Primary breast angiosarcoma: avoiding a common trap

Primary retroperitoneal angiosarcoma: A case report

Angiosarcoma is a rare subtype of soft tissue sarcoma with identifiable vascular differentiation. It can occur at any age and develop throughout the body, but it is most commonly found in skin, soft, and breast tissues. Primary retroperitoneal angiosarcoma is rarely reported in the relevant literature. This article reports a case of primary retroperitoneal angiosarcoma in a middle-aged man, with the relevant literature reviewed in detail. A 46-year-old male had experienced left waist pain for 2 months. An ultrasonic examination revealed a mass in the left retroperitoneum, and left retroperitoneal lesions were confirmed via computed tomography (CT) and magnetic resonance imaging (MRI). The tumor was removed surgically, and the CT scan revealed local tumor recurrence after 1 month when the first adjuvant therapy was performed. The patient died of a massive hemorrhage from a ruptured tumor. Angiosarcoma has high malignancy and a poor prognosis. Its early diagnosis and treatment significantly impact the long-term survival rate of patients.

R, Dewangan M, Issar AK. Primary Angiosarcoma of the Breast: A Rare Case Report in Postmenopausal Women

Primary angiosarcoma (PAS) of the breast is a rare malignant tumor arising from endothelial cells lining the blood vessel and accounts for 0.04% of all breast tumors. It occurs predominantly in young patients usually presenting as nonspecific imaging features and is often overlooked and misdiagnosed at radiology and pathology. Angiosarcoma prognosis is generally poor; however, surgery followed by adjuvant chemotherapy and radiotherapy improves the prognosis. We report a rare case of PAS in a 65-year-old postmenopausal woman. She was diagnosed with PAS based on typical clinical, mammography, ultrasound, and magnetic resonance imaging (MRI) features followed by core biopsy of the lesion. Our case had the unique features of enlarged vessels within and surrounding the lesion in mammography, as well as in MRI, which could be very helpful for future diagnosis of this rare PAS in postmenopausal women.

Primary breast angiosarcoma: a case report

Background

Angiosarcomas are rare and fast growing tumors that arise from vascular structures. This case report is significant because it is rare and may cause treatment delay if not considered as a differential diagnosis. Hence, we aim to inform efficient, appropriate, and evidence-based imaging practice to the benefit of patients regionally and worldwide.

Case presentation

Thirty-five-year-old lady, presented with a large left breast swelling. She had recent history of trauma to the breast which initially caused confusion regarding the possible diagnosis. Ultrasound and MRI raised high suspicion of an angiosarcoma. Patient went through embolectomy prior to mastectomy and axillary clearance. Histopathology confirmed the diagnosis of an angiosarcoma. She had no distant metastases at the time of diagnosis and the patient was treated with chemotherapy and radiotherapy. However, she returned with recurrence within 1-year duration.

Conclusion

Primary breast angiosarcomas are rare aggressive vascular tumors with generally poor prognosis and no pathognomonic signs on radiological imaging, especially mammogram. Ultrasound and MRI do help in characterizing these tumors and raising the suspicion of a vascular tumor. Ultrasound-guided biopsy is recommended to avoid unnecessary complications. In young patients with rapidly growing, highly vascular breast tumors, a differential diagnosis of primary angiosarcomas should be considered until proven otherwise.

Primary Mammary Angiosarcoma: Literature Review

Angiosarcomas of the breast are extremely rare, highly aggressive tumors of vascular origin comprising 0.04% of all malignant neoplasms of the breast. They can be classified into primary mammary angiosarcomas and cutaneous (secondary) angiosarcomas. Primary angiosarcomas, owing to their unusual clinical presentation, are diagnosed late. In addition, the available literature to date lacks sufficient evidence to establish standard treatment guidelines for this group of tumors, thereby resulting in poor prognosis. In medical database, most available papers concern secondary angiosarcomas, with only a few case reports of primary angiosarcomas. The aim of this paper is to review what is known hitherto about the presentation, diagnostic tools, and therapeutic modalities for primary mammary angiosarcomas.

Primary angiosarcoma of the breast: Case report of a rare vascular tumor

This is a case report of a woman in her sixth decade of life diagnosed with primary angiosarcoma of the breast using mammography and ultrasound, confirmed with imaging-guided biopsy, and finally treated with surgery and radiation. Imaging studies obtained and discussed include mammography, ultrasonography, and MRI. Further discussion on the presenting symptoms, useful imaging modalities, and treatment options takes place. It is important to consider primary angiosarcoma of the breast, though rare, in any woman presenting with a palpable breast mass and, if feasible, an MRI will be most helpful in the diagnosis of this rare tumor.

Primary angiosarcoma of the breast: a radiation oncologist's perspective with a concise review of the literature

A 28-year-old premenopausal woman presented with a painful rapidly growing mass in her right breast and was evaluated with a core needle biopsy, which was suggestive of poorly differentiated carcinoma. Immunohistochemical evaluation revealed primary angiosarcoma of breast. Whole body ¹⁸flouro-deoxyglucose positron emission tomography CT showed few metabolically active soft tissue lesions in upper inner quadrant of right breast. The patient underwent breast conservation surgery and in view of positive surgical margins, received adjuvant radiation therapy. Post-treatment completion, the patient has been disease free for 6 months. Primary angiosarcoma of the breast is a rare malignancy which is best managed with a surgery as first approach, with due importance being given to the patient's perspective on their disease and choices for adjuvant treatment. Decisions in addition to adjuvant radiotherapy need to be made in the multidisciplinary clinic, due to paucity of data.

Primary Angiosarcoma Of the Breast: A Case Report

Primary angiosarcoma of the breast is a rare (0.04% of all malignant breast tumors) and potentially life-threatening disease. Given its variable and non-specific clinical, radiological and pathological presentation, accurate diagnosis is a challenge. Primary angiosarcoma of the breast predominantly occurs in younger patients and it is often overlooked and misdiagnosed at radiology and pathology. To ensure that this aggressive malignancy is not overlooked, radiologists need to be aware of the fact that such tumors may present with non-specific imaging features. We report a case of a 32-year-old female with primary angiosarcoma of the breast presenting with non-specific imaging features. It was initially interpreted as a capillary cavernous hemangioma at histopathology following an ultrasound-guided biopsy. This eventually turned out to be angiosarcoma after a second histopathology opinion was sought in light of the radiology-pathology discordance.

Rare case of bleeding nipple hemangioma in a lactating mother

Hemangiomas of nipple of the breast are rare lesions and are limited to case reports in the literature. Such pathology in a lactating mother are clearly a hindrance preventing the child from breastfeeding with its benefits. We report a rare case of a bleeding nipple hemangioma in a 24 years old lactating mother with the clinical, imaging and histopathological findings.

Primary Angiosarcoma of the Breast after Bilateral Breast Reduction

Angiosarcoma of the breast is a rare malignancy of endothelial cell origin, representing less than 1% of all breast malignancy. Primary angiosarcomas can occur in the setting of chronic lymphedema, but it also may occur spontaneously without any preceding treatment. Surgery is the primary therapeutic intervention for breast angiosarcomas with radiation and chemotherapy as adjuvant treatment. Angiosarcomas are aggressive and tend to have a high risk of local and metastatic recurrence. We present a case of primary angiosarcoma that developed in a patient who had bilateral breast reduction surgery in the past.

Spuriously aggressive features of a lactating adenoma prompting repeated biopsies

We present an atypical presentation of a common pregnancy-related breast mass, a lactating adenoma with imaging and pathologic correlation. The patient presented with a rapidly enlarging left breast mass associated with skin changes and severe pain in the perinatal period. Core biopsies were considered discordant, and the patient went on to surgical excision for the definitive diagnosis of an infarcted lactating adenoma. The symptoms of infarction may obscure the diagnosis of common entities and result in additional evaluation.

Recurrent Primary Angiosarcoma of the Breast Presenting as Kasabach-Merritt Syndrome: A Case Report and Review of Literature

Angiosarcoma of the breast is an unusual tumour. The diagnosis of this condition is difficult clinically, pathologically and radiologically. Treatment includes surgery followed by chemoradiation. The tumour is notorious for its recurrence and is generally associated with poor prognosis. Kasabach-Merritt syndrome also is a very rare entity seen primarily in infants with vascular malformations and carries a poor prognosis. In this report, the authors describe a patient with recurrent primary angiosarcoma of the breast, which presented as Kasabach-Merritt syndrome.

Exsanguinating Hemorrhage during Open Biopsy in a Primary Breast Angiosarcoma: A Case Report

Angiosarcomas are endothelial cell neoplasms in the lining of the blood vessel wall and account for about 0.04% of all breast malignancies with a high rate of error in primary diagnosis. The breast angiosarcoma is a rare and uncommon pathology and has been described mostly as case reports. Indeed, only a limited number of cases have been published. Accordingly, the natural history of this tumor and its clinical course remain unclear, and as a consequence, no uniform treatment strategy exists. We present the clinical course and challenges in the diagnosis of a primary angiosarcoma of the breast in a young woman, presenting with a mass in her left breast. Fine-needle aspiration and core needle biopsy failed to confer a correct diagnosis. She suffered severe bleeding at the time of open biopsy and underwent total mastectomy, followed by adjuvant chemotherapy. Young women with solid breast tumors, especially those that are highly vascular, should be considered malignant until proven otherwise. Accurate diagnosis may be difficult. Open biopsy can be diagnostic, although exsanguinating bleeding may occur. Thus, performing open biopsy in locations other than equipped operating rooms may be hazardous and should be avoided.

Primary angiosarcoma of the breast

Primary angiosarcoma (AS) of the breast is a rare neoplasia that is not related to radiation exposure. It represents less than 0.05% of all malignant breast tumors. This lesion is characterized by aggressive patterns and poor prognosis and by the absence of typical features at radiologic examination. Currently there are not evidence-based guidelines regarding surgical and adjuvant treatment for this tumor even though wide surgical resection followed by chemo- radiotherapy appears to improve both disease free survival and overall survival. The aim of this study was to analyze the available series of AS patients suggesting the most reliable treatment options for this rare neoplasia.

Primary Angiosarcoma of the Breast: A Case Report and Review of Literature

Angiosarcoma of the breast (ASB) is a rare but aggressive tumor with very poor prognosis. It is important to recognize this tumor early and to distinguish between primary and secondary ASB. While mammograms frequently miss these lesions, ultrasound and MRI show promise as imaging modalities. In spite of characteristic features described on pathology, misdiagnosis is common, with over 35% tumors initially thought to be benign. We present the case of a 32-year-old woman with a history of bilateral reduction mammoplasty who presented with a non-tender lump in her right breast. After repeated aspirations and biopsies, a diagnosis of primary ASB was made. She underwent bilateral simple mastectomies followed by adjuvant chemo-therapy and radiation. While surgery is the mainstay of treatment, roles of radiation and chemo-therapy are still evolving; we review the literature and discuss the decision pathways for diagnosis and management of this rare tumor.

Primary angiosarcoma of the breast: a case report

Primary angiosarcoma of the breast is extremely rare. Radiologic findings are often non specific and may appear completely normal in one-third of cases with primary angiosarcoma. The prognosis is usually poor because of the high rates of local recurrence and early development of metastasis. Surgical removal followed by adjuvant chemotherapy seems improve the prognosis.

We report a case of a 33- year-old woman with a highly vascular mass in her right breast which is suggestive of malignancy at radiology. Initial core needle biopsy showed a benign hemangioma. The patient underwent a mastectomy. The tumor histology showed papillary formations and vascular structures lined by atypical cells with hyperchromatic nucleus and eosinophilic cytoplasm with solid areas. The tumor cells expressed CD34 and CD31 but were negative for cytokeratin. The diagnosis of angiosarcoma grade III was made. The patient is now receiving chemotherapy. She is still alive.

Primary cutaneous angiosarcoma of the breast after breast trauma

Primary angiosarcoma of the breast is a rare malignant tumor. We report a case of breast primary cutaneous angiosarcoma in a patient with a strong family history of malignancy. For definitive diagnosis, a tissue biopsy is needed, with immunostaining for the presence of blood vessel endothelial markers CD31 and CD34. Total mastectomy is the preferred method of surgical treatment. Chemotherapy has not been shown to increase overall survival, but in some instances it may improve local control and disease-free survival. Surgery combined with radiation may increase local control, but patients at high risk of recurrence may benefit from adjuvant treatment as well. We discuss the potential benefits from various treatments for primary cutaneous breast angiosarcoma.