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Wong HH, Cojocaru E, Watkins J, James S, Aloysius T, Harrington J, Horan G, Hatcher H. Radiation-induced angiosarcoma of the breast: retrospective analysis at a regional treatment centre. Breast Cancer 2024; 31:272-282. [PMID: 38147173 DOI: 10.1007/s12282-023-01535-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Radiation-induced angiosarcoma (RIA) is an uncommon but morbid complication after radiotherapy for breast cancer. METHODS Retrospective analysis of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England. RESULTS 22 patients were identified between 2010 and 2022. Median age of diagnosis was 65 years (range 41-78). Median time from breast radiotherapy to RIA diagnosis was 6.5 years (range 2.4-16.0)-this interval has decreased over the last 24 years (r2 = 0.6601). 9% had metastasis at presentation. All patients underwent surgery (55% at CUH, 45% at local hospitals). 27% received peri-operative pegylated liposomal doxorubicin in the first-line setting. 62% relapsed following their primary curative-intent treatments after a median of 28 months. Metastases occurred in 36%, the commonest sites being lung (100%) and lymph node (50%). 2-year and 5-year overall survival (OS) rates for all patients were 73% and 60%, respectively. No correlation between progression-free survival (PFS) and OS was found with tumour size, margin, peri-operative chemotherapy, and whether surgery was performed at CUH. Patients with multifocal disease on their breasts had shorter PFS following surgery compared to single-lesion disease (median 10 vs 65 months; HR = 4.359 [95% CI 1.342-14.16]; P = 0.0143). Patients aged > 72 years had a median OS of 45 months vs 102 months for those ≤ 72 years (HR = 7.129 [95% CI 1.646-30.88]; P = 0.0086). CONCLUSION RIA has high rates of recurrence and mortality and appears to be occurring sooner after breast radiotherapy. Further studies on its pathogenesis and effective treatment are warranted.
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Affiliation(s)
- Han Hsi Wong
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Elena Cojocaru
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - James Watkins
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sujil James
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Tony Aloysius
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Jennifer Harrington
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Gail Horan
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Helen Hatcher
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
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2
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Rohr E, Laverde-Saad A, Lu J, Chergui M, Nguyen KH. Case - Urothelial carcinoma recurrence presenting with painless cutaneous plaques and papules. Can Urol Assoc J 2024; 18:E43-E45. [PMID: 37812787 PMCID: PMC10766336 DOI: 10.5489/cuaj.8476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Eliana Rohr
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Jessica Lu
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - May Chergui
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Khue Huu Nguyen
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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3
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Dermawan JK, Chi P, Tap WD, Rosenbaum E, D'Angelo S, Alektiar KM, Antonescu CR. Distinct genomic landscapes in radiation-associated angiosarcoma compared with other radiation-associated sarcoma histologies. J Pathol 2023; 260:465-477. [PMID: 37350195 PMCID: PMC10756077 DOI: 10.1002/path.6137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/31/2023] [Accepted: 05/05/2023] [Indexed: 06/24/2023]
Abstract
MYC amplifications have been frequently detected in radiation (RT)-associated angiosarcomas (ASs) by low-resolution molecular methods. However, large-scale next-generation sequencing (NGS) studies to investigate the genomic landscape of RT-AS are scarce, particularly compared with other RT-associated sarcomas. We performed a detailed comparative genomic investigation of RT-AS versus other RT-associated histotypes, as well as sporadic sarcomas with similar histologies. Our institutional targeted DNA-NGS assay database was searched for RT-associated sarcomas. Clinical outcome data, pathologic diagnosis, and the types and frequencies of genomic alterations, including single nucleotide variants (SNVs) and copy number alterations (CNAs), were analyzed. The cohort consisted of 82 patients, 68 (83%) females and 14 (17%) males, aged 37-88 (mean 64) years. Forty-four RT-ASs (38 from breast) and 38 RT sarcomas of other histologies, including 12 malignant peripheral nerve sheath tumors (RT-MPNSTs), 14 undifferentiated pleomorphic sarcomas (RT-UPSs), and 12 osteosarcomas (RT-OSs), were included. Median time intervals from radiation to initial diagnosis in RT-AS (8.0 years) were significantly lower than those in RT-MPNST and RT-UPS (12.5 and 18.5 years), respectively. Each RT-sarcoma histotype harbored distinct mutations and CNAs. RT-associated AS had more frequent MYC, FLT4, CRKL, HRAS, and KMT2D alterations than sporadic AS (enriched in TP53, KDR, ATM, ATRX), whereas the mutational landscapes of MPNST, UPS, and OS were similar in both RT and non-RT settings. CDKN2A/B deletions and TP53 alterations were infrequent in RT-AS compared with other RT sarcomas. Among RT sarcomas, RT-AS harbored the lowest fraction of genome altered (FGA), while RT-MPNST showed the highest FGA. RT-AS had the lowest insertion:SNV and deletion:SNV ratios, while RT-UPS had the highest. The predominant mutational signatures were associated with errors in DNA repair and replication. In conclusion, RT-AS has a distinct genomic landscape compared with other RT sarcomas and sporadic AS. Potential molecular targets for precision medicine may be histotype-dependent. © 2023 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Josephine K Dermawan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sandra D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina R Antonescu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Do Q, Farooqui ZA, Parajuli D. Primary Epithelioid Angiosarcoma of the Colon With Peritoneal Carcinomatosis. Cureus 2023; 15:e36709. [PMID: 37113364 PMCID: PMC10129070 DOI: 10.7759/cureus.36709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/28/2023] Open
Abstract
Angiosarcoma is a rare mesenchymal tissue neoplasm, typically involving lymphatic or vascular endothelial cells. The tumor can arise anywhere in the body, though it is most often found as cutaneous lesions in the head and neck region. Due to its rarity, a diagnosis can sometimes be missed, especially when the sarcoma involves an uncommon site like the gastrointestinal tract. In this case, we describe a male patient who was found to have primary epithelioid angiosarcoma of the colon. Initial biopsies with immunohistochemistry staining were weakly positive for anti-cytokeratin (CAM 5.2) and negative for SRY-Box transcription factor 10 (SOX-10) and B-cell-specific activator protein (PAX-5). He was misdiagnosed as having poorly differentiated carcinoma as a result. However, a more in-depth look at the colon specimen after tumor resection revealed CD-31 and factor VIII positivity, which established the diagnosis of epithelioid angiosarcoma of the colon. This case suggests the use of rare histopathology markers as part of the workup for colonic lesions to confirm the diagnosis, especially when tissue biopsy is limited.
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5
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El-Ghazzi N, Bay JO. [Rare tumors: Angiosarcoma]. Bull Cancer 2023; 110:581-588. [PMID: 36973135 DOI: 10.1016/j.bulcan.2023.03.002] [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: 11/14/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
Angiosarcomas are a rare subtype representing 1-2% of soft tissue sarcomas. Risk factors are rarely elucidated but radiotherapy and lymphedema are the most common ones, usually following local treatment for local breast cancer. Despite the improvement of our knowledge, the prognosis remains poor with 35-40% of 5 year-overall survival. Local treatment when feasible should include a R0 surgery completed with adjuvant radiation. When metastatic, front lines chemotherapies include doxorubicine or weekly paclitaxel. If possible, in oligometastatic patients, metastasectomy should always be considered allowing the best responses. The knowledge of angiosarcoma's biology is rapidly increasing and new biomarkers are emerging. The use of immunotherapy in particular subtypes including head and neck angiosarcomas shows promising results. The model of the angiosarcoma project, a patient-participating study, seems to be an excellent way to study rare tumors. We should focus our efforts on understanding the underlying molecular biology to propose the best precision medicine for those patients.
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Affiliation(s)
- Nathan El-Ghazzi
- CHU Gabriel-Montpied, service d'oncologie médicale, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France.
| | - Jacques-Olivier Bay
- CHU Gabriel-Montpied, service d'oncologie médicale, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
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Lascu R, Alexandru A, Oltenescu A, Vlaicu O, Andrei RT. Postirradiation Angiosarcoma – A Late, Severe Complication of Radiotherapy for Mammary Neoplasm. ROMANIAN JOURNAL OF MILITARY MEDICINE 2023. [DOI: 10.55453/rjmm.2023.126.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
"Angiosarcoma is a malignant tumor derived from the endothelium of the blood and lymphatic vessels. Its aggressive behavior results in a poor prognosis for the patients. Radiation-associated angiosarcoma is a rare recently described particular subtype of angiosarcoma best shown in patients after treatment of breast cancer. The latency period of development is approximately 8 years, thus the 5-year standard follow-up after mammary neoplasm therapy needs to be extended up to 10 years. Radiotherapy is an independent risk factor for angiosarcoma development. Rapid diagnosis is essential for prompt therapeutical intervention to improve the patient’s prognosis. The importance of early diagnosis is emphasized by a case of a 54 years old woman, with a diagnosis of breast cancer treated by sectorectomy and radiotherapy 7 years prior, presenting to our Dermatology Department for the recent occurence of erythemato-violaceous cutaneous patches on the area subjected to radiotherapy. "
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7
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Layton C, Twadell S, McDonald KA, Genuit T, Richter S. Preoperative Accelerated Hyperfractionated Whole-Breast Radiation as Treatment for Secondary Angiosarcoma of the Breast After Prior Accelerated Hypofractionated Whole-Breast Radiation Therapy: A Case Report and Review of the Literature. Adv Radiat Oncol 2022; 7:100846. [PMID: 35243183 PMCID: PMC8866668 DOI: 10.1016/j.adro.2021.100846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Christina Layton
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Sara Twadell
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Kerry Ann McDonald
- Department of Breast Surgery, Lynn Women's Health and Wellness Institute, Boca Raton, Florida
| | - Thomas Genuit
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Samuel Richter
- Department of Radiation Oncology, Lynn Cancer Institute, Boca Raton, Florida
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8
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Wei Y, Yang X, Gao L, Xu Y, Yi C. Differences in potential key genes and pathways between primary and radiation-associated angiosarcoma of the breast. Transl Oncol 2022; 19:101385. [PMID: 35263699 PMCID: PMC8905315 DOI: 10.1016/j.tranon.2022.101385] [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: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Angiosarcoma of the breast is a high-grade malignant soft tissue tumor, it can be divided into primary and secondary. The differences between primary and secondary angiosarcomas in terms of pathogenesis, clinical behavior, early diagnosis biomarkers, genetic abnormalities, and therapeutic targets remain to be fully elucidated. Due to its rarity, most of the current information relating to angiosarcoma is provided by case reports and single-institution retrospective cohort studies and the research with large-scale genomic studies published to date are very limited. We identified the differentially expressed genes (DEGs) between primary and second breast angiosarcomas and identified the hub genes as well as predicted novel biomarkers, pathways, and potential therapeutic targets for primary and secondary breast angiosarcomas. We aimed to identify novel biomarkers, pathways, and potential therapeutic targets for primary and secondary breast angiosarcomas to facilitate future research.
Background Angiosarcoma of the breast is a high-grade malignant soft tissue tumor, it can be divided into primary and radiation-associated angiosarcoma(secondary). However, the differences between primary and secondary angiosarcomas in terms of pathogenesis, clinical behavior, early diagnosis biomarkers, genetic abnormalities, and therapeutic targets remain to be fully elucidated. At the same time, due to its rarity, most of current information relating to angiosarcoma is provided by case reports. Therefore, exploring the mechanisms of primary and secondary breast angiosarcoma have important value for the discovery of new biomarkers and research into potential therapeutic targets. Methods The differentially expressed genes (DEGs) between 36 cases of primary angiosarcoma and 54 cases of secondary angiosarcoma were screened. Then, the DEGs were used to gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Then, a protein-protein interaction (PPI) network was constructed using the STRING database. Results A total of 18 DEGs were identified, of which 13 were upregulated and 5 were downregulated in secondary breast angiosarcoma. The GO enrichment analysis showed that the DEGs were most enriched in metabolism, energy pathways, and protein metabolism in biological processes. The enriched signaling pathways of DEGs were the transforming growth factor-β (TGF-β), Wnt, Hippo and PI3K-Akt signaling pathways. Then, the PPI network was conducted and hub genes were identified and they were involved in thyroid hormone, Hippo and other signaling pathways. Conclusion This study lay the foundation for the discovery of effective and reliable molecular biomarkers and essential therapeutic targets for these malignancies.
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Kokkali S, Moreno JD, Klijanienko J, Theocharis S. Clinical and Molecular Insights of Radiation-Induced Breast Sarcomas: Is There Hope on the Horizon for Effective Treatment of This Aggressive Disease? Int J Mol Sci 2022; 23:ijms23084125. [PMID: 35456944 PMCID: PMC9029574 DOI: 10.3390/ijms23084125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Radiation-induced breast sarcomas (RIBS) are rare entities representing <1% of all primary breast malignancies, limiting most reports to small retrospective case series. They constitute a heterogeneous group of neoplasms, with high-grade angiosarcoma being the most common subtype. Other sarcoma histotypes, such as undifferentiated pleomorphic sarcoma and leiomyosarcoma, can also be identified. Radiation-induced breast angiosarcoma (RIBA) has an incidence of approximately 0.1% after breast-conserving therapy and arises mainly from the dermis of the irradiated breast. MYC gene amplification is highly indicative of secondary breast angiosarcomas. Their clinical presentation often mimics benign port-radiation lesions, leading to a delay in diagnosis and a lost window of opportunity for cure. Surgery with negative margins is the mainstay of treatment of localized RIBS. In the case of angiosarcoma, technical difficulties, including multifocality, infiltrative margins, and difficulty in assessing tumor margins, render surgical treatment quite challenging. A limited number of studies showed that adjuvant radiation therapy reduces local recurrences; therefore, it is proposed by many groups for large, high-grade tumors. Chemotherapy has been evaluated retrospectively in a small subset of patients, with some evidence supporting its use in angiosarcoma patients. Approximately half of patients with RIBA will show local recurrence. In the advanced setting, different therapeutic options are discussed in the review, including chemotherapy, antiangiogenic therapy, and immunotherapy, whereas the need for further research on molecular therapeutic targets is pointed out.
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Affiliation(s)
- Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
- Oncology Unit, 2nd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Hippocratio General Hospital of Athens, V. Sofias 114, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-6932326547
| | - Jose Duran Moreno
- Hellenic Group of Sarcoma and Rare Cancers, G. Theologou 5, 11471 Athens, Greece;
| | - Jerzy Klijanienko
- Department of Pathology, Institut Curie, 26 Rue d’Ulm, CEDEX 05, 75248 Paris, France;
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
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Cozzi S, Najafi M, Bardoscia L, Ruggieri MP, Giaccherini L, Blandino G, Botti A, Ciammella P, Iotti C. Radiation-induced breast angiosarcoma: report of two patients after accelerated partial breast irradiation (APBI) and review of the literature. Rep Pract Oncol Radiother 2021; 26:827-832. [PMID: 34760317 DOI: 10.5603/rpor.a2021.0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background Angiosarcoma may rarely complicate radiotherapy of breast cancer. This so-called radiation-induced angiosarcoma (RIAS) occurs in less than 0.3% of patients that underwent breast conservation surgeries, usually years after completion of radiotherapy. Case presentation we introduce two cases of invasive ductal carcinoma who underwent lumpectomy and accelerated partial breast irradiation (APBI) as an alternative protocol to whole breast irradiation (WBI). They received adjuvant partial breast radiotherapy on tumor cavity for a total dose of 38.5 Gy in 10 fractions in 5 days using 3D-external-beam RT. In both cases, RIAS occurred eight years after radiotherapy, in the sub-cicatricial area in one patient and outside the irradiated area in the other one. They both underwent radical surgery and chemotherapy was performed in one patient. Discussion The underlying mechanism for development of RIAS is not well known, but its incidence seems to be increasing. RIAS after partial breast irradiation is very rare and has been reported in two cases so far. As it may be suggested in case 2, it is still a matter of debate if the risk of radiation-induced sarcoma is radiation-dose dependent. Although mastectomy is considered as a standard treatment, choice of treatment should be made according to the patient's specifications. Conclusion There are very few studies in the literature that report RIAS after APBI. Present study is the only one reporting two cases after the external 3D technique APBI. Prognosis of RIAS remains poor. Only a careful evaluation in a multidisciplinary context can offer to the patients the best result in terms of local control and survival.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Masoumeh Najafi
- Department of Radiation Oncology Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran, Iran
| | - Lilia Bardoscia
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | | | | | - Gladys Blandino
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Department of Oncology and Advanced Technology, AUSL-IRCCS, Reggio Emilia, Italy
| | | | - Cinzia Iotti
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
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Chen TWW, Burns J, Jones RL, Huang PH. Optimal Clinical Management and the Molecular Biology of Angiosarcomas. Cancers (Basel) 2020; 12:E3321. [PMID: 33182685 PMCID: PMC7696056 DOI: 10.3390/cancers12113321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
Angiosarcomas comprise less than 3% of all soft tissue sarcomas but have a poor prognosis. Most angiosarcomas occur without obvious risk factors but secondary angiosarcoma could arise after radiotherapy or chronic lymphedema. Surgery remains the standard treatment for localized angiosarcoma but neoadjuvant systemic treatment may improve the curability. For advanced angiosarcoma, anthracyclines and taxanes are the main chemotherapy options. Anti-angiogenic agents have a substantial role but the failure of a randomized phase 3 trial of pazopanib with or without an anti-endoglin antibody brings a challenge to future trials in angiosarcomas. Immune checkpoint inhibitors as single agents or in combination with oncolytic virus may play an important role but the optimal duration remains to be investigated. We also report the current understanding of the molecular pathways involved in angiosarcoma pathogenesis including MYC amplification, activation of angiogenic pathways and different molecular alterations that are associated with angiosarcomas of different aetiology. The success of the patient-partnered Angiosarcoma Project (ASCProject) has provided not only detailed insights into the molecular features of angiosarcomas of different origins but also offers a template for future fruitful collaborations between patients, physicians, and researchers. Lastly, we provide our perspective of future developments in optimizing the clinical management of angiosarcomas.
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Affiliation(s)
- Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital and Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Jessica Burns
- Division of Molecular Pathology, The Institute of Cancer Research, London SW3 6JB, UK;
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London SW3 6JJ, UK;
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London SW3 6JB, UK;
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12
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Multidisciplinary Management of Angiosarcoma - A Review. J Surg Res 2020; 257:213-220. [PMID: 32858322 DOI: 10.1016/j.jss.2020.07.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023]
Abstract
Angiosarcomas (AS) are a diverse group of soft tissue sarcomas, arising from blood and lymphatic vessels. They frequently present in the elderly, and in patients with previous radiation or lymphedema. A wide range of genetic derangements contribute to their development, and AS histology is often high-grade in keeping with aggressive disease biology. The clinical presentation, while often innocuous, is marked by its infiltrative and aggressive nature, with a proclivity for metastatic spread, and outcomes are often poor. Surgery is performed for localized, resectable cases. A multidisciplinary approach, appropriately employing surgery, radiation, chemotherapy, or potentially recently approved immune-oncology agents, can result in positive outcomes.
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13
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Ashack KA, Kuritza V, Visconti MJ, Ashack L. Dermatologic Sequelae Associated with Radiation Therapy. Am J Clin Dermatol 2020; 21:541-555. [PMID: 32410134 DOI: 10.1007/s40257-020-00519-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Radiation therapy is a mainstay for the treatment of primary malignancies and metastatic disease and is associated with several dermatological adverse events that are underreported in the literature. The objective of this paper was to review the literature regarding cutaneous manifestations associated with radiation therapy in order to promote awareness of the cutaneous radiation therapy-associated adverse effects. This extensive literature review was performed using the Pubmed and Embase databases. Studies were reviewed for relevance and critical evidence pertaining to cutaneous manifestations of radiation therapy. The most commonly reported cutaneous sequelae associated with radiation therapy include radiation dermatitis, non-melanoma skin cancer, radiation-associated angiosarcoma, morphea, bullous pemphigoid, lymphangioma circumscriptum, and pseudosclerodermatous panniculitis. For many of these conditions, only case reports or case series exist and there is an absence of large-scale cohort studies. Despite these limitations, this review describes the wide range of dermatological adverse events associated with radiation therapy.
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Corradini AG, Asioli S, Morandi L, Brotto M, Righi A, Iommi M, Agostinelli C, Rucci P, Asioli S, Sapino A, Viale G, Foschini MP. Post-radiotherapy vascular lesions of the breast: immunohistochemical and molecular features of 74 cases with long-term follow-up and literature review. Histopathology 2020; 77:293-302. [PMID: 32043616 DOI: 10.1111/his.14090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 12/13/2022]
Abstract
AIMS A wide range of post-radiotherapy (RT) vascular lesions can occur, ranging from benign lymphangiomatous papules of the skin (BLAPs), to atypical vascular lesions (AVLs) and post-RT angiosarcomas (ASs). The relationship between benign and malignant post-RT breast lesions and their prognostic features are still controversial. The aims of this study were to investigate the relationship between benign and malignant mammary post-RT vascular lesions and to define post-RT AS prognostic features. METHODS AND RESULTS Seventy-four post-RT vascular lesion cases were obtained and stained with antibodies against CD34, CD31, D2-40, Ki67, and c-Myc. Mutational analysis was performed by deep sequencing for the following genes: KRAS, NRAS, HRAS, BRAF, PIK3CA, TP53, NOTCH1, PTEN, CDKN2A, EGFR, AKT1, CTNNB1, hTERT, and PTPRB. Post-RT AS cases were graded according to a previously reported breast AS grading system. AVL cases showed a low number of HRAS and hTERT mutations, whereas post-RT AS cases showed a high frequency of EGFR, TP53, HRAS and hTERT mutations. On follow-up, all BLAP and AVL patients were alive with no evidence of disease. Post-RT AS 5-year overall survival declined with the increase in grade, as follows: 85.7% for grade 1, 83.3% for grade 2, and 40.4% for grade 3. CONCLUSIONS Our findings confirm that BLAP and AVL have a good prognosis, and that post-RT AS prognosis is strongly related to histological grading. On molecular analysis, AVL and post-RT AS shared HRAS and hTERT mutations, suggesting a relationship between the two lesions.
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Affiliation(s)
- Angelo G Corradini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomical Pathology at Bellaria Hospital, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomical Pathology at Bellaria Hospital, Bologna, Italy
| | - Luca Morandi
- Department of Biomedical and Neuromotor Sciences, Section of Anatomical Pathology at Bellaria Hospital, Bologna, Italy
| | - Maurizio Brotto
- Department of Pathology, Singleton Hospital, Swansea University, Abertawe Bro Morgannwg University Hospital Trust, Swansea, UK
| | - Alberto Righi
- Department of Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marica Iommi
- Advanced School for Health Policy-Specialisation School for Public Administration, University of Bologna, Bologna, Italy
| | - Claudio Agostinelli
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paola Rucci
- Advanced School for Health Policy-Specialisation School for Public Administration, University of Bologna, Bologna, Italy
| | - Silvia Asioli
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Anna Sapino
- Candiolo Cancer Institute-FPO-IRCCS, Candiolo (To), Italy.,Department of Medical Sciences, University of Torino, Torino, Italy
| | - Giuseppe Viale
- Department of Pathology and Laboratory Medicine, IBCSG Central Pathology Laboratory, European Institute of Oncology, Milan, Italy.,University of Milan, Milan, Italy
| | - Maria P Foschini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomical Pathology at Bellaria Hospital, Bologna, Italy
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15
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Smyczyńska U, Strzemecki D, Czarnecka AM, Fendler W, Fiedorowicz M, Wełniak-Kamińska M, Guzowska M, Synoradzki K, Cheda Ł, Rogulski Z, Grieb P. TP53-Deficient Angiosarcoma Expression Profiling in Rat Model. Cancers (Basel) 2020; 12:cancers12061525. [PMID: 32532104 PMCID: PMC7352674 DOI: 10.3390/cancers12061525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/28/2022] Open
Abstract
Sarcomas are a heterogeneous group of malignant tumors, that develop from mesenchymal cells. Sarcomas are tumors associated with poor prognosis and expected short overall survival. Efforts to improve treatment efficacy and treatment outcomes of advanced and metastatic sarcoma patients have not led to significant improvements in the last decades. In the Tp53C273X/C273X rat model we therefore aimed to characterize specific gene expression pattern of angiosarcomas with a loss of TP53 function. The presence of metabolically active tumors in several locations including the brain, head and neck, extremities and abdomen was confirmed by magnetic resonance imaging (MRI) and positron emission tomography (PET) examinations. Limb angiosarcoma tumors were selected for microarray expression analysis. The most upregulated pathways in angiosarcoma vs all other tissues were related to cell cycle with mitosis and meiosis, chromosome, nucleosome and telomere maintenance as well as DNA replication and recombination. The downregulated genes were responsible for metabolism, including respiratory chain electron transport, tricarboxylic acid (TCA) cycle, fatty acid metabolism and amino-acid catabolism. Our findings demonstrated that the type of developing sarcoma depends on genetic background, underscoring the importance of developing more malignancy susceptibility models in various strains and species to simulate the study of the diverse genetics of human sarcomas.
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Affiliation(s)
- Urszula Smyczyńska
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland; (U.S.); (W.F.)
| | - Damian Strzemecki
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland; (D.S.); (M.F.); (M.W.-K.); (M.G.); (K.S.); (P.G.)
| | - Anna M. Czarnecka
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland; (D.S.); (M.F.); (M.W.-K.); (M.G.); (K.S.); (P.G.)
- Department of Soft Tissue, Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-608-6474
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland; (U.S.); (W.F.)
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02284-9168, USA
| | - Michał Fiedorowicz
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland; (D.S.); (M.F.); (M.W.-K.); (M.G.); (K.S.); (P.G.)
- Small Animal Magnetic Resonance Imaging Laboratory, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Marlena Wełniak-Kamińska
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland; (D.S.); (M.F.); (M.W.-K.); (M.G.); (K.S.); (P.G.)
- Small Animal Magnetic Resonance Imaging Laboratory, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Magdalena Guzowska
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland; (D.S.); (M.F.); (M.W.-K.); (M.G.); (K.S.); (P.G.)
- Department of Physiological Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, 02-776 Warsaw, Poland
| | - Kamil Synoradzki
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland; (D.S.); (M.F.); (M.W.-K.); (M.G.); (K.S.); (P.G.)
| | - Łukasz Cheda
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, 02-093 Warsaw, Poland; (Ł.C.); (Z.R.)
| | - Zbigniew Rogulski
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, 02-093 Warsaw, Poland; (Ł.C.); (Z.R.)
| | - Paweł Grieb
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland; (D.S.); (M.F.); (M.W.-K.); (M.G.); (K.S.); (P.G.)
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16
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Salter DM, Griffin M, Muir M, Teo K, Culley J, Smith JR, Gomez-Cuadrado L, Matchett K, Sims AH, Hayward L, Henderson NC, Brunton VG. Development of mouse models of angiosarcoma driven by p53. Dis Model Mech 2019; 12:dmm038612. [PMID: 31221668 PMCID: PMC6679377 DOI: 10.1242/dmm.038612] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/13/2019] [Indexed: 01/17/2023] Open
Abstract
Angiosarcomas are a rare group of tumours which have poor prognosis and limited treatment options. The development of new therapies has been hampered by a lack of good preclinical models. Here, we describe the development of an autochthonous mouse model of angiosarcoma driven by loss of p53 in VE-cadherin-expressing endothelial cells. Using Cdh5-Cre to drive recombination in adult endothelial cells, mice developed angiosarcomas with 100% penetrance upon homozygous deletion of Trp53 with a median lifespan of 325 days. In contrast, expression of the R172H mutant p53 resulted in formation of thymic lymphomas with a more rapid onset (median lifespan 151 days). We also used Pdgfrb-Cre-expressing mice, allowing us to target predominantly pericytes, as these have been reported as the cell of origin for a number of soft tissue sarcomas. Pdgfrb-Cre also results in low levels of recombination in venous blood endothelial cells in multiple tissues during development. Upon deletion of Trp53 in Pdgfrb-Cre-expressing mice (Pdgfrb-Cre,Trp53fl/fl mice), 65% developed lymphomas and 21% developed pleomorphic undifferentiated soft tissue sarcomas. None developed angiosarcomas. In contrast, 75% of Pdgfrb-Cre,Trp53R172H/R172H mice developed angiosarcomas, with 60% of these mice also developing lymphomas. The median lifespan of the Pdgfrb-Cre,Trp53R172H/R172H mice was 151 days. Re-implantation of angiosarcoma tumour fragments from Cdh5-Cre, Trp53fl/fl mice provided a more consistent and rapid model of angiosarcoma than the two spontaneous models. The ability to passage tumour fragments through the mouse provides a novel model which is amenable to preclinical studies and will help the development of potential new therapies for angiosarcoma.
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Affiliation(s)
- Donald M Salter
- Centre for Genomic & Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Meredyth Griffin
- Edinburgh Cancer Research UK Centre, Institute of Genetics & Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Morwenna Muir
- Edinburgh Cancer Research UK Centre, Institute of Genetics & Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Katy Teo
- Edinburgh Cancer Research UK Centre, Institute of Genetics & Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Jayne Culley
- Edinburgh Cancer Research UK Centre, Institute of Genetics & Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - James R Smith
- Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Laura Gomez-Cuadrado
- Edinburgh Cancer Research UK Centre, Institute of Genetics & Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Kylie Matchett
- Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Andrew H Sims
- Edinburgh Cancer Research UK Centre, Institute of Genetics & Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Larry Hayward
- Edinburgh Cancer Research UK Centre, Institute of Genetics & Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Neil C Henderson
- Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Valerie G Brunton
- Edinburgh Cancer Research UK Centre, Institute of Genetics & Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
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17
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Verdura V, Di Pace B, Concilio M, Guastafierro A, Fiorillo G, Alfano L, Nicoletti GF, Savastano C, Cascone AM, Rubino C. A new case of radiation-induced breast angiosarcoma. Int J Surg Case Rep 2019; 60:152-155. [PMID: 31228777 PMCID: PMC6597493 DOI: 10.1016/j.ijscr.2019.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/25/2019] [Accepted: 06/07/2019] [Indexed: 11/30/2022] Open
Abstract
A biopsy of any suspicious breast skin lesion after radiotherapy is recommended. Patients with clinical anomalies post-breast cancer surgery and RT need attention. The Angiosarcoma was cured due to surgery and high-dose neoadjuvant chemotherapy. A correct 6 month follow-up is needed: check-ups, chest X-rays and ultrasound. The survival of the patient suggests possible ways to manage this rare tumour type.
Introduction Radiation-induced breast angiosarcoma is a severe but rare late complication in the breast-preserving management of breast cancer through surgery and radiotherapy. Often the initial diagnosis is complex given its relatively anodyne nature and the fact that it usually presents in the form of typically multifocal reddish-purple papular skin lesions. Presentation of the case We describe the clinical and pathologic findings of a 79-year-old woman, who developed a radiation-induced breast angiosarcoma after around 8 years. She initially refused a mastectomy leading to an adaptation in the management of this cancer. Discussion The average latency of secondary angiosarcoma of the breast following radiation therapy is around six years. Breast angiosarcoma is typically considered to affect the dermis, and is therefore cutaneous in origin. An incisional biopsy of the discoloured skin and underlying mass is necessary. The treatment is surgical resection. The role of chemotherapy has not been clearly defined. Most data originate from retrospective case series studies suggesting that angiosarcomas are relatively sensitive to taxanes and anthracyclines. Conclusion The preferred treatment is always aggressive surgical removal and, as our atypical clinical case suggests, neoadjuvant chemotherapy in very high doses is also needed. A biopsy of any suspicious breast skin lesion after radiotherapy is recommended. Despite the treatment challenges, our case provides enlightening details on the management of such a rare cancer even when faced with unplanned events which do not always allow for a textbook approach.
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Affiliation(s)
- Vincenzo Verdura
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.
| | - Bruno Di Pace
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" PhD School in Translational Medicine of Development and Active Aging, Università degli Studi di Salerno, Salerno, Italy
| | - Marina Concilio
- Department of Medicine, Surgery and Dentistry, Plastic Surgery Unit, Università degli Studi di Salerno, Salerno, Italy
| | - Antonio Guastafierro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Fiorillo
- A.O.U. San Giovanni di Dio e Ruggi D'Aragona, via San Leonardo, Salerno, Italy
| | - Luigi Alfano
- A.O.U. San Giovanni di Dio e Ruggi D'Aragona, via San Leonardo, Salerno, Italy
| | - Giovanni Francesco Nicoletti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Anna Maria Cascone
- A.O.U. San Giovanni di Dio e Ruggi D'Aragona, via San Leonardo, Salerno, Italy
| | - Corrado Rubino
- Department of Medicine, Surgery and Dentistry, Plastic Surgery Unit, Università degli Studi di Salerno, Salerno, Italy; Plastic Surgery Unit, Department of Surgery, Microsurgery and Medical Sciences, University Hospital Trust, Università degli Studi di Sassari, Sassari, Italy
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18
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Hakozaki M, Ito S, Fujii T, Kiya Y, Udagawa H, Fukayama M, Fukusato T. Combined hepatocellular-cholangiocarcinoma with angiosarcomatoid change: A case report with immunohistochemical study. Pathol Int 2019; 69:110-116. [DOI: 10.1111/pin.12755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/27/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Mayu Hakozaki
- Department of Pathology; Toranomon Hospital; Tokyo Japan
- Department of Pathology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Shinji Ito
- Department of Pathology; Toranomon Hospital; Tokyo Japan
| | - Takeshi Fujii
- Department of Pathology; Toranomon Hospital; Tokyo Japan
- Respiratory Disease Research Team; Okinaka Memorial Institute for Medical Research; Tokyo Japan
| | - Yoshitaka Kiya
- Department of Gastroenterological Surgery; Toranomon Hospital; Tokyo Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery; Toranomon Hospital; Tokyo Japan
| | - Masashi Fukayama
- Department of Pathology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Toshio Fukusato
- Department of Pathology; Toranomon Hospital; Tokyo Japan
- General Medical Education and Research Center; Teikyo University; Tokyo Japan
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19
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Bui N, Kamat N, Ravi V, Chawla S, Lohman M, Ganjoo KN. A multicenter phase II study of Q3 week or weekly paclitaxel in combination with bevacizumab for the treatment of metastatic or unresectable angiosarcoma. Rare Tumors 2018; 10:2036361318771771. [PMID: 29760870 PMCID: PMC5946584 DOI: 10.1177/2036361318771771] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/26/2018] [Indexed: 12/22/2022] Open
Abstract
Paclitaxel (P) and bevacizumab (B) are agents that provide clinical benefit in advanced angiosarcoma (AS). The objective of this study was to assess the efficacy and safety of P-B in two different scheduled regimens. Patients were to receive P 200mg/m2 IV with B 15mg/kg IV every 21 days (Regimen A) or P 90mg/m2 IV weekly D1, 8, 15 with B 15mg/kg IV D1 of a 28 day cycle (Regimen B) x6 cycles. Maintenance B followed at a dose of 15 mg/kg intravenously once every 21 days. The primary end point was 4 month non-progression rate (NPR). A total of 16 patients were enrolled. 4 month NPR was 62.5% with median overall survival 16 months and median progression free survival 5.06 months. 11 patients made it to cycle 3 and were evaluable for response with 1 CR (9%), 4 PR (36%), 2 SD (18%), and 6 PD (36%). There were ten grade 3 toxicities and four grade 4 toxicities. The breakdown between the two regimens revealed comparable efficacy and safety. Paclitaxel and Bevacizumab is an active regimen in angiosarcoma. Q3 week and weekly paclitaxel appear similar in efficacy and safety.
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Affiliation(s)
- Nam Bui
- Stanford Cancer Institute, Stanford, CA, USA
| | - Nikhil Kamat
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Vinod Ravi
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sant Chawla
- Sarcoma Oncology Center, Santa Monica, CA, USA
| | - Marti Lohman
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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20
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Primary Peritoneal Angiosarcoma Metastatic to Liver and Bone without History of Radiation Therapy. Case Rep Pathol 2018; 2018:1257284. [PMID: 29545961 PMCID: PMC5818931 DOI: 10.1155/2018/1257284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/11/2017] [Indexed: 11/30/2022] Open
Abstract
Angiosarcoma is a rare vascular soft tissue tumor of endothelial origin most commonly seen in the elderly as a primary cutaneous head and neck malignancy. Furthermore, a peritoneal angiosarcoma is an exceedingly rare entity. This is the second case of primary peritoneal angiosarcoma reported in literature that is not associated with prior radiotherapy. Herein, we describe a case of primary peritoneal angiosarcoma metastatic to both the liver and bone in a male patient with metachronous renal cell carcinoma and parathyroid adenoma.
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21
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Farran Y, Padilla O, Chambers K, Philipovskiy A, Nahleh Z. Atypical Presentation of Radiation-Associated Breast Angiosarcoma: A Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1347-1350. [PMID: 29249796 PMCID: PMC5742473 DOI: 10.12659/ajcr.905157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Radiation-associated breast angiosarcoma is a rare clinical entity that is thought to be increasing in incidence. CASE REPORT Here we present the case of a 67-year-old female with a history of left breast invasive ductal carcinoma who received breast conserving surgery and radiation therapy eight years ago. She then presented with a painless mild skin discoloration of the left breast that had been present for over one year. Mammograms and ultrasounds were normal. A punch biopsy and a subsequent excisional biopsy revealed the diagnosis of angiosarcoma. The patient was treated with mastectomy and had no subsequent recurrences. CONCLUSIONS The long-term clinical surveillance for all patients who receive breast conservation surgery is recommended and a high degree of suspicion should be exercised in view of potential atypical presentations of this disease.
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Affiliation(s)
- Yvette Farran
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Osvaldo Padilla
- Department of Pathology, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Karinn Chambers
- Department of Surgery, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Alexander Philipovskiy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Zeina Nahleh
- Department of Hematology/Oncology, Cleveland Clinic Florida, Maroone Cancer Center, Weston, FL, USA
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22
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Shustef E, Kazlouskaya V, Prieto VG, Ivan D, Aung PP. Cutaneous angiosarcoma: a current update. J Clin Pathol 2017; 70:917-925. [PMID: 28916596 DOI: 10.1136/jclinpath-2017-204601] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/15/2017] [Indexed: 01/11/2023]
Abstract
Cutaneous angiosarcoma (cAS) is a rare malignant neoplasm with variable clinical presentation. Although a distinct vascular tumour, cAS shares many overlapping histopathological features with other vasoformative and epithelioid tumours or 'mimickers'. cAS shows aggressive behaviour and carries a grave prognosis, thus early diagnosis is of paramount importance to achieve the best possible outcomes. Recently, several genetic studies were conducted leading to the identification of novel molecular targets in the treatment of cAS. Herein, we present a comprehensive review of cAS with discussion of its clinical, histopathological and molecular aspects, the differential diagnosis, as well as current therapies including ongoing clinical trials.
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Affiliation(s)
- Elina Shustef
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Victor G Prieto
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Doina Ivan
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phyu P Aung
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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23
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Requena C, Sendra E, Llombart B, Sanmartín O, Guillén C, Lavernia J, Traves V, Cruz J. Cutaneous Angiosarcoma: Clinical and Pathology Study of 16 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.032] [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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24
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Seo CJ, Lek SM, Tan GHC, Teo M. Radiation-associated peritoneal angiosarcoma. BMJ Case Rep 2017; 2017:bcr-2016-217887. [PMID: 28536208 DOI: 10.1136/bcr-2016-217887] [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] [Indexed: 01/20/2023] Open
Abstract
Angiosarcomas account for only 1-2% of all soft tissue sarcomas, with the most common site of origin being in the head and neck region. Peritoneal angiosarcoma is an extremely rare tumour and few cases have been reported previously. Presentation of peritoneal angiosarcoma can be very variable, hence making diagnosis difficult. Herein, we review the current literature and describe a rare case of a patient who presented with haemorrhagic ascites, 17 years after radiotherapy for endometrial carcinoma and was subsequently diagnosed with peritoneal angiosarcoma. Due to extensive disease, surgery was not a viable option. She was started on palliative chemotherapy, but despite treatment, her condition deteriorated further and she eventually passed away. We highlight the diagnostic challenges and considerations in these patients as well as current treatment and management options available.
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Affiliation(s)
- Chin Jin Seo
- Singapore General Hospital, Singapore, Singapore
| | | | - Grace Hwei Ching Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Melissa Teo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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25
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Requena C, Sendra E, Llombart B, Sanmartín O, Guillén C, Lavernia J, Traves V, Cruz J. Cutaneous Angiosarcoma: Clinical and Pathology Study of 16 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:457-465. [PMID: 28318524 DOI: 10.1016/j.ad.2017.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Primary cutaneous angiosarcoma is one of the most aggressive skin tumors and carries a very poor prognosis. Its initially indolent clinical presentation explains the frequently late diagnosis that, together with its typically multifocal pattern and poor delimitation, often makes surgery difficult. The low incidence of primary cutaneous angiosarcoma means that few large single-center series have been published. We review the clinical and pathologic characteristics of cutaneous angiosarcomas treated in our hospital, looking for prognostic factors and for possible diagnostic traits that could facilitate early diagnosis. MATERIAL AND METHODS This was a retrospective observational study including all patients diagnosed with cutaneous angiosarcoma in Instituto Valenciano de Oncología in Valencia, Spain between January 2000 and December 2015. We recorded 16 clinical parameters, including age, sex, type of angiosarcoma, site, size, and time since diagnosis, and 8 histopathologic parameters. RESULTS We identified 16 patients (11 women and 5 men) with cutaneous angiosarcoma. Their mean age was 67 years (median, 71 years). The most common site was the trunk (10 cases), followed by the head and neck (5 cases). The mean size of the tumor was 10cm (median, 6.5cm). Fourteen patients underwent surgical excision. Six of the 16 patients were alive at the end of the study, after a mean follow-up period of 42.5 months. CONCLUSIONS The major determinants of survival among patients with cutaneous angiosarcoma are tumor size and patient age. Other characteristics associated with a poor prognosis were infiltration of deep planes (muscle), a predominantly solid histologic pattern, and a larger number of mitoses.
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Affiliation(s)
- C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - E Sendra
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - J Lavernia
- Servicio de Oncología, Instituto Valenciano de Oncología, Valencia, España
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - J Cruz
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
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26
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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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Provenzano E, Pinder SE. Modern therapies and iatrogenic changes in breast pathology. Histopathology 2016; 70:40-55. [PMID: 27960235 DOI: 10.1111/his.13098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Iatrogenic changes within the breast can provide challenges for the histopathologist in routine practice. Diagnostic procedures, such as core biopsies, result in reactive changes and can cause displacement of benign and malignant cells, the interpretation of which may cause difficulties in the resection specimen. Breast augmentation surgery with implants or injection of fillers, performed for cosmetic reasons or as part of a reconstructive process following removal of breast cancer, also produces reactive changes locally and at distant sites that may mimic cancer. The entity of implant-associated anaplastic large-cell lymphoma is now well recognized, with progress in our understanding of the underlying biological factors that drive its development. Chemotherapy and radiotherapy used in the treatment of breast cancer causes characteristic changes in normal breast tissue, and can alter the histological appearance and receptor status of the tumour. Radiotherapy to the breast, for breast cancer or childhood malignancies, increases the risk of developing a secondary malignancy in the breast long after treatment. In this review, we describe some of the iatrogenic changes that may be seen in histological specimens from the breast.
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Affiliation(s)
- Elena Provenzano
- Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
| | - Sarah E Pinder
- Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
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Clinical and dermoscopic features of atypical abdominal brachytherapy-induced angiosarcoma. Postepy Dermatol Alergol 2016; 33:311-3. [PMID: 27605906 PMCID: PMC5004222 DOI: 10.5114/ada.2016.61609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/27/2015] [Indexed: 11/17/2022] Open
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Iacoponi S, Calleja J, Hernandez G, Sainz de la Cuesta R. Primary breast angiosarcoma in a young woman. Int J Surg Case Rep 2016; 24:101-3. [PMID: 27232295 PMCID: PMC4885116 DOI: 10.1016/j.ijscr.2016.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022] Open
Abstract
Angiosarcomas are rare malignant vascular tumors of the breast. They frequently are associated with previous breast radiotherapy. Total mastectomy without axillary lymphadenectomy appears to be the only treatment. Chemotherapy and radiotherapy have not proven any benefit in terms of survival.
Introduction Angiosarcomas of the breast are a rare subtype of sarcomas that frequently are diagnosed after radiation therapy for primary breast cancer. Primary angiosarcomas are rare entities accounting 0.05% of all malignant breast neoplasm. Presentation of Case We report a case of primary angiosarcoma of the breast in a 25 years woman, with no previous radiotherapy, treated with a total mastectomy followed by radio-chemotherapy. Discussion Total mastectomy appears to be the only treatment known that has proven to benefit these patients. Adjuvant treatment has not proven value up until today. The 5-year disease free survival for grade 1 tumors can be as high as 76%, and up to 15% for grade 3. Conclusion Due to the rarity of these tumors there is no standard therapies approach.
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Affiliation(s)
- Sara Iacoponi
- Gynecologic Oncology Unit. Quiron university hospital Madrid, Spain.
| | - Jackie Calleja
- Gynecologic Oncology Unit. Quiron university hospital Madrid, Spain
| | - Gines Hernandez
- Gynecologic Oncology Unit. Quiron university hospital Madrid, Spain
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Gill RM, Buelow B, Mather C, Joseph NM, Alves V, Brunt EM, Liu TC, Makhlouf H, Marginean C, Nalbantoglu ILK, Sempoux C, Snover DC, Thung SN, Yeh MM, Ferrell LD. Hepatic small vessel neoplasm, a rare infiltrative vascular neoplasm of uncertain malignant potential. Hum Pathol 2016; 54:143-51. [PMID: 27090685 DOI: 10.1016/j.humpath.2016.03.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/14/2016] [Accepted: 03/31/2016] [Indexed: 12/14/2022]
Abstract
Characteristic but rare vascular neoplasms in the adult liver composed of small vessels with an infiltrative border were collected from an international group of collaborators over a 5-year period (N=17). These tumors were termed hepatic small vessel neoplasm (HSVN), and the histologic differential diagnosis was angiosarcoma (AS). The average age of patients was 54years (range, 24-83years). HSVN was more common in men. The average size was 2.1cm (range, 0.2-5.5cm). Diagnosis was aided by immunohistochemical stains for vascular lineage (CD31, CD34, FLI-1), which were uniformly positive in HSVN. Immunohistochemical stains (p53, c-Myc, GLUT-1, and Ki-67) for possible malignant potential are suggestive of a benign/low-grade tumor. Capture-based next-generation sequencing (using an assay that targets the coding regions of more than 500 cancer genes) identified an activating hotspot GNAQ mutation in 2 of 3 (67%) tested samples, and one of these cases also had a hotspot mutation in PIK3CA. When compared with hepatic AS (n=10) and cavernous hemangioma (n=6), the Ki-67 proliferative index is the most helpful tool in excluding AS, which demonstrated a tumor cell proliferative index greater than 10% in all cases. Strong p53 and diffuse c-Myc staining was also significantly associated with AS but not with HSVN or cavernous hemangioma. There have been no cases with rupture/hemorrhage, disseminated intravascular coagulation, or Kasabach-Merritt syndrome. Thus far, there has been no metastasis or recurrence of HSVN, but complete resection and close clinical follow-up are recommended because the outcome remains unknown.
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Affiliation(s)
- Ryan M Gill
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143.
| | - Benjamin Buelow
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143
| | - Cheryl Mather
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143
| | - Nancy M Joseph
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143
| | - Venancio Alves
- Universidade de Sao Paulo, Department of Pathology, Sao Paulo, Brazil, 05508-090
| | - Elizabeth M Brunt
- Washington University, Department of Pathology and Immunology, St Louis, MO, United States, 63110
| | - Ta-Chiang Liu
- Washington University, Department of Pathology and Immunology, St Louis, MO, United States, 63110
| | | | - Celia Marginean
- Ottawa Hospital, Department of Pathology, Ottawa, Ontario, Canada, K1H 8L6
| | - ILKe Nalbantoglu
- Washington University, Department of Pathology and Immunology, St Louis, MO, United States, 63110
| | - Christine Sempoux
- Institut Universitaire de Pathologie, CHUV, Lausanne, Switzerland, CH-1011
| | - Dale C Snover
- Fairview Southdale Hospital, Edina, MN, 55435; Department of Laboratory Medicine and Pathology, The University of Minnesota Medical School, Minneapolis, MN, 55435
| | - Swan N Thung
- Mount Sinai Health System, Department of Pathology, NY, New York, United States, 10029
| | - Matthew M Yeh
- University. of Washington, Department of Pathology, Seattle, Washington, United States, 98195
| | - Linda D Ferrell
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143
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Hillenbrand T, Menge F, Hohenberger P, Kasper B. Primary and secondary angiosarcomas: a comparative single-center analysis. Clin Sarcoma Res 2015; 5:14. [PMID: 26413264 PMCID: PMC4582641 DOI: 10.1186/s13569-015-0028-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/14/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Angiosarcomas (AS) are rare vascular malignancies. They are subdivided into primary (PAS) and secondary angiosarcomas (SAS). The objective was to compare the characteristics of AS subtypes. METHODS Eighteen PAS and ten SAS patients treated at our institution between 2004 and 2012 were included in this study. RESULTS Median age of PAS and SAS patients was 52.9 and 64.2 years, respectively (p = 0.1448). The percentage of women was 27.8% for PAS, but 80.0% for SAS (p = 0.0163). While PAS occurred throughout the body, the majority of SAS arose from the breast (p = 0.0012). All SAS were radiation-induced with a median latency of 7.7 years. The majority of patients with PAS and SAS underwent surgery as primary or recurrence treatment (p > 0.95). Local recurrence was developed by 27.8% of PAS and 50.0% of SAS (p = 0.4119). 61.1% of PAS metastasized, but only 40.0% of SAS (p = 0.4328). Median overall survival for PAS and SAS was 19 and 57 months, respectively (p = 0.2306). CONCLUSION Radical surgery remains the mainstay of both primary and recurrence treatment. SAS show a high local recurrence rate, while PAS tend towards developing early metastases. Overall, prognosis is poor for both groups.
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Affiliation(s)
- Thorsten Hillenbrand
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Franka Menge
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Peter Hohenberger
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Kanokrungsee S, Vachiramon V, Sirithanabadeekul P. The 'pantie' tumour. Case Rep Dermatol 2015; 6:274-8. [PMID: 25566052 PMCID: PMC4280461 DOI: 10.1159/000369992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We present a case of radiation-associated angiosarcoma. A 67-year-old Thai woman was diagnosed with endometrium carcinoma stage IC and was treated with surgery and radiations. Ten years later, she presented with a gradually enlarging mass on the pubic area, in the shape of a pair of panties. Skin biopsy of lesions confirmed angiosarcoma. The diagnosis was radiation-associated angiosarcoma. She was treated with chemotherapy due to unresectable tumour. The chemotherapy was started with paclitaxel 70 mg/m2 every 2 weeks. After completing the fifth cycle of paclitaxel, the lesion was markedly decreased in size and the symptoms previously described were also completely resolved.
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Affiliation(s)
- Silada Kanokrungsee
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Punyaphat Sirithanabadeekul
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ; Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Khlong Luang, Thailand
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