1
|
Nehila T, Bair C, Alford N, Dayicioglu D. Radiation-Induced Angiosarcoma in a Patient With Klippel-Trenaunay Syndrome: A Case Report. EPLASTY 2024; 24:e46. [PMID: 39224409 PMCID: PMC11367161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background Klippel-Trenaunay syndrome (KTS) is a rare vascular disorder that typically presents in the lower limb with unilateral port-wine discoloration of the skin due to capillary malformations, varicose veins, and soft tissue and bone overgrowth. Radiation-induced angiosarcoma (RIAS) is a rare vascular malignancy that develops as a long-term complication secondary to radiation therapy. While there is no well-established direct relationship between KTS and development of angiosarcoma, there is literature that suggests a logical association between the 2 disorders. The present case report highlights the importance of further research into a potential connection between KTS and RIAS. Methods A 51-year-old female with a history of KTS was referred to the plastic surgery clinic for delayed breast reconstruction following RIAS of the left breast. It was decided that a 2-stage left latissimus dorsi musculocutaneous flap reconstruction with silicone implant would best achieve her goal of symmetry. Results The patient reported here had an unremarkable postoperative course. Of note, this patient experienced severe body dysmorphia after her mastectomy and RIAS excision due to the absence of her left breast juxtaposed with her prior large right breast augmentation. The choice of 2-stage combined autologous/implant reconstruction likely contributed to her satisfactory cosmetic outcome. Conclusions While RIAS and KTS are distinct conditions, a link may exist between the two. More research is needed to investigate this possible relationship. Aggressive treatment of RIAS is crucial for patient recovery, and a 2-stage combined autologous/implant reconstruction is an optimal choice for post-RIAS reconstruction, especially in patients hoping to achieve a large breast size.
Collapse
Affiliation(s)
- Timothy Nehila
- USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida
- Department of Plastic Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Carson Bair
- USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida
- Department of Plastic Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Nicholas Alford
- USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida
- Department of Plastic Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Deniz Dayicioglu
- USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida
- Department of Plastic Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida
| |
Collapse
|
2
|
Cozzi S, Finocchi Ghersi S, Tava F, Bardoscia L, Najafi M, Ruggieri MP, Serre AA, Roukoz C, Gutierrez Miguelez C, Lazrek A, Sardaro A, Taverna C. Radiation-Associated Angiosarcoma of the Breast: The State of the Art of a Rare and Aggressive Disease. J Pers Med 2024; 14:859. [PMID: 39202050 PMCID: PMC11355165 DOI: 10.3390/jpm14080859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Considering the increasing number of conservative surgeries (quadrantectomies) for primary breast carcinoma, especially in the early stages, often followed by adjuvant radiotherapy, the incidence of radiation-associated angiosarcoma (RAS) is expected to rise in the coming decades, and it will represent a clinical and therapeutic challenge, as limited data are available due to the rarity and heterogeneity of the disease. Though the prognosis of these patients is poor, a number of clinical and pathological factors can be evaluated to better understand the course of RAS. The aim of this systematic review is to explore the available clinical-pathological, therapeutic, and prognostic data regarding RAS to evaluate its occurrence, diagnosis, treatment, and outcomes. METHOD RAS clinical data were identified by a systematic review conducted in five different databases (Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane). Only RAS works published in English, with access to the full manuscript text, and with clear results, were considered as eligible. RESULTS We considered 52 papers comprising 319 RAS cases. The patient age at diagnosis ranged from 37 to 93 years, with most cases occurring from 5 to 10 years after breast irradiation. The most common clinical presentation was an aggressive development of macules, papules, or erythematous-violaceous skin discoloration at the site of previous radiation treatment for primary breast carcinoma. Complete surgical excision appeared to be the first-line treatment of the disease, in some cases followed by adjuvant local and/or systemic therapies. Despite different treatments, local recurrence rates ranged from 40% to 90%, leading to negative outcomes and poor prognosis for patients. CONCLUSION Although the literature is limited and the data are heterogeneous and contentious, our review aims to highlight the importance of early diagnosis, multimodal treatment, and long-term follow-up of RAS in order to limit and prevent the aggressiveness of this neoplasm.
Collapse
Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Department, Centre Léon Bérard, 69373 Lyon, France; (A.-A.S.); (C.R.)
| | - Sebastiano Finocchi Ghersi
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.F.G.); (M.P.R.)
| | - Francesca Tava
- Pathology Unit, Azienda Sanitaria Locale, Ospedale San Giacomo, 15067 Novi Ligure, Italy; (F.T.); (C.T.)
| | - Lilia Bardoscia
- Radiation Oncology Unit, San Luca Hospital, AUSL Toscana Nord Ovest, 55100 Lucca, Italy
| | - Masoumeh Najafi
- Department of Radiation Oncology, Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran 1997667665, Iran;
| | - Maria Paola Ruggieri
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.F.G.); (M.P.R.)
| | - Anne-Agathe Serre
- Radiation Oncology Department, Centre Léon Bérard, 69373 Lyon, France; (A.-A.S.); (C.R.)
| | - Camille Roukoz
- Radiation Oncology Department, Centre Léon Bérard, 69373 Lyon, France; (A.-A.S.); (C.R.)
| | - Cristina Gutierrez Miguelez
- Brachytherapy Unit, Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Amina Lazrek
- Radiation Oncology Unit, International University Hospital Cheikh Zaid, Rabat 10000, Morocco;
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Cecilia Taverna
- Pathology Unit, Azienda Sanitaria Locale, Ospedale San Giacomo, 15067 Novi Ligure, Italy; (F.T.); (C.T.)
- Department of Health Sciences, Università del Piemonte Orientale UNIUPO, 28100 Novara, Italy
| |
Collapse
|
3
|
Rhoul C, Kharkhach A, Aabdi H, Atmani A, Mhand M, Seghrouchni N, Amal B, Bouhout T, Serji B, El Harroudi T. Radiation-induced angiosarcoma of the breast: a case report. Ann Med Surg (Lond) 2023; 85:5047-5050. [PMID: 37811031 PMCID: PMC10553051 DOI: 10.1097/ms9.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 07/31/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Breast angiosarcoma is a rare, aggressive tumour affecting adult women. It can occur in two forms, primary form and secondary forms or radiation-induced breast angiosarcoma affecting patients with history of breast or chest radiotherapy. Case presentation The authors report a new case of breast angiosarcoma in 52-year-old women, with history of invasive ductal carcinoma, and reporting a discoloration of her breast skin. The patient did undergo a mastectomy of right breast and adjuvant chemotherapy. Conclusion/discussion Surgery with total excision associated or not to adjuvant chemotherapy remains the treatment of choice in breast angiosarcoma.
Collapse
Affiliation(s)
- Chafik Rhoul
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Ayoub Kharkhach
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Houssam Aabdi
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Abderrahman Atmani
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Mohammed Mhand
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Noura Seghrouchni
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Pathology, Mohammed VI University Hospital Oujda Morocco
| | - Bennani Amal
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Pathology, Mohammed VI University Hospital Oujda Morocco
| | - Tarik Bouhout
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Badr Serji
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| | - Tijani El Harroudi
- Faculty of Medicine and Pharmacy, Mohammed Ist university
- Department of Oncological Surgery, Regional oncology Center
| |
Collapse
|
4
|
Mergancová J, Lierová A, Coufal O, Žatecký J, Melichar B, Zedníková I, Mergancová J, Jesenková A, Šťastný K, Gatěk J, Kubala O, Prokop J, Dyttert D, Karaba M, Schwarzbacherová I, Humeňanská A, Šuk J, Valenta M, Moucha V, Sákra L, Hlávka A, Hácová M, Vojtíšek R, Sochor M, Jirásek T, Zábojníková M, Zemanová M, Macháleková K, Rusnáková D, Kúdelová E, Smolár M. Radiation-associated angiosarcoma of the breast: An international multicenter analysis. Surg Oncol 2022; 41:101726. [DOI: 10.1016/j.suronc.2022.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/27/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
de Oliveira LAA, de Pádua AF, Medeiros e Melo MA, Galvão ERDCGN, Vieira MC, Ibiapina JO, Fontinele DRDS, Vieira SC. Radiation-induced angiosarcoma: case report. EINSTEIN-SAO PAULO 2020; 18:eRC5439. [PMID: 33295433 PMCID: PMC7690932 DOI: 10.31744/einstein_journal/2020rc5439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 06/12/2020] [Indexed: 12/03/2022] Open
Abstract
Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named "radiogenic angiosarcoma of the breast", which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Sabas Carlos Vieira
- Universidade Federal do PiauíTeresinaPIBrazilUniversidade Federal do Piauí, Teresina, PI, Brazil.
| |
Collapse
|
7
|
Primary Leiomyosarcoma of the Calvarium with Intracranial Extension: a Case Report. Indian J Surg Oncol 2020; 11:165-169. [PMID: 33364689 DOI: 10.1007/s13193-020-01129-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 06/08/2020] [Indexed: 11/27/2022] Open
|
8
|
Bonito FJP, de Almeida Cerejeira D, Dahlstedt-Ferreira C, Oliveira Coelho H, Rosas R. Radiation-induced angiosarcoma of the breast: A review. Breast J 2019; 26:458-463. [PMID: 31448482 DOI: 10.1111/tbj.13504] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 01/07/2023]
Abstract
Angiosarcoma is a rare, aggressive malignant vascular neoplasm with poor prognosis that has a predilection for skin and superficial soft tissue. It can arise spontaneously or in association with factors like chronic lymphedema or radiation therapy. Radiotherapy used to treat invasive breast tumors is a known risk factor for the development of the so-called radiation-induced angiosarcoma (RIAS), a condition that has been described in the literature with increasing frequency. Radiation-induced angiosarcoma of the breast usually arises on the previously irradiated skin area several years after radiotherapy and presents as painless multifocal erythematous patches or plaques similar to a hematoma. Cutaneous biopsy is essential for the diagnosis. Histologically, RIAS is characterized by irregular anastomosing vessels lined by endothelial cells showing nuclear atypia. Treatment is mostly surgical, and mastectomy with negative margins is considered the standard procedure. However, recurrences are common, and an approach combining surgery, chemo- and radiotherapy may be more effective. The purpose of this study is to review the most recent medical literature on RIAS of the breast, with emphasis on its pathophysiology, clinical and histological features and current treatment options.
Collapse
Affiliation(s)
| | | | | | | | - Rosalina Rosas
- Department of Anatomic Pathology, Hospital Garcia de Orta E.P.E., Almada, Portugal
| |
Collapse
|
9
|
Zacher M, Heppt MV, Brinker TJ, Hayani KM, Flaig MJ, Berking C. Primary leiomyosarcoma of the skin: a comprehensive review on diagnosis and treatment. Med Oncol 2018; 35:135. [PMID: 30140957 DOI: 10.1007/s12032-018-1196-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/15/2018] [Indexed: 12/19/2022]
Abstract
Sarcomas are a heterogeneous group of mesenchymal tumors which can affect bone and soft tissue. Leiomyosarcoma (LMS) is a rare subtype localized to the skin or subcutaneous tissue. Due to the heterogeneity of sarcomas, reviews and guidelines with an in-depth focus specifically on primary LMS of the skin are sparse. This article is intended to provide an up to date and systematic overview on diagnosis, treatment, and surveillance of this rare entity to provide a framework for decision making and management for dermato-oncologists. We discuss novel treatment options for advanced disease such as targeted therapy with kinase inhibitors and immune checkpoint blockade which may improve the prognosis even in advanced stages of LMS.
Collapse
Affiliation(s)
- Martina Zacher
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Markus V Heppt
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Titus J Brinker
- Department of Dermatology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany.,Department of Translational Oncology, German Cancer Research Center, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Kinan M Hayani
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Michael J Flaig
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337, Munich, Germany.
| |
Collapse
|