice of the surgical approach should be made by considering the tumor size, pathological type, and patient preferences. In clinical practice, the selection of surgical methods should be carried out with comprehensive consideration of tumor size, pathological types and patients' wishes. There is no clear consensus on whether radiotherapy and chemotherapy should be carried out after surgery, and its optimal program and efficacy are uncertain. This article reviews the etiology, clinical manifestations, pathological features, imaging findings, treatment, prognosis and other aspects of breast angiosarcoma, so as to strengthen clinicians' overall understanding of this disease and avoid missed diagnosis and misdiagnosis.
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Affiliation(s)
- Ran An
- School of Clinical Medicine, Shandong Second Medical University, Weifang 261041, Shandong Province, China
- Department of Thyroid and Breast Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
| | - Xiao-Juan Men
- Department of Thyroid and Breast Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
| | - Xi-Hao Ni
- School of Clinical Medicine, Shandong Second Medical University, Weifang 261041, Shandong Province, China
| | - Wei-Tao Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang 261041, Shandong Province, China
| | - Chang-Liang Wang
- Department of Thyroid and Breast Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
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Parisi S, Gambardella C, Iovino F, Ruggiero R, Lucido FS, Nesta G, Tolone S, Brusciano L, Fisone F, Mongardini FM, Cozzolino G, Della Corte CM, Napolitano S, Orditura M, Esposito R, Docimo L. Post-Irradiation Breast Angiosarcoma: All the Possible Treatments and Electrochemotherapy. Case Report and Literature Review. J Clin Med 2024; 13:567. [PMID: 38256700 PMCID: PMC10816174 DOI: 10.3390/jcm13020567] [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: 12/10/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Breast angiosarcoma is a rare malignancy, accounting for less than 1% of all soft tissue cancers. It comprises primitive and secondary subtypes, such as radiogenic breast angiosarcoma (RAS). Despite multimodal treatment, angiosarcomas represent an incurable disease for many patients and a significant cause of deterioration in their quality of life. Surgery is a cornerstone in management, but high recurrence rates are reported. Electrochemotherapy (ECT) is a practicable locoregional treatment for patients with advanced angiosarcoma as part of a multimodal therapeutic strategy. The palliative benefits of ECT include optimal patient compliance, good local hemostasis control, and positive local responses. Since only 22 cases are described in the literature, we reported a rare case of RAS treated with ECT after a multidisciplinary approach, including Next Generation Sequencing (NGS). A literature review on the feasibility of ECT in RAS management was also performed.
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Affiliation(s)
- Simona Parisi
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Claudio Gambardella
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesco Iovino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
- Department of Translational Medical Sciences, Division of General Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Roberto Ruggiero
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesco Saverio Lucido
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Giusiana Nesta
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Salvatore Tolone
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Luigi Brusciano
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesca Fisone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Giovanni Cozzolino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Carminia Maria Della Corte
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Stefania Napolitano
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Michele Orditura
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Ludovico Docimo
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
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Gonzalez Apraez JE, Rubio D, Cuadrado D. Angiosarcoma primario de mama. Reporte de caso y revisión de la literatura. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introducción. El angiosarcoma primario de la mama es una neoplasia maligna derivada de las células endoteliales de los vasos sanguíneos, potencialmente agresiva independientemente de su grado histológico, por lo que su pronóstico es malo. Su diagnóstico prequirúrgico es difícil, ya que las características clínicas e imagenológicas son inespecíficas, y el diagnóstico definitivo únicamente se realiza por estudios de patología. Para su tratamiento generalmente se requiere de resección quirúrgica, radioterapia y, ocasionalmente, quimioterapia.
Caso clínico. Paciente de 49 años sin antecedentes, que consultó por cuadro clínico de 5 meses de evolución de aparición y rápido crecimiento de masa en mama izquierda. Se realizaron estudios imagenológicos que reportaron lesión BIRADS 4a y diagnóstico histológico de lesión vascular con atipía, por lo cual fue llevada a mastectomía simple, con informe final de patología de angiosarcoma primario de mama; tuvo que ser reintervenida por márgenes positivos. Completó 33 ciclos de radioterapia y dos años después de la cirugía presentó cambios inflamatorios en la cicatriz quirúrgica, de la cual se tomó biopsia con reporte de lesión vascular atípica, por lo que fue operada nuevamente, con reporte histológico negativo para angiosarcoma residual. Actualmente la paciente está en seguimiento imagenológico, sin evidencia de recaída tumoral.
Conclusión. Los angiosarcomas primarios de la mama son neoplasias raras y muy agresivas, independientemente de su grado histológico, por lo cual es importante hacer un diagnóstico histológico y tratamiento oncológico oportunos
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Machado I, Giner F, Lavernia J, Cruz J, Traves V, Requena C, Llombart B, López-Guerrero JA, Llombart-Bosch A. Angiosarcomas: histology, immunohistochemistry and molecular insights with implications for differential diagnosis. Histol Histopathol 2020; 36:3-18. [PMID: 32885407 DOI: 10.14670/hh-18-246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Angiosarcomas (AS) represent a heterogenous group of tumors with variable clinical presentation. AS share an important morphologic and immunohistochemical overlap with other sarcomas, hence the differential diagnosis is challenging, especially in poorly-differentiated tumors. Although molecular studies provide significant clues, especially in the differential diagnosis with other vascular neoplasms, a thorough hematoxylin and eosin analysis remains an essential tool in AS diagnosis. In this review, we discuss pathological and molecular insights with emphasis on implications for differential diagnosis in cutaneous, breast, soft tissue and visceral AS.
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Affiliation(s)
- Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain.,Pathology Department, Hospital Quirón, Valencia, Spain.
| | - Francisco Giner
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | - Javier Lavernia
- Department of Oncology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Julia Cruz
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Víctor Traves
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Celia Requena
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Beatriz Llombart
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - José Antonio López-Guerrero
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, Valencia, Spain.,IVO-CIPF Joint Research Unit of Cancer, Príncipe Felipe Research Center (CIPF), Valencia, Spain.,Department of Pathology, School of Medicine, Catholic University of Valencia 'San Vicente Mártir', Valencia, Spain
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