1
|
Rehman S, Harikrishna A, Silwal A, Sumie BR, Mohamed S, Kolhe N, Maddi M, Huynh L, Gutierrez J, Annepu YR, Farrukh AM. Ovarian angiosarcoma: A systematic review of literature and survival analysis. Ann Diagn Pathol 2024; 73:152331. [PMID: 38811255 DOI: 10.1016/j.anndiagpath.2024.152331] [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: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
Ovarian angiosarcoma (OA) is rare, with only sporadic cases reported in English literature. We performed a systematic review of cases published in the PubMed, Science Direct, and Google Scholar databases with the aim of describing the reported clinicopathological features of OA. Fifty-three articles that reported 60 patients were reviewed. Of the 60 patients, 7 (11.6 %) were diagnosed with secondary (metastatic) ovarian angiosarcoma and 53 (88.3 %) were diagnosed with primary ovarian angiosarcoma. The mean age at presentation for ovarian angiosarcoma was 38.3±17.8 years. The average tumor size for ovarian angiosarcoma was 11.9±6.1 cm. Abdominal distention was reported in 45/60 (75 %). Microscopic examination revealed necrosis in 28/60 (46.7 %), pleomorphism in 32/59 (54.2 %), mitotic figures in 44/60 (73.3 %), spindle-shaped cells in 27/36 (75 %), epithelioid-shaped cells in 20/36 (55.5 %), and mixed epithelioid and spindle-shaped cells in 12/36 (33.3 %) patients. On immunohistochemistry CD 31 was positive in 41/41 (100 %), CD 34 in 38/39 (97.4 %), and Factor VIII related antigen in 18/21 (85.7 %) patients. Metastasis was present in 43/60 (71.6 %) patients. Chemotherapy and surgery was performed in 36/52 (69.2 %). The median follow-up time for ovarian angiosarcoma was 7 months (IQR1-IQR3:2-13.5 months). 24 (48 %) of the 50 patients with available survival data were alive and 26/50 (52 %) were dead of disease. Survival analyses (KM curves) revealed that the presence of necrosis (log-rank test; p = 0.05) and absence of spindle-shaped cells (log rank test; p = 0.04) on histopathology were associated with worse outcomes, while treatment with combined chemotherapy and surgical excision was associated with better survival (P < 0.001) therefore, prompt diagnosis and early treatment with combined chemotherapy and surgical excision can prolong survival in OA.
Collapse
Affiliation(s)
- Shafi Rehman
- Department of Histopathology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Pakistan.
| | | | - Amisha Silwal
- Cagayan State University College of Medicine, Philippines
| | - B R Sumie
- KMCH Medical College Hospital, India
| | - Safdar Mohamed
- Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of Moldova
| | | | - Meghana Maddi
- Kamineni Academy of Medical Sciences and Research Center, Hyderabad, India
| | - Linh Huynh
- Kansas College of Osteopathic Medicine, United States of America
| | | | | | | |
Collapse
|
2
|
Peng X, Duan Z, Yin H, Dai F, Liu H. Ovarian epithelioid angiosarcoma complicating pregnancy: a case report and review of the literature. J Int Med Res 2021; 49:3000605211019641. [PMID: 34039070 PMCID: PMC8168035 DOI: 10.1177/03000605211019641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Epithelioid angiosarcoma is a rare and highly aggressive soft tissue angiosarcoma most commonly arising in the deep soft tissues. Given that abundant vascular cavities anastomose with each other, most angiosarcomas prone to metastasis recur quickly, and the overall prognosis is poor. We report a 25-year-old woman at 24 weeks’ gestation who presented with a 1-month history of abdominal distension. Ultrasonography suggested a mass in the right adnexa, and she underwent two operations owing to uncontrolled intraperitoneal bleeding with progressive anemia. The right ovarian tumor and right adnexa were removed successively. Biopsy yielded a diagnosis of primary epithelioid angiosarcoma with mature cystic teratoma. The patient died from uncontrolled progressive bleeding 1 week after the second operation. This case revealed that epithelial angiosarcoma is a highly malignant endothelial cell tumor. The results of surgery and chemoradiotherapy tend to be poor, and the recurrence rate is high. The purpose of this study is to raise clinical awareness of epithelial angiosarcoma and its adverse events and to provide new ideas for the treatment of these adverse events. Immunohistochemical staining of pathological specimens can facilitate diagnosis. Pregnancy with malignant tumors may lead to rapid disease progression, extensive lesions, and a poor prognosis.
Collapse
Affiliation(s)
- Xiaotong Peng
- Department of Gynecology and Obstetrics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Zhi Duan
- Department of Pathology, The First Hospital of Changsha City, Changsha, Hunan, China
| | - Hongling Yin
- Department of Pathology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Furong Dai
- Department of Gynecology and Obstetrics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Huining Liu
- Department of Gynecology and Obstetrics, Xiangya Hospital Central South University, Changsha, Hunan, China
| |
Collapse
|
3
|
Primary ovarian angiosarcoma: a rare and recognizable ovarian tumor. J Ovarian Res 2021; 14:21. [PMID: 33509230 PMCID: PMC7844967 DOI: 10.1186/s13048-021-00771-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/20/2021] [Indexed: 01/21/2023] Open
Abstract
The diagnosis of primary angiosarcoma of ovary is still a challenge as it has no specific clinical symptoms and is easily confused with other malignant neoplasms in morphology. Here, we described a case of primary ovarian angiosarcoma and reviewed the literature. A 47-year-old female showed a left ovary mass. Grossly, the cut surface of the tumor was solid and gray-white with intermediate texture. Some areas were spongy and atropurpureus with a soft texture. Microscopically, the tumor cells were arranged into a variety of different structures with visible hemorrhage. Immunochemically, the tumor cells were positive for CD31, ERG, Fli1, D2-40 and vimentin in a strong and diffused manner. CD34 stain showed focal positivity. Epithelial markers (e.g. CK, CK7, CK8/18 and PAX8) were all negative. Negative immunostaining for SMA, S-100, P53 and calretinin also were detected. The proliferative index (Ki-67) was approximately 40%. After surgery, the patient was treated with radiotherapy, targeted therapy and immunotherapy. In the 9-month follow-up, the patient was survival without evidence of disease. The diagnosis of ovarian angiosarcoma required the careful observation of morphology and the reasonable application of immunohistochemistry. Targeted therapy and immunotherapy are the potential directions for the treatment of angiosarcoma.
Collapse
|
4
|
Rezk A, Richards S, Patricia Castillo R, Schlumbrecht M. Anastomosing hemangioma of the ovary mimics metastatic ovarian cancer. Gynecol Oncol Rep 2020; 34:100647. [PMID: 33005720 PMCID: PMC7509397 DOI: 10.1016/j.gore.2020.100647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022] Open
Abstract
Anastomosing hemangioma of the ovary is a benign neoplasm. It may present with features similar to invasive ovarian carcinoma. Radiology, pathology, and clinical correlation are important for diagnosis.
Anastomosing hemangioma (AH) is an uncommon benign vascular tumor reported to occur in the kidney and, in rare instances, the ovary. While most cases of AH in the ovary are incidental findings, we report a case of ovarian AH presenting with abdominal ascites and elevated CA-125 suggestive of metastatic ovarian cancer. Postoperative histopathologic examination demonstrated a tumor consisting of numerous vascular spaces lined by benign-appearing endothelial cells with exuberant hilus cell hyperplasia. These characteristics led to the diagnosis of anastomosing hemangioma of the ovary. A summary of the characteristics of AH, along with a review of all previously reported cases and possible theories for its presentation, are discussed.
Collapse
Affiliation(s)
- Andrew Rezk
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephanie Richards
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - R Patricia Castillo
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Matthew Schlumbrecht
- Sylvester Comprehensive Cancer Center, Miami, FL, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
5
|
Nath AG, Rema P, Suchetha S, Radhakrishnan N. Angiosarcoma Ovary and Kasabach–Merritt Syndrome in a Pre-pubertal Girl: An Exceedingly Rare Case Report. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00427-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
6
|
Thankamony P, Chandar R, Kattoor J, Nair RK. Pediatric Primary Ovarian Angiosarcoma: From Rarity to a Realization. J Pediatr Adolesc Gynecol 2018; 31:629-631. [PMID: 30179666 DOI: 10.1016/j.jpag.2018.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/18/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Angiosarcoma is an uncommon high-grade sarcoma in children. Visceral angiosarcoma involving the ovary is extremely rare. Because of the lack of recurrent cytogenetic alterations, histopathological identification of this uncommon tumor in unusual sites like the ovary demands pathologic expertise. Complete surgical resection and radiotherapy are the chief treatment modalities determining survival, with chemotherapy contributing a minor role. CASE We discuss a 11-year-old prepubertal girl who presented with primary angiosarcoma of the ovary. SUMMARY AND CONCLUSION Early realization of such exceptional presentations of these tumors is needed to achieve the best treatment outcome.
Collapse
Affiliation(s)
| | - Rumesh Chandar
- Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Jayasree Kattoor
- Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
| | | |
Collapse
|
7
|
Novel Therapy for Pediatric Angiosarcoma With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. J Pediatr Hematol Oncol 2018; 40:e505-e510. [PMID: 29863582 DOI: 10.1097/mph.0000000000001231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The management of pediatric abdominopelvic angiosarcoma remains unclear due to limited clinical experience. Herein, we presented the first 2 pediatric patients with abdominal angiosarcoma who were treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant therapy. The first patient is alive with recurrent disease at 1-year follow-up and the second patient remains disease free after 1 year. CRS and HIPEC should be considered as a therapeutic option in the management of pediatric abdominal angiosarcomas. A multi-institutional international shared registry is needed to further evaluate the role of CRS and HIPEC in inducing remission of abdominopelvic angiosarcomas in the pediatric population.
Collapse
|
8
|
Kudela E, Nachajova M, Biringer K, Slavik P, Plank L, Danko J. Bilateral ovarian angiosarcoma arising from the mature cystic teratomas - A case report and review of the literature. Int J Surg Case Rep 2017; 42:90-93. [PMID: 29227858 PMCID: PMC5726881 DOI: 10.1016/j.ijscr.2017.11.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Ovarian teratomas undergo the malignant transformation in 0.2-2% of cases. The behavior of malignancies in mature cystic teratomas (MCT) is determined by their phenotype and not their derivation from germ cells. We can recognize pure angiosarcomas or as a part of other tumors like malignant mixed Mullerian tumors and adenosarcomas. PRESENTATION OF CASE We present the first case of bilateral ovarian angiosarcoma arising from the mature teratomas. Due to widespread disease, we performed limited surgical procedure consisting of bilateral adnexectomy and omentectomy. Exploratory laparotomy in 44-year old patient showed massive ascites, necrotic tissue of omentum and bilateral tumors originating from both ovaries measuring 8 and 6cm with necrotic surface. Immunohistochemistry of the tumors showed positive staining for CD31, vimentin, desmin and focal positivity for CD34. DISCUSSION Sarcomas of gynecologic origin are extremely rare tumors. They present with unspecified symptoms and are diagnosed in late stages of the disease. The appropriate management of angiosarcomas is difficult due to the rarity of disease and late stage of the diseases. Surgical therapy should contain the hysterectomy with bilateral salpingo-oophorectomy and omentectomy. Pelvic lymphadenectomy was not performed in published cases with no effect on patient survival. CONCLUSION This work summarizes the current knowledge in the diagnosis and treatment of angiosarcomas arising in the mature teratomas. Promising results are expected from the trials devoted to antiangiogenic strategies in treatment of aggressive sarcomas.
Collapse
Affiliation(s)
- Erik Kudela
- Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia.
| | - Marcela Nachajova
- Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Kamil Biringer
- Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Pavol Slavik
- Institute of Pathological Anatomy, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Lukas Plank
- Institute of Pathological Anatomy, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Jan Danko
- Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| |
Collapse
|
9
|
Yonezawa I, Waki M, Tamura Y, Onoda R, Narushima M, Ishizuka T, Tajima S. Gemcitabine-based regimen for primary ovarian angiosarcoma with MYC amplification. ACTA ACUST UNITED AC 2014; 21:e782-9. [PMID: 25489268 DOI: 10.3747/co.21.2144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Angiosarcoma is a rare and aggressive type of sarcoma, and primary angiosarcoma of the ovary is extremely rare. We report the case of a 29-year-old woman who was diagnosed with ovarian angiosarcoma and possible bone metastases. We treated this patient with a gemcitabine-based regimen as postoperative adjuvant chemotherapy, after which she achieved at least 7 years of progression-free survival, an extremely long duration given the aggressive features of this tumour. We retrospectively performed immunohistochemical analyses and fluorescence in situ hybridization to make a pathology diagnosis and to investigate the tumour features. MYC amplification and c-Myc protein overexpression were positively detected. It might be possible to correlate the effectiveness of the gemcitabine-based chemotherapeutic regimen with MYC gene amplification and c-Myc protein overexpression.
Collapse
Affiliation(s)
- I Yonezawa
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - M Waki
- Cell Biology and Anatomy, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Y Tamura
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - R Onoda
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - M Narushima
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - T Ishizuka
- Obstetrics and Gynecology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - S Tajima
- Pathology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| |
Collapse
|
10
|
Guseh SH, Bradford LS, Hariri LP, Schorge JO. Ovarian angiosarcoma: Extended survival following optimal cytoreductive surgery and adjuvant chemotherapy. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 4:23-5. [PMID: 24371666 DOI: 10.1016/j.gynor.2012.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/08/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie H Guseh
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, USA ; Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital, USA
| | - Leslie S Bradford
- Division of Gynecologic Oncology, Massachusetts General Hospital, USA
| | - Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, USA
| | - John O Schorge
- Division of Gynecologic Oncology, Massachusetts General Hospital, USA
| |
Collapse
|
11
|
Xu Z, Padmore R, Faught C, Duffet L, Burns BF. Langerhans cell sarcoma with an aberrant cytoplasmic CD3 expression. Diagn Pathol 2012; 7:128. [PMID: 23006414 PMCID: PMC3502395 DOI: 10.1186/1746-1596-7-128] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/23/2012] [Indexed: 12/13/2022] Open
Abstract
Abstract Langerhans cell sarcoma is a rare and aggressive high grade hematopoietic neoplasm with a dismal prognosis. It has a unique morphological and immunotypic profile with a CD1a/ langerin/S100 + phenotype. T cell lineage markers except for CD4 in Langerhans cell sarcoma have not been documented previously. We report a case of 86 year-old male of Caucasian descent who presented with an enlarging right neck mass over 2 months with an underlying unknown cause of anemia. Computed tomography scan of the neck, chest and abdomen revealed generalized lymphadenopathy and mild splenomegaly suspicious for lymphoma. Diagnostic core biopsy performed on right neck mass revealed a possible T cell lymphoma with expression of T cell lineage specific marker CD3 but conclusive diagnosis could not be made due to insufficient core biopsy sample. Further excisional biopsy performed on a left inguinal node showed a hematopoietic neoplasm with features of Langerhans cell sarcoma with a focal cytoplasmic CD3 expression in 30-40% of the tumor cells. PCR for T cell receptor (TCR) gene rearrangement failed to demonstrate a clonal gene rearrangement in the tumor cells arguing against a T cell lineage transdifferentiation, suggesting an aberrant CD3 expression. To the best of our knowledge, this case represents the first report of Langerhans cell sarcoma with an aberrant cytoplasmic CD3 expression. Virtual slides http://www.diagnosticpathology.diagnomx.eu/vs/2065486371761991
Collapse
Affiliation(s)
- Zhaodong Xu
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | | | | | | | | |
Collapse
|
12
|
Lin XY, Liu Y, Zhang Y, Yu JH, Wang EH. The co-expression of cytokeratin and p63 in epithelioid angiosarcoma of the parotid gland: a diagnostic pitfall. Diagn Pathol 2012; 7:118. [PMID: 22943673 PMCID: PMC3487964 DOI: 10.1186/1746-1596-7-118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 08/10/2012] [Indexed: 01/21/2023] Open
Abstract
Summary Epithelioid angiosarcoma of the parotid gland is rare, and may pose a great diagnostic challenge. We report a case of primary epithelioid angiosarcoma in a 64-year-old male without history of radiation. The histopathological findings demonstrated a high grade epithelioid neoplasm. Immunostaining showed that the tumor was positive for the pan-cytokeratin, p63, cytokeratin18, Vimentin and vascular markers CD31, and was negative for CD34, cytokeratin5/6, cytokeratin7, cytokeratin20, CD68, CD30, S-100, HMB45, desmin, α–SMA and CD45. The tumor was diagnosed as an epithelioid angiosarcoma. To our knowledge, this is the first reported case of angiosarcoma which showed common positivity for cytokeratin and p63. In addition to cytokeratin, p63 is considered a useful marker for carcinoma. The co-expression of cytokeratin and p63 in epithelioid angiosarcoma represents a diagnostic pitfall. Thus, using a panel of antibodies is essential for distinguishing this tumor from poorly differentiated carcinoma. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/6548916707504750
Collapse
Affiliation(s)
- Xu-Yong Lin
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China
| | | | | | | | | |
Collapse
|
13
|
Pelvic Angiosarcoma Occurring in a Postmenopausal Female: Case Report and Review of the Literature. Pathol Oncol Res 2012; 19:135-9. [DOI: 10.1007/s12253-012-9540-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 05/17/2012] [Indexed: 01/18/2023]
|
14
|
Abstract
Primary angiosarcoma of the breast is a rare tumour that account for fewer than 0.05% of all malignant mammary tumours. Angiosarcoma may have an perfidious clinical onset. Radiologic findings are often nonspecific 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 metastases. Aggressive surgical resection is the mainstay of treatment. The role of adjuvant therapy has not yet been well established. Here we present a case of a 53 year old, postmenopausal women with primary angiosarcoma arising in fibroadenoma. To our knowledge, this is the first case described in the literature to date.
Collapse
|