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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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Reijers SJM, Huis In 't Veld EA, Grünhagen DJ, Smith MJF, van Ginhoven TM, van Coevorden F, van der Graaf WTA, Schrage Y, Strauss DC, Haas RLM, Verhoef CJ, Hayes AJ, van Houdt WJ. Prognosis of Patients with Cutaneous Angiosarcoma After Surgical Resection with Curative Intent: Is There a Difference Between the Subtypes? Ann Surg Oncol 2023; 30:493-502. [PMID: 36209324 DOI: 10.1245/s10434-022-12601-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/09/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The etiology of cutaneous angiosarcoma (cAS) may be idiopathic (I-cAS), or arise secondary to radiotherapy (RT-cAS), in chronic lymphedema (ST-cAS), or related to UV exposure (UV-cAS). The aim of this study was to evaluate oncological outcomes of different cAS subtypes. PATIENTS AND METHODS Non-metastatic cAS patients, treated with surgery for primary disease with curative intent, were retrospectively analyzed for oncological outcome, including local recurrence (LR), distant metastases (DM), and overall survival (OS). RESULTS A total of 234 patients were identified; 60 I-cAS, 122 RT-cAS, 9 ST-cAS, and 43 UV-cAS. The majority was female (78%), the median age was 66 years (IQR 57-76 years), the median tumor size was 4.4 cm (IQR 2.5-7.0 cm), and most common site of disease was the breast (59%). Recurrence was identified in 66% (44% LR and/or 41% DM), with a median follow up of 26.5 months (IQR 12-60 months). The 5-year OS was estimated at 50%, LRFS at 47%, and DMFS at 50%. There was no significant difference in LR, DM, or OS between the subtypes. Age < 65 years and administration of radiotherapy (RT) were significantly associated with lower LR rates (HR 0.560, 95% CI 0.3373-0.840, p = 0.005 and HR 0.421, 95% CI 0.225-0.790, p = 0.007, respectively), however no prognostic factors were identified for development of DM. Development of DM, but not LR (p = 0.052), was significantly associated with decreased OS (HR 6.486, 95% CI 2.939-14.318 p < 0.001). CONCLUSION We found no significant difference in oncological outcome between the different cAS subtypes. OS remains relatively poor, and RT is associated with lower LR rates.
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Affiliation(s)
- Sophie J M Reijers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Myles J F Smith
- Department of Surgical Oncology, Royal Marsden Hospital, London, UK
| | - Tessa M van Ginhoven
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frits van Coevorden
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dirk C Strauss
- Department of Surgical Oncology, Royal Marsden Hospital, London, UK
| | - Rick L M Haas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelis J Verhoef
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andrew J Hayes
- Department of Surgical Oncology, Royal Marsden Hospital, London, UK
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Cren PY, Cordoba A, Maindiaux L, Lebellec L. Re: Chemotherapy in patients with localized angiosarcoma of any site. A retrospective European study. Eur J Cancer 2022; 175:41-42. [PMID: 36087396 DOI: 10.1016/j.ejca.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Pierre-Yves Cren
- Département d'Oncologie Médicale, Centre Oscar Lambret, Lille, France.
| | - Abel Cordoba
- Département Universitaire de Radiothérapie, Centre Oscar Lambret, Lille, France
| | - Laure Maindiaux
- Département d'Oncologie Médicale, Centre Oscar Lambret, Lille, France
| | - Loïc Lebellec
- Département d'Oncologie Médicale, Centre Oscar Lambret, Lille, France
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Colmant C, Turpin S, Lambert R, Wong N, Ondrejchak S, Lapointe C, Powell J, Dubois J, McCuaig C. Pediatric Lymphedema: Study of 180 Patients Referred to a Tertiary Lymphedema Clinic. J Cutan Med Surg 2022; 26:502-511. [PMID: 35848765 DOI: 10.1177/12034754221112002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Lymphedema is due to dysfunction of the lymphatic system. It can be primary or secondary. Pediatric lymphedema is more often primary and is a chronic disease with a heavy burden on quality of life. METHODS Medical records of patients under 18 years of age referred between 1996 and 2021 to the specialized lymphedema clinic at the Sainte-Justine University Hospital Center were reviewed. Demographic data, sex, age at presentation, location of the lymphedema, clinical features, genetic testing, symptoms, complications, investigations, and treatment were collected. RESULTS Of 180 referred patients, lymphedema was confirmed in 151, and 137 were primary lymphedema. Median age of apparition of primary lymphedema was 7.00 years and was significantly lower in boys than in girls. Primary congenital lymphedema was more frequent in boys (51.0%, 27.3% in girls, P = .007), and onset of primary lymphedema during adolescence was more frequent in girls (53.4%, 25.0% in boys, P = .001). Lower limbs were the most impacted (88.3%). Sixty patients had genetic testing, and 38 (63.3%) of them were discovered to have a pertinent genetic mutation. The most common mutated gene was the FLT4 gene (in 9 patients). Seven patients (5.1%) had associated extensive/central lymphatic malformation and 24 (17.6%) had a polymalformative syndrome/syndromic lymphedema. CONCLUSIONS Pediatric lymphedema is more frequent in girls, usually involves lower limb, and is most often sporadic, but often associated with a genetic mutation, and genetic testing should be performed.
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Affiliation(s)
- Caroline Colmant
- 25461 Dermatology Division, Department of Pediatrics, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Sophie Turpin
- 25461 Nuclear Medicine Division, Department of Medical Imaging, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Raymond Lambert
- 25461 Nuclear Medicine Division, Department of Medical Imaging, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Nicole Wong
- 25461 Dermatology Division, Department of Pediatrics, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Sandra Ondrejchak
- 25461 Vascular Anomalies Nurse, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Chantal Lapointe
- 25461 Physiotherapy, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Julie Powell
- 25461 Dermatology Division, Department of Pediatrics, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Josée Dubois
- 25461 Department of Medical Imaging, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
| | - Catherine McCuaig
- 25461 Dermatology Division, Department of Pediatrics, Sainte-Justine University Hospital Center University of Montreal, Montreal, Quebec, Canada
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Jiang T, Ye Z, Shao T, Luo Y, Wang B. Prognostic nomograms for predicting overall survival and cancer-specific survival in patients with angiosarcoma, a SEER population-based study. Sci Rep 2022; 12:3479. [PMID: 35241714 PMCID: PMC8894406 DOI: 10.1038/s41598-022-07444-5] [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: 04/15/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
Angiosarcoma (AS) is a kind of highly aggressive cancer with high occurrence and mortality rates. This study aimed to establish a comprehensive and validated prognostic nomogram with various clinical indicators in non-metastatic AS patients after surgery. Data of non-metastatic AS patients diagnosed after surgery between 2010 and 2015 was retrieved from the surveillance epidemiology and end results database. Univariate and multivariate Cox proportional hazards regression analysis were performed to identify the independent prognostic factors associated with survival to construct the predictive nomogram of 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates. Concordance-index (C-index), calibration plots and receiver operating characteristic (ROC) curves were applied to evaluate the predictive ability of the nomograms. 251 patients in total were divided into the training group (N = 177) and the validation group (N = 74). After the multivariate Cox regression analysis, gender, AJCC stage group 7th ed, T, N stage 7th ed, histologic grade and primary site were statistically identified as independent factors with OS and CSS (P < 0.05). We incorporated the significant factors above and age into nomograms. The C-index of the nomograms for OS and CCS in the training cohort was 0.757 (95%CI 0.697–0.817) and 0.762 (95%CI 0.702–0.822), meanwhile, the C-index of those in the validation cohort was 0.749 (95%CI 0.668–0.830) and 0.756 (95%CI 0.676–0.836) respectively. The results of calibration plots and ROC curve showed the nomograms qualified to measure the risk and prognosis. Our study has developed novel and practical nomograms for predicting prognosis in patients with non-metastatic AS after surgery contributing to cancer management.
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Affiliation(s)
- Ting Jiang
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Zixiang Ye
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, China
| | - Tianyu Shao
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Yiyang Luo
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Binbin Wang
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China.
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