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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.
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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
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Roberto S, Riccardo N, Sokol S, Paolo DTA, Marta S, Milella M, Aldo S. Cutaneous Angiosarcoma. JAMA Otolaryngol Head Neck Surg 2024; 150:746-748. [PMID: 38958936 DOI: 10.1001/jamaoto.2024.1715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
This case report describes a 42-year-old woman with cutaneous angiosarcoma and venous malformation of the nasal tip.
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Affiliation(s)
- Scirpo Roberto
- Unit of Maxillo Facial Surgery-Head and Neck Department, University of Verona, Verona, Italy
| | - Nocini Riccardo
- Unit of Otolaryngology-Head and Neck Department, University of Verona, Verona, Italy
| | - Sina Sokol
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Department of Pathology and Diagnostics, Hospital Trust of Verona, Verona, Italy
| | | | - Sbaraglia Marta
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Michele Milella
- Section of Innovation Biomedicine-Oncology Area, Department of Engineering for Innovation Medicine, University of Verona and Verona University and Hospital Trust (AOUI Verona), Verona, Italy
| | - Scarpa Aldo
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Chung M, Ton L, Lee AY. Forget Me Not: Incidental Findings on Breast MRI. JOURNAL OF BREAST IMAGING 2024:wbae023. [PMID: 38758984 DOI: 10.1093/jbi/wbae023] [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: 09/02/2023] [Indexed: 05/19/2024]
Abstract
With the growing utilization and expanding role of breast MRI, breast imaging radiologists may encounter an increasing number of incidental findings beyond the breast and axilla. Breast MRI encompasses a large area of anatomic coverage extending from the lower neck to the upper abdomen. While most incidental findings on breast MRI are benign, identifying metastatic disease can have a substantial impact on staging, prognosis, and treatment. Breast imaging radiologists should be familiar with common sites, MRI features, and breast cancer subtypes associated with metastatic disease to assist in differentiating malignant from benign findings. Furthermore, detection of malignancies of nonbreast origin as well as nonmalignant, but clinically relevant, incidental findings can significantly impact clinical management and patient outcomes. Breast imaging radiologists should consistently follow a comprehensive search pattern and employ techniques to improve the detection of these important incidental findings.
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Affiliation(s)
- Maggie Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Lauren Ton
- School of Medicine, University of California, San Francisco, CA, USA
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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4
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Sills WS, Tooze JA, Olson JD, Caudell DL, Dugan GO, Johnson BJ, Kock ND, Andrews RN, Schaaf GW, Lang RA, Cline JM. Total-Body Irradiation Is Associated With Increased Incidence of Mesenchymal Neoplasia in a Radiation Late Effects Cohort of Rhesus Macaques (Macaca mulatta). Int J Radiat Oncol Biol Phys 2022; 113:661-674. [PMID: 35361520 PMCID: PMC9250621 DOI: 10.1016/j.ijrobp.2022.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Cancer is a severe delayed effect of acute radiation exposure. Total-body irradiation has been associated with an increased risk of solid cancer and leukemia in Japanese atomic bomb survivors, and secondary malignancies, such as sarcoma, are a serious consequence of cancer radiation therapy. The radiation late effects cohort (RLEC) of rhesus macaques (Macaca mulatta) is a unique resource of more than 200 animals for studying the long-term consequences of total-body irradiation in an animal model that closely resembles humans at the genetic and physiologic levels. METHODS AND MATERIALS Using clinical records, clinical imaging, histopathology, and immunohistochemistry, this retrospective study characterized the incidence of neoplasia in the RLEC. RESULTS Since 2007, 61 neoplasms in 44 of 239 irradiated animals were documented (18.4% of the irradiated population). Only 1 neoplasm was diagnosed among the 51 nonirradiated controls of the RLEC (2.0%). The most common malignancies in the RLEC were sarcomas (38.3% of diagnoses), which are rare neoplasms in nonirradiated macaques. The most common sarcomas included malignant nerve sheath tumors and malignant glomus tumors. Carcinomas were less common (19.7% of diagnoses), and consisted primarily of renal cell and hepatocellular carcinomas. Neoplasia occurred in most major body systems, with the skin and subcutis being the most common site (40%). RNA analysis showed similarities in transcriptional profiles between RLEC and human malignant nerve sheath tumors. CONCLUSIONS This study indicates that total-body irradiation is associated with an increased incidence of neoplasia years following irradiation, at more than double the incidence described in aging, nonirradiated animals, and promotes tumor histotypes that are rarely observed in nonirradiated, aging rhesus macaques.
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Affiliation(s)
- W Shane Sills
- Department of Pathology, Section on Comparative Medicine
| | | | - John D Olson
- Department of Pathology, Section on Comparative Medicine
| | | | - Greg O Dugan
- Department of Pathology, Section on Comparative Medicine
| | | | - Nancy D Kock
- Department of Pathology, Section on Comparative Medicine
| | - Rachel N Andrews
- Department of Pathology, Section on Comparative Medicine; Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Richard A Lang
- Department of Pathology, Section on Comparative Medicine
| | - J Mark Cline
- Department of Pathology, Section on Comparative Medicine; Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Chaudhry IUH. Radical surgical resection of giant Angiosarcoma of the posterior Mediastinum: A rare neoplasm with rare presentation as epigastric pain. Ann Med Surg (Lond) 2021; 72:103087. [PMID: 34868576 PMCID: PMC8626570 DOI: 10.1016/j.amsu.2021.103087] [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: 09/27/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022] Open
Abstract
Angiosarcoma of the Posterior Mediastinum is a rare entity. We herein report a case of a giant posterior mediastinal Angiosarcoma. A 54-year female presented with a one-year history of epigastric pain. Her upper gastrointestinal tract endoscopy revealed no abnormality. Chest x-Ray showed a shadow in the hilar area. A computed tomographic scan of the Thorax (CT) and MRI Scan showed a mass in the Posterior Mediastinum. CT-guided biopsy revealed the tumor of vascular origin. The tumor was completely resected. Post-operative recovery was uneventful. After 14 months follow up patient is disease-free, and a CT scan of the chest showed no recurrence.
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Guram S, Covelli AM, O’Neill AC, Shultz DB, Demicco EG, Gupta AA, Gladdy RA. Multidisciplinary Intervention in Radiation-Associated Angiosarcoma of the Breast: Patterns of Recurrence and Response to Treatment. Ann Surg Oncol 2021; 29:522-532. [DOI: 10.1245/s10434-021-10477-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
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Jeyaraman M, Muthu S, Prabhakar M, Jeyaraman N, Agarwal G, Jain R. Primary Angiosarcoma of Humerus - A Case Report and Literature Review. J Orthop Case Rep 2021; 11:12-17. [PMID: 34557431 PMCID: PMC8422013 DOI: 10.13107/jocr.2021.v11.i05.2186] [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: 02/08/2023] Open
Abstract
INTRODUCTION Osseous angiosarcoma is a very rare tumor of bone with aggressive behavior, propensity for recurrences, and distant metastasis. The etiology of osseous angiosarcoma is uncertain; however, specific risk factors have been recognized. The diagnosis of angiosarcoma of bone demands multimodality imaging in conjunction with histopathological and vascular marker evaluation to aptly differentiate them from other vascular tumors. Treatment of osseous angiosarcoma remains controversial. CASE REPORT A 53-year-old male presented with pain and swelling of the right upper 1/3rd of the arm following heaviness while lifting weight for 3 months. He had a history of significant weight loss and appetite with no history of inciting trauma or irradiation in the past. On examination, a diffuse swelling was noted in the right shoulder and right scapular aspect with varied consistency and ill-defined borders and margins. The skin over the swelling was stretched and shiny with dilated engorged veins over it. The plain radiograph of the right shoulder with humerus revealed a large expansile lytic soft-tissue mass in the right proximal humerus with a wide zone of transition without sclerotic margins. Magnetic resonance imaging showed T1 hypointense, T2/PDFS hyperintense large well-defined expansile lytic lesion with multi-loculated cysts, and multiple blood-fluid levels involving right proximal humerus. The patient underwent an incisional biopsy which exhibited angiosarcoma of the humerus. The patient was treated with six cycles of chemotherapy with a mesna, doxorubicin, ifosfamide, and dacarbazine regimen. The patient was still under follow-up. CONCLUSION Being a rare clinical entity, controversy exists in angiosarcoma of humerus regarding its etiology and recommended management protocols. Histopathology and immunohistochemistry remain the gold standard in differentiating osseous angiosarcoma from other osseous vascular tumors. The treatment protocol has to be standardized to decrease morbidity and to improve the functional quality of life of the patient.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh. India
| | - Sathish Muthu
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul, Tamil Nadu. India
- Address of Correspondence: Dr. Sathish Muthu, Department of Orthopaedics, Government Medical College and Hospital, Dindigul, Tamil Nadu. India. E-mail:
| | - Manoj Prabhakar
- Department of Radio-Diagnosis, Osmania Medical College, Hyderabad, Telangana. India
| | - Naveen Jeyaraman
- Department of Orthopedics, Kasturba Medical College, MAHE University, Manipal, Karnataka. India
| | - Garima Agarwal
- Department of Pathology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh. India
| | - Rashmi Jain
- Department of Orthopedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh. India
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Bonilla CE, Perez Lugo LM, Vallejo Yepes C, Osma Charris HR. Atypical Vascular Proliferation Secondary to Radiotherapy in a Patient With a History of Synovial Sarcoma. Cureus 2020; 12:e10179. [PMID: 33029459 PMCID: PMC7529495 DOI: 10.7759/cureus.10179] [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: 11/17/2022] Open
Abstract
We present the case of a 21-year-old male patient with a history of monophasic synovial sarcoma in his left thigh, which was treated with surgical resection, radiotherapy, and chemotherapy with mesna, doxorubicin, and Ifosfamide (MAI protocol). Approximately six years after the end of the oncological treatment, he presented a nodular, polypoid lesion in the left popliteal region, which was painless and fast growing. Ultimately, the biopsy was consistent with atypical vascular proliferation (AVP). Vascular lesions after radiotherapy include a wide spectrum of pathologies that range from benign lesions such as AVP to malignant ones with very poor prognosis such as angiosarcoma, the distinction between one and the other can be difficult, being the determination rearrangement or amplification of gene c-myc, a key to make an accurate diagnosis in case of doubt.
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Primary mammary angiosarcomas harbor frequent mutations in KDR and PIK3CA and show evidence of distinct pathogenesis. Mod Pathol 2020; 33:1518-1526. [PMID: 32123305 DOI: 10.1038/s41379-020-0511-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/21/2022]
Abstract
Angiosarcoma (AS) is the most frequent primary sarcoma of the breast but nevertheless remains uncommon, accounting for <0.05% of breast malignancies. Secondary mammary AS arise following radiation therapy for breast cancer, in contrast to primary AS which occur sporadically. Essentially all show aggressive clinical behavior independent of histologic grade and most are treated by mastectomy. MYC amplification is frequently identified in radiation-induced AS but only rarely in primary mammary AS (PMAS). As a heterogeneous group, AS from various anatomic sites have been shown to harbor recurrent alterations in TP53, MAP kinase pathway genes, and genes involved in angiogenic signaling including KDR (VEGFR2) and PTPRB. In part due to its rarity, the pathogenesis of PMAS has not been fully characterized. In this study, we examined the clinical, pathologic, and genomic features of ten cases of PMAS, including one patient with bilateral disease. Recurrent genomic alterations were identified in KDR (70%), PIK3CA/PIK3R1 (70%), and PTPRB (30%), each at higher frequencies than reported in AS across all sites. Six tumors harbored a KDR p.T771R hotspot mutation, and all seven KDR-mutant cases showed evidence suggestive of biallelism (four with loss of heterozygosity and three with two aberrations). Of the seven tumors with PI3K alterations, six harbored pathogenic mutations other than in the canonical PIK3CA residues which are most frequent in breast cancer. Three AS were hypermutated (≥10 mutations/megabase (Mb)); hypermutation was seen concurrent with KDR or PIK3CA mutations. The patient with bilateral disease demonstrated shared alterations, indicative of contralateral metastasis. No MYC or TP53 aberrations were detected in this series. Immunohistochemistry for VEGFR2 was unable to discriminate between KDR-mutant tumors and benign vascular lesions of the breast. These findings highlight the underrecognized frequency of KDR and PIK3CA mutation in PMAS, and a significant subset with hypermutation, suggesting a pathogenesis distinct from other AS.
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Abstract
With current life expectancies exceeding 78 years on average, to be confronted with the discovery of a rare cancer often found in advanced stages is a startling devastation. Angiosarcoma of the intestine is a rare and aggressive tumor that is not often considered in the differential diagnosis of intestinal obstruction. Once found and accurately diagnosed, it is a bewildering race against time as its median survival time is 150 days from diagnosis. This case report details a rare small intestinal angiosarcoma with its host surpassing current epidemiological standards of survival time despite only being eligible for chemotherapy.
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Affiliation(s)
- Sindhura Kolli
- Clinical Obesity Medicine, NYU Langone Health, New York, USA
| | - Owen Chan
- Pathology, Pali Momi Medical Center, Affiliate of Hawai'i Pacific Health, Honolulu, USA
| | - C Galen Choy
- Oncology, Pali Momi Medical Center, Affiliate of Hawai'i Pacific Health, Honolulu, USA
| | - Mel A Ona
- Gastroenterology, Pali Momi Medical Center, Affiliate of Hawai'i Pacific Health, Honolulu, USA
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Hanna WM, Parra-Herran C, Lu FI, Slodkowska E, Rakovitch E, Nofech-Mozes S. Ductal carcinoma in situ of the breast: an update for the pathologist in the era of individualized risk assessment and tailored therapies. Mod Pathol 2019; 32:896-915. [PMID: 30760859 DOI: 10.1038/s41379-019-0204-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 12/30/2022]
Abstract
Ductal carcinoma in situ (DCIS) is a neoplastic proliferation of mammary ductal epithelial cells confined to the ductal-lobular system, and a non-obligate precursor of invasive disease. While there has been a significant increase in the diagnosis of DCIS in recent years due to uptake of mammography screening, there has been little change in the rate of invasive recurrence, indicating that a large proportion of patients diagnosed with DCIS will never develop invasive disease. The main issue for clinicians is how to reliably predict the prognosis of DCIS in order to individualize patient treatment, especially as treatment ranges from surveillance only, breast-conserving surgery only, to breast-conserving surgery plus radiotherapy and/or hormonal therapy, and mastectomy with or without radiotherapy. We conducted a semi-structured literature review to address the above issues relating to "pure" DCIS. Here we discuss the pathology of DCIS, risk factors for recurrence, biomarkers and molecular signatures, and disease management. Potential mechanisms of progression from DCIS to invasive cancer and problems faced by clinicians and pathologists in diagnosing and treating this disease are also discussed. Despite the tremendous research efforts to identify accurate risk stratification predictors of invasive recurrence and response to radiotherapy and endocrine therapy, to date there is no simple, well-validated marker or group of variables for risk estimation, particularly in the setting of adjuvant treatment after breast-conserving surgery. Thus, the standard of care to date remains breast-conserving surgery plus radiotherapy, with or without hormonal therapy. Emerging tools, such as pathologic or biologic markers, may soon change such practice. Our review also includes recent advances towards innovative treatment strategies, including targeted therapies, immune modulators, and vaccines.
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Affiliation(s)
- Wedad M Hanna
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Carlos Parra-Herran
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Fang-I Lu
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Elzbieta Slodkowska
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Eileen Rakovitch
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Sharon Nofech-Mozes
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, E432-2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Taffurelli M, Pellegrini A, Meattini I, Orzalesi L, Tinterri C, Roncella M, Terribile D, Caruso F, Tazzioli G, Pollini G, Friedman D, Mariotti C, Cianchetti E, Cabula C, Thomas R, Cedolini C, Rovera F, Grassi M, Lucani G, Cappella A, Bortul M, Stacul G, Scarabeo F, Procaccini E, Galimberti V. Secondary breast angiosarcoma: A multicentre retrospective survey by the national Italian association of Breast Surgeons (ANISC). Breast 2019; 45:56-60. [PMID: 30877870 DOI: 10.1016/j.breast.2019.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Breast angiosarcoma is a malignant mesenchymal neoplasm, which accounts for approximately 2% of all soft tissue sarcomas. Secondary breast angiosarcoma (SBA) may be related to chronic lymphedema after a mastectomy with lymph node dissection (Stewart Treves syndrome) and previous radiotherapy for complications from breast radiation treatment. It is a very rare condition; therefore, diagnosis and management are still a challenge. METHODS The ANISC collected SBA data by means of a survey sent to all Italian breast centres in the ANISC. The clinicopathological characteristics and the management of this disease were analysed. RESULTS Twenty-four centres participated in this survey in which 112 cases of SBA were analysed. The median age of the women with SBA was 68.9 years and it appeared approximately 90 months after the first irradiation for breast cancer. In 92% of cases, a mastectomy was performed without axillary dissection for those patients having a high grade of SBA (74.2%). The prognosis was worse in the high-grade cases (overall survival-OS: 36 months) as compared with the low-grade cases (OS: 48 months). After a follow-up of 5 years, 50.5% of the patients were still alive. Disease-free survival (DFS) was 35 months, and there were no differences between the groups of patients with either high- or low-grade histology. CONCLUSIONS Secondary breast angiosarcoma is a very aggressive disease associated with a short survival outcome. The surgical approach still remains an important step in the course of treatment; furthermore, an accurate histological examination is helpful in establishing the prognosis of the patient. A mastectomy is mandatory. A longer OS was observed in patients with low-grade angiosarcoma as compared to high-grade angiosarcoma (C.I. 40-57 vs. 31-41 months).
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Affiliation(s)
- M Taffurelli
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy
| | - A Pellegrini
- Breast Unit Policlinico, S. Orsola-Malpighi, Bologna, Italy.
| | - I Meattini
- AOU Carreggi Breast Unit, Firenze, Italy
| | - L Orzalesi
- AOU Carreggi Breast Unit, Firenze, Italy
| | - C Tinterri
- Humanitas Research Hospital, Milano, Italy
| | | | | | - F Caruso
- Breast Centre Humanitas, Catania, Italy
| | - G Tazzioli
- Breast Unit AOU Policlinico di, Modena, Italy
| | | | | | | | - E Cianchetti
- Oncologia Chirurgica Ospedale A. Businco, Ortona, Italy
| | - C Cabula
- Ospedale Oncologico di, Cagliari, Italy
| | - R Thomas
- Clinica Mediterranea, Napoli, Italy
| | - C Cedolini
- Ospedale S. Maria Misericordia, Udine, Italy
| | - F Rovera
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - M Grassi
- Humanitas Gavezzani, Bergamo, Italy
| | - G Lucani
- Breast Unit Policlinico di, Monza, Italy
| | - A Cappella
- Centro di Riferimento Oncologico IRCC, Aviano, Italy
| | | | - G Stacul
- SC Chirurgia Generale Ospedale di, Gorizia, Italy
| | - F Scarabeo
- Policlinico P. Veneziale, Isernia, Italy
| | - E Procaccini
- Breast Unit Seconda Università di, Napoli, Italy
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Abstract
RATIONALE Angiosarcomas are malignant vascular tumors, and angiosarcoma occurring in the anterior mediastinum is rare. Here we report a case of angiosarcoma that originated in the anterior mediastinum treated with surgery, followed by radiotherapy and synchronous chemotherapy. PATIENT CONCERNS A 56-year-old female was admitted to our hospital with chest pain for 3 days. Chest computerized tomogram (CT) examination showed a heterogeneous mass in the anterior superior mediastinum, and after injection of contrast agent, the mass showed obvious heterogeneous enhancement. Magnetic resonance imaging (MRI) with T1 weighted image (T1WI) showed isointensity and T2 weighted image (T2WI) showed heterogeneous signal intensity, the mass showed an obvious heterogeneously enhancement after intravenous administration of contrast material. DIAGNOSIS AND INTERVENTIONS Surgical resection operation was carried out. According to its morphologic and immunohistochemic feature of tumor cells which expressing CD31, CD34, and ERG, the tumor was categorized as an angiosarcoma. After operation, the patient received radiotherapy and synchronous chemotherapy. OUTCOMES At present, 8 months postoperatively, no signs of recurrence have been observed. LESSONS Although angiosarcoma in anterior mediastinum is rare, when a mass located in this area, a more careful immunohistological analysis should be performed to avoid overlooking the presence of angiosarcoma.
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Affiliation(s)
| | | | | | - Jin-Fan Li
- Department of Pathology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
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Ronen S, Ivan D, Torres-Cabala CA, Curry JL, Tetzlaff MT, Aung PP, Nagarajan P, Suster S, Prieto VG. Post-radiation vascular lesions of the breast. J Cutan Pathol 2018; 46:52-58. [DOI: 10.1111/cup.13363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/03/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shira Ronen
- Department of Pathology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Doina Ivan
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | | | - Jonathan L. Curry
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | - Michael T. Tetzlaff
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | - Phyu P. Aung
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | | | - Saul Suster
- Department of Pathology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Victor G. Prieto
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
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15
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Nai Q, Ansari M, Liu J, Razjouyan H, Pak S, Tian Y, Khan R, Broder A, Bagchi A, Iyer V, Hamouda D, Islam M, Sen S, Yousif A, Hu M, Lou Y, Duhl J. Primary Small Intestinal Angiosarcoma: Epidemiology, Diagnosis and Treatment. J Clin Med Res 2018; 10:294-301. [PMID: 29511417 PMCID: PMC5827913 DOI: 10.14740/jocmr3153w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023] Open
Abstract
Angiosarcoma is an aggressive mesenchymal sarcoma of endothelial cell origin with high mortality. Its occurrence in the small intestine is exceedingly low. In addition to the rarity of small intestine angiosarcoma, the nonspecific early clinical symptoms obscure the suspicion of such tumors and thereby delay the diagnosis. In a hope to improve the knowledge of this rare but fatal neoplasm, we report one case of angiosarcoma of duodenum and jejunum in a 73-year-old man. Furthermore, we summarize and analyze the common clinical features, tumor markers, treatment, and survival of previous reported cases of this malignancy. Small bowel angiosarcoma occurs more often in men than women (1.6:1). The median age at diagnosis is 68.5 years. The overall median survival time is 150 days; the median survival time in female (300 days) is longer than that of male patients (120 days). Von Willebrand factor (vWF), CD31, CD34, vimentin, and Ulex europaeus agglutinin 1 appear to be the most useful markers for the diagnosis. The majority of the patients underwent surgical resection alone or surgery with subsequent chemotherapy. The patients treated with surgery plus chemotherapy survive longer than those underwent surgical resection only (median 420 days, n = 7 vs. 96.5 days, n = 26, respectively; P = 0.0275). Further studies of more cases are needed for a better understanding of this rare entity, as well as the development of effective strategies for prevention, early diagnosis, and treatment.
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Affiliation(s)
- Qiang Nai
- University of Toledo Medical Center, Toledo, OH 43614, USA
- These authors contributed equally
| | - Mohammad Ansari
- Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
- These authors contributed equally
| | - Jing Liu
- School of Public Health, Shandong University, Jinan 250012, China
| | - Hadi Razjouyan
- Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
| | - Stella Pak
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Yufei Tian
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Rafay Khan
- Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | - Arkady Broder
- Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
| | - Arindam Bagchi
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Veena Iyer
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Danae Hamouda
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | | | - Shuvendu Sen
- Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | | | - Man Hu
- Department of Radiation Oncology and Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
- Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Yali Lou
- Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Jozsef Duhl
- Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
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16
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Fujisawa Y, Yoshino K, Fujimura T, Nakamura Y, Okiyama N, Ishitsuka Y, Watanabe R, Fujimoto M. Cutaneous Angiosarcoma: The Possibility of New Treatment Options Especially for Patients with Large Primary Tumor. Front Oncol 2018; 8:46. [PMID: 29552543 PMCID: PMC5840142 DOI: 10.3389/fonc.2018.00046] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/14/2018] [Indexed: 01/26/2023] Open
Abstract
The most widely accepted treatment for cutaneous angiosarcoma (CAS) is wide local excision and postoperative radiation to decrease the risk of recurrence. Positive surgical margins and large tumors (T2, >5 cm) are known to be associated with poor prognosis. Moreover, T2 tumors are known to be associated with positive surgical margins. According to previous reports, the majority of CAS patients in Japan had T2 tumors, whereas less than half of the patients in the studies from western countries did so. Consequently, the reported 5-year overall survival of Japanese CAS patients without distant metastasis was only 9%, lower than that for stage-IV melanoma. For patients with T2 tumors, management of subclinical metastasis should be considered when planning the initial treatment. Several attempts to control subclinical metastasis have been reported, such as using adjuvant/neoadjuvant chemotherapy in addition to conventional surgery plus radiation. Unfortunately, those attempts did not show any clinical benefit. Besides surgery, new chemotherapeutic approaches for advanced CAS have been introduced in the past couple of decades, such as paclitaxel and docetaxel. We proposed the use of chemoradiotherapy (CRT) using taxanes instead of surgery plus radiation for patients with T2 tumors without distant metastasis and showed a high response ratio with prolonged survival. However, this prolonged survival was seen only in patients who received maintenance chemotherapy after CRT, indicating that continuous chemotherapy is mandatory to control subclinical residual tumors. With the recent development of targeted drugs for cancer, many potential drugs for CAS are now available. Given that CAS expresses a high level of vascular endothelial growth factor (VEGF) receptor, drugs that target VEGF signaling pathways such as anti-VEGF monoclonal antibody and tyrosine kinase inhibitors are also promising, and several successful treatments have been reported. Besides targeted drugs, several new cytotoxic anticancer drugs such as eribulin or trabectedin have also been shown to be effective for advanced sarcoma. However, most of the clinical trials did not include a sufficient number of CAS patients. Therefore, clinical trials focusing only on CAS should be performed to evaluate the effectiveness of these new drugs.
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Affiliation(s)
| | - Koji Yoshino
- Dermatology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | | | | | - Naoko Okiyama
- Dermatology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Rei Watanabe
- Dermatology, University of Tsukuba, Tsukuba, Ibaraki, Japan
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17
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Bonzano E, Guenzi M, Corvò R. Salvage Hypofractionated Radiotherapy in a Progressive Radiation-Induced Angiosarcoma: A Case Report. Cureus 2017; 9:e1886. [PMID: 29387515 PMCID: PMC5786349 DOI: 10.7759/cureus.1886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We report a case of a long-term local control and survival achieved in a patient affected by radiation-induced angiosarcoma (RIA). A 57-year-old woman had a history of breast-conserving surgery and radiation therapy for primary breast cancer. Eight years after the mastectomy, multiple nodal progression was diagnosed as RIA and subsequentially treated by salvage lymph node dissection followed by adjuvant intensified radiotherapy to control the residual disease. Two and a half years later, the patient is alive and cancer-free. This experience shows that radiotherapy may have the potential to be a feasible and effective treatment to control RIA progression, and it may also play a role in the management of RIA as adjuvant.
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Affiliation(s)
- Elisabetta Bonzano
- Radiation Oncology, University of Genoa Ospedale Policlinico San Martino
| | - Marina Guenzi
- Radiation Oncology, University of Genoa Ospedale Policlinico San Martino
| | - Renzo Corvò
- Radiation Oncology, University of Genoa Ospedale Policlinico San Martino
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18
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[Diagnostic challenges on breast needle core biopsies. Case 5: Well-differentiated primary angiosarcoma]. Ann Pathol 2017; 37:389-395. [PMID: 28935418 DOI: 10.1016/j.annpat.2017.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 11/23/2022]
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19
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Wang L, Lao IW, Yu L, Wang J. Clinicopathological features and prognostic factors in angiosarcoma: A retrospective analysis of 200 patients from a single Chinese medical institute. Oncol Lett 2017; 14:5370-5378. [PMID: 29113171 PMCID: PMC5656021 DOI: 10.3892/ol.2017.6892] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/23/2017] [Indexed: 12/20/2022] Open
Abstract
Angiosarcoma is a rare soft tissue sarcoma, and the data about its clinicopathological features and prognostic factors are limited. The purpose of the present study was to report a large series of angiosarcoma at a single institution. Clinical data from 200 cases of angiosarcoma from the Shanghai Cancer Center (Shanghai, China) between March 2006 and March 2014 were retrospectively analyzed. The study population included 97 males and 103 females with ages between 4 and 91 years (median, 53 years). According to the tumor location, 200 cases were divided into 4 groups: i) Tumors involving the head and neck; ii) breast; iii) viscera (including internal organs and bone); and iv) soft tissue (including trunk and extremities). Of the 113 patients with follow-up data, 46 patients succumbed to the disease with a median interval of 10 months. Tumor recurrence/metastasis was identified in 66 patients with a median interval of 4 months. The disease-free survival (DFS) rate at 5-years was 19.3% and the overall survival (OS) rate at 5-years was 40.8%. Site of tumor origin, size (≥5 cm) and histological differentiation influenced DFS (P=0.032, 0.038 and <0.001, respectively), and OS (P<0.001, 0.008 and <0.001, respectively) rates. Age (<65 years) and multimodal treatment correlated with improved OS (P=0.003 and <0.001, respectively). Tumor differentiation and treatment modality were identified to be independent determinants of OS (P<0.001 and 0.038, respectively). Tumor recurrence/metastasis was an independent predictor of DFS (P<0.001). The prognosis of angiosarcoma is poor and the mortality rate is high. The site of tumor origin, size, histological differentiation, age, treatment modality and tumor recurrence/metastasis are all significant prognostic factors. In the present study, multimodal treatment may improve the clinical outcome of patients with angiosarcoma.
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Affiliation(s)
- Lei Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, P.R. China
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, P.R. China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, P.R. China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, P.R. China
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20
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Udager AM, Ishikawa MK, Lucas DR, McHugh JB, Patel RM. MYC immunohistochemistry in angiosarcoma and atypical vascular lesions: practical considerations based on a single institutional experience. Pathology 2016; 48:697-704. [PMID: 27780597 DOI: 10.1016/j.pathol.2016.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/16/2016] [Accepted: 08/30/2016] [Indexed: 10/20/2022]
Abstract
Angiosarcoma (AS) is an uncommon vascular malignancy with an aggressive clinical course. Radiation-associated angiosarcoma (RAAS) and Stewart-Treves syndrome are associated with MYC gene amplification and protein overexpression, while other radiation-associated vascular lesions including atypical vascular lesions (AVL) are not associated with MYC overexpression. In contrast, de novo AS represent a group of molecularly heterogeneous tumours, for which MYC expression has not been extensively examined. In this study, MYC immunohistochemistry (IHC) was performed on representative whole tissue sections of a large retrospective cohort of de novo AS, RAAS, Stewart-Treves syndrome, and AVL and evaluated using a semi-quantitative scoring method. MYC is strongly expressed in the majority of RAAS and Stewart-Treves syndrome. De novo AS demonstrate variable MYC expression, with high-grade tumours showing significantly higher MYC expression than low-grade tumours. In contrast, MYC expression in AVL is predominantly negative but may occasionally show focal staining. These results indicate that unequivocal strong MYC IHC staining supports the diagnosis of RAAS. In rare cases of RAAS without strong MYC expression, however, particularly relatively low-grade tumours for which the differential diagnosis includes AVL, the distinction between these lesions should be made on morphological grounds using previously established criteria (i.e., significant atypia, deep invasion, infiltrative growth, etc.). Increased MYC expression in high-grade de novo AS suggests that MYC overexpression may play a role in the pathogenesis of these tumours, and MYC IHC may be a prognostic and/or therapeutic biomarker in a subset of these tumours.
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Affiliation(s)
- Aaron M Udager
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Martin K Ishikawa
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, United States
| | - David R Lucas
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Rajiv M Patel
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, United States.
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21
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Shah S, Rosa M. Radiation-Associated Angiosarcoma of the Breast: Clinical and Pathologic Features. Arch Pathol Lab Med 2016; 140:477-81. [DOI: 10.5858/arpa.2014-0581-rs] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast angiosarcoma is an unusual malignancy accounting for approximately 1% of soft tissue sarcomas. It can occur as a primary form without a known precursor or as a secondary form associated with radiotherapy. Adjuvant radiotherapy has a significant role in preventing local recurrence in women treated with conservation therapy for early stage breast carcinoma or multicentric tumors. Postradiation angiosarcoma usually affects the dermis of the breast within the radiation field and may occasionally develop in the breast parenchyma. Compared with the latency of other radiation-associated sarcomas, the latency for breast radiation-associated angiosarcoma is relatively short with a median of 6 years. The risk of developing secondary angiosarcoma does not outweigh the benefit of treatment; therefore, radiation therapy continues to be a mainstay modality in the treatment of breast cancer patients. Early detection is essential because angiosarcomas are associated with a poor prognosis. Wide surgical resection is the standard treatment for these tumors.
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Affiliation(s)
| | - Marilin Rosa
- From the Departments of Anatomic Pathology (Drs Shah and Rosa) and Women's Oncology (Dr Rosa), Moffitt Cancer Center, Tampa, Florida
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22
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Costigan DC, Doyle LA. Advances in the clinicopathological and molecular classification of cutaneous mesenchymal neoplasms. Histopathology 2016; 68:776-95. [PMID: 26763770 DOI: 10.1111/his.12930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, there have been several important refinements in the classification of cutaneous mesenchymal neoplasms, including the description of new tumour types, along with the identification of novel and recurrent molecular genetic findings. In addition to providing new insights into tumour biology, many of these advances have had significant clinical consequences with regard to diagnostics, management, and prognostication. Newly described entities include pseudomyogenic haemangioendothelioma, haemosiderotic fibrolipomatous tumour, and fibroblastic connective tissue naevus, which are reviewed in the context of the principal differential diagnoses and significant clinical implications. Genetic characterization of several soft tissue tumour types that occur in the skin has resulted in the identification of diagnostically useful markers: ALK gene rearrangement with corresponding ALK protein expression by immunohistochemistry in epithelioid fibrous histiocytoma; the WWTR1-CAMTA1 fusion gene with CAMTA1 protein expression in epithelioid haemangioendothelioma; MYC amplification and overexpression in radiation-associated angiosarcoma; and EWSR1 gene rearrangement in cutaneous myoepithelial tumours. Finally, the classification of intradermal smooth muscle tumours and unclassified/pleomorphic dermal sarcoma has been refined, resulting in both improved classification and improved prognostication. Many of the tumour types listed above are encountered not only by specialist dermatopathologists, but also by practising general surgical pathologists, and this review should therefore provide a widely applicable update on the histological and molecular classification of cutaneous mesenchymal neoplasms, along with the appropriate use of ancillary diagnostic tests, in particular immunohistochemistry, in the evaluation of such lesions and their histological mimics.
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Affiliation(s)
- Danielle C Costigan
- Department of Histopathology, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Leona A Doyle
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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23
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Dodd LG, Ware P, Duncan D, Hertel J. Doing more with less: New markers for sarcoma diagnosis and their applicability to cytology specimens. Diagn Cytopathol 2016; 44:351-60. [DOI: 10.1002/dc.23428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/16/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Leslie G Dodd
- Department of Pathology; Section of Cytopathology, University of North Carolina Chapel Hill; Chapel Hill NC 27514
| | - Patrick Ware
- Department of Pathology; Section of Cytopathology, University of North Carolina Chapel Hill; Chapel Hill NC 27514
| | - Daniel Duncan
- Department of Pathology; Section of Cytopathology, University of North Carolina Chapel Hill; Chapel Hill NC 27514
| | - Johann Hertel
- Department of Pathology; Section of Cytopathology, University of North Carolina Chapel Hill; Chapel Hill NC 27514
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24
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Fraga-Guedes C, André S, Mastropasqua MG, Botteri E, Toesca A, Rocha RM, Peradze N, Rotmensz N, Viale G, Veronesi P, Gobbi H. Angiosarcoma and atypical vascular lesions of the breast: diagnostic and prognostic role of MYC gene amplification and protein expression. Breast Cancer Res Treat 2015; 151:131-40. [DOI: 10.1007/s10549-015-3379-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 04/09/2015] [Indexed: 12/29/2022]
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25
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Generation of a murine hepatic angiosarcoma cell line and reproducible mouse tumor model. J Transl Med 2015; 95:351-62. [PMID: 25418579 DOI: 10.1038/labinvest.2014.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 12/28/2022] Open
Abstract
Hepatic angiosarcoma (AS) is a rare and highly aggressive tumor of endothelial origin with dismal prognosis. Studies of the molecular biology of AS and treatment options are limited as animal models are rare. We have previously shown that inducible knockout of Notch1 in mice leads to spontaneous formation of hepatic AS. The aims of this study were to: (1) establish and characterize a cell line derived from this murine AS, (2) identify molecular pathways involved in the pathogenesis and potential therapeutic targets, and (3) generate a tumor transplantation model. AS cells retained specific endothelial properties such as tube formation activity, as well as expression of CD31 and Von Willebrand factor. However, electron microscopy analysis revealed signs of dedifferentiation with loss of fenestrae and loss of contact inhibition. Microarray and pathway analysis showed substantial changes in gene expression and revealed activation of the Myc pathway. Exposing the AS cells to sorafenib reduced migration, filopodia dynamics, and cell proliferation but did not induce apoptosis. In addition, sorafenib suppressed ERK phosphorylation and expression of cyclin D2. Injection of AS cells into NOD/SCID mice resulted in formation of undifferentiated tumors, confirming the tumorigenic potential of these cells. In summary, we established and characterized a murine model of spontaneous AS formation and hepatic AS cell lines as a useful in vitro tool. Our data demonstrate antitumor activity of sorafenib in AS cells with potent inhibition of migration, filopodia formation, and cell proliferation, supporting further evaluation of sorafenib as a novel treatment strategy. In addition, AS cell transplantation provides a subcutaneous tumor model useful for in vivo preclinical drug testing.
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Abstract
Angiosarcoma is a rare malignant tumour of endothelial cells. Primary angiosarcoma of venous origin is extremely rare, and has a very poor prognosis. A 63-year-old woman with retroperitoneal mass underwent en bloc resection on a part of iliac vein followed by adjuvant radiotherapy. No recurrence was detected during 3 years of follow-up.
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Affiliation(s)
- Kamuran Ibis
- Department of Radiation Oncology, Trakya University Medical Faculty, Istanbul, Turkey
| | - Ufuk Usta
- Department of Pathology, Trakya University Medical Faculty, Edirne, Turkey
| | - Rusen Cosar
- Department of Radiation Oncology, Trakya University Medical Faculty, Edirne, Turkey
| | - Cem Ibis
- Department of Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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27
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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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28
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Chen WH, Wu BY, Wang WM. Distinction of a postradiation atypical vascular lesion from cutaneous angiosarcoma in a patient with a history of breast cancer. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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29
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Clinicopathological and immunohistochemical study of 30 cases of post-radiation atypical vascular lesion of the breast. Breast Cancer Res Treat 2014; 146:347-54. [DOI: 10.1007/s10549-014-3020-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 05/31/2014] [Indexed: 01/02/2023]
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30
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Crowley TP, Sainsbury DCG, Crowley DM, Milner RH, Ragbir M. The surgical management of angiosarcoma of the breast—a single institution experience. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0972-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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31
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Genomic profiling reveals extensive heterogeneity in somatic DNA copy number aberrations of canine hemangiosarcoma. Chromosome Res 2014; 22:305-19. [PMID: 24599718 DOI: 10.1007/s10577-014-9406-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 01/08/2023]
Abstract
Canine hemangiosarcoma is a highly aggressive vascular neoplasm associated with extensive clinical and anatomical heterogeneity and a grave prognosis. Comprehensive molecular characterization of hemangiosarcoma may identify novel therapeutic targets and advanced clinical management strategies, but there are no published reports of tumor-associated genome instability and disrupted gene dosage in this cancer. We performed genome-wide microarray-based somatic DNA copy number profiling of 75 primary intra-abdominal hemangiosarcomas from five popular dog breeds that are highly predisposed to this disease. The cohort exhibited limited global genomic instability, compared to other canine sarcomas studied to date, and DNA copy number aberrations (CNAs) were predominantly of low amplitude. Recurrent imbalances of several key cancer-associated genes were evident; however, the global penetrance of any single CNA was low and no distinct hallmark aberrations were evident. Copy number gains of dog chromosomes 13, 24, and 31, and loss of chromosome 16, were the most recurrent CNAs involving large chromosome regions, but their relative distribution within and between cases suggests they most likely represent passenger aberrations. CNAs involving CDKN2A, VEGFA, and the SKI oncogene were identified as potential driver aberrations of hemangiosarcoma development, highlighting potential targets for therapeutic modulation. CNA profiles were broadly conserved between the five breeds, although subregional variation was evident, including a near twofold lower incidence of VEGFA gain in Golden Retrievers versus other breeds (22 versus 40 %). These observations support prior transcriptional studies suggesting that the clinical heterogeneity of this cancer may reflect the existence of multiple, molecularly distinct subtypes of canine hemangiosarcoma.
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32
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D'Angelo SP, Antonescu CR, Kuk D, Qin L, Moraco N, Carvajal RC, Chi P, Dickson MA, Gounder M, Keohan ML, Singer S, Schwartz GK, Tap WD. High-risk features in radiation-associated breast angiosarcomas. Br J Cancer 2013; 109:2340-6. [PMID: 24104962 PMCID: PMC3817330 DOI: 10.1038/bjc.2013.590] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/25/2013] [Accepted: 09/04/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Radiation-associated breast angiosarcoma (RT-AS) is an uncommon malignancy with an incidence of less than 1 % of all soft tissue sarcomas. The overall prognosis is quite dismal with high rates of recurrences and poor overall survival. There is an obvious paucity of data regarding clinical outcomes of patients with breast RT-AS. METHODS We identified all patients with RT-AS treated at the Memorial Sloan-Kettering Cancer Center between 1982-2011 and collected their correlative clinical information. RESULTS We identified 79 women with RT-AS with a median age of 68 (range 36-87). The median interval between radiation and development of RT-AS was 7 years (range 3-19). The median time to local and distant recurrence was 1.29 years (95 % CI 0.72-NA) and 2.48 years (95 % CI 1.29-NA), respectively. The median disease-specific survival was 2.97 years (95 % CI 2.21-NA). Independent predictors of worse disease-specific survival included age 68 years (HR 3.11, 95 % CI 1.20-8.08, P=0.020) and deep tumors (HR 3.23, 95 % CI 1.02-10.21, P=0.046.) CONCLUSION RT-AS has high local/distant recurrence rates, limited duration on standard chemotherapy and poor disease-specific survival.
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Affiliation(s)
- S P D'Angelo
- 1] Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA [2] Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Hu S, Bueso-Ramos CE, Verstovsek S, Miranda RN, Yin CC, McDonnell T, Medeiros LJ, Lin P. Metastatic splenic angiosarcoma presenting with thrombocytopenia and bone marrow fibrosis mimicking idiopathic thrombocytopenic purpura and primary myelofibrosis: a diagnostic challenge. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2013; 13:629-33. [PMID: 23800601 DOI: 10.1016/j.clml.2012.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/28/2012] [Indexed: 02/03/2023]
Affiliation(s)
- Shimin Hu
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
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34
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Ravo V, Falivene S, De Chiara A, De Palma G, Pizzolorusso A, Di Franco R, Muto P, Apice G. Treatment of Cutaneous Angiosarcoma of the Face: Efficacy of Combined Chemotherapy and Radiotherapy. TUMORI JOURNAL 2013; 99:e211-5. [DOI: 10.1177/030089161309900515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Cutaneous angiosarcoma (AS) is a rare form of soft tissue sarcoma. It is aggressive and has a poor prognosis. The aim of our report is to show that with combined chemotherapy and radiotherapy it is possible to obtain good results in terms of local control, complete response, and aesthetic outcome. Case report We present the case of a 60-year-old man affected by AS covering the entire surface of the nose. Surgery, although indicated, was excluded because it was considered mutilating and would give a poor cosmetic result. The patient was treated with chemotherapy consisting of paclitaxel 80 mg/m2 for 6 cycles followed by radiotherapy at a dose of 50 Gy. Then 3 additional cycles of chemotherapy were administered according to the same scheme. A complete response was obtained. At 40 months after treatment, the patient did not show any signs of late toxicity, all lesions had disappeared, and all laboratory tests were negative. Conclusions Our experience shows that concomitant chemoradiotherapy can be delivered safely and can be tolerated with low toxicity and good results in terms of local control and complete response. We obtained an excellent aesthetic result with improvement of the patient's quality of life.
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Affiliation(s)
- Vincenzo Ravo
- UOC Radioterapia, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples
| | - Sara Falivene
- Dipartimento Diagnostica per Immagini e Radioterapia, Seconda Università degli Studi di Napoli, Naples
| | - Annarosaria De Chiara
- Dipartimento di Patologia Diagnostica e di Laboratorio, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples, Italy
| | - Giampaolo De Palma
- UOC Radioterapia, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples
| | - Antonio Pizzolorusso
- Dipartimento Oncologia Sarcomi, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples, Italy
| | - Rossella Di Franco
- Dipartimento Diagnostica per Immagini e Radioterapia, Seconda Università degli Studi di Napoli, Naples
| | - Paolo Muto
- UOC Radioterapia, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples
| | - Gaetano Apice
- Dipartimento Oncologia Sarcomi, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples, Italy
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35
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Patel AM, Chou EL, Findeiss L, Kelly KM. The horizon for treating cutaneous vascular lesions. ACTA ACUST UNITED AC 2013; 31:98-104. [PMID: 22640429 DOI: 10.1016/j.sder.2012.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/17/2012] [Accepted: 02/17/2012] [Indexed: 12/28/2022]
Abstract
Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.
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Affiliation(s)
- Amit M Patel
- Department of Dermatology, University of California, Irvine, CA 92612, USA
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36
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Tan PH, Ellis IO. Myoepithelial and epithelial-myoepithelial, mesenchymal and fibroepithelial breast lesions: updates from the WHO Classification of Tumours of the Breast 2012. J Clin Pathol 2013; 66:465-70. [PMID: 23533258 DOI: 10.1136/jclinpath-2012-201078] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the 4th edition of the WHO Classification of Tumours of the Breast, myoepithelial lesions are retitled myoepithelial and epithelial-myoepithelial lesions in order to better reflect the dual participation of luminal and myoepithelial compartments in some key entities. Malignant myoepithelioma, described as a section within the chapter on myoepithelial lesions in the 3rd edition, is recognised in the 4th edition as part of metaplastic carcinoma. Adenomyoepithelioma with malignancy is categorised in terms of the cellular component undergoing malignant transformation. The list of antibodies that can be used for identifying myoepithelial cells is updated. Among mesenchymal lesions, new additions are nodular fasciitis and atypical vascular lesions, while the haemangiopericytoma is removed. The 3rd edition stated that pathological prediction of behaviour of phyllodes tumours is difficult in the individual case. In the 4th edition, some progress has been made in prioritisation and weighting of histological parameters that can potentially estimate probability of recurrence. The WHO Working Group advocates leaning towards a diagnosis of fibroadenoma in cases where there is histological uncertainty in distinction from a benign phyllodes tumour, or adopting the neutral term 'benign fibroepithelial neoplasm', as the clinical behaviour of fibroadenoma overlaps with that of benign phyllodes tumour. The 3rd edition terminology of 'periductal stromal sarcoma' is revised to 'periductal stromal tumour', akin to the widespread consensus to avoid the use of the term 'cystosarcoma' in the context of phyllodes tumours.
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Affiliation(s)
- Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore
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Fernandes CP, Oliveira FAF, Costa FWG, Patrocínio RMDSV, Mota MRL, Nunes Alves APN, Sousa FB. Clinical, histological, and immunohistochemical features of a mandibular metastasis from a primary cardiac angiosarcoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e121-7. [PMID: 23510686 DOI: 10.1016/j.oooo.2012.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/06/2012] [Accepted: 12/24/2012] [Indexed: 10/27/2022]
Abstract
Primary cardiac angiosarcoma is an extremely rare malignant tumor. Distant metastases are common at the time of diagnosis but have never been reported in the jaw. A 45-year-old female patient with primary cardiac angiosarcoma was referred for dental care due to pain in the mandibular alveolar ridge. Oral examination revealed a red-violet lesion that was soft on palpation and had been present for 3 months. Histological analysis confirmed the diagnosis of metastatic cardiac angiosarcoma. The patient died of multiple metastases.
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Affiliation(s)
- Clarissa Pessoa Fernandes
- Department of Stomatology and Oral Pathology, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil.
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38
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Fisher C. Unusual myoid, perivascular, and postradiation lesions, with emphasis on atypical vascular lesion, postradiation cutaneous angiosarcoma, myoepithelial tumors, myopericytoma, and perivascular epithelioid cell tumor. Semin Diagn Pathol 2013; 30:73-84. [PMID: 23327731 DOI: 10.1053/j.semdp.2012.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In recent years, a number of new soft tissue tumor entities have been described that occur in the skin only, or that also occur in other sites but form clinically and pathologically distinct subsets when arising in the skin and subcutaneous tissue. These include a variety of mesenchymal lineages and have variable malignant potential, although superficial malignant soft tissue tumors generally have a more favorable outcome than their more deeply located counterparts. This article reviews the clinical and pathologic features and differential diagnoses of atypical vascular lesion, postradiation cutaneous angiosarcoma, myoepithelioma, myopericytoma, and perivascular epithelioid cell tumor.
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Affiliation(s)
- Cyril Fisher
- Department of Histopathology, Royal Marsden Hospital, London, UK.
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Deroux A, Destors M, Coudurier M, Lantuejoul S, Aubert M, Girard N, Moro-Sibilot D. [A case of mediastinal angiosarcoma]. Rev Mal Respir 2012. [PMID: 23200585 DOI: 10.1016/j.rmr.2012.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Mediastinal angiosarcoma is a rare intrathoracic tumour and the therapeutic approach remains poorly codified. CASE REPORT We report the case of a 65-year-old female patient presenting with chest pain. Further exploration revealed an anterior mediastinal mass with pericardial invasion. Transthoracic biopsy gave the diagnosis of angiosarcoma. Multimodal treatment with neoadjuvant chemotherapy (doxorubicin 20 mg/m(2), Ifosfamide 2500 mg/m(2), Uromitexan® 2500 mg/m(2)) and surgery followed by adjuvant radiotherapy has led to remission of the tumour that has persisted for 12 months. CONCLUSION Systematic recording of such conditions in dedicated registries could contribute to enhance the description of the clinical and pathological characteristics, thus helping define the principles of specific management.
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Affiliation(s)
- A Deroux
- PCMAC, unité d'oncologie thoracique, CHU de Grenoble, Grenoble cedex, France.
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40
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Widespread atypical vascular lesions of the skin after whole-body electron beam therapy: expanding the clinical spectrum. Am J Dermatopathol 2012; 35:e11-5. [PMID: 22935890 DOI: 10.1097/dad.0b013e318268175c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atypical vascular lesion of the skin is an uncommon usually benign condition, thus far reported almost exclusively from mammary skin after radiotherapy for carcinoma of the breast. Some clinical and histological overlap exists with early angiosarcoma, which can also occur on irradiated skin. The lesions are divided into vascular and lymphatic types, the first representing a higher risk for development of angiosarcoma and the latter being more common. This article reports a rare case of widespread, progressive, vascular-type atypical vascular lesion after repeated whole-body electron beam irradiation administered as treatment for mycosis fungoides.
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Abstract
Cutaneous sarcomas are a rare subset of soft tissue sarcomas. These tumors are primarily managed with definitive surgical resection; however, upon unresectable recurrence or metastatic spread, systemic therapy is warranted. As with other sarcomas, these treatments have classically included cytotoxic chemotherapy programs that were associated with variable response rates and poor overall survival. Recently, major advances have been made in the understanding of the molecular biology of these tumors, and treatment paradigms are changing. Multiple pathways have been documented to be important in the growth of cutaneous sarcomas, including receptor tyrosine kinases such as platelet-derived growth factor receptor, insulin-like growth factor receptor and KIT. Dysregulated angiogenesis, through vascular endothelial growth factor (VEGF) and other pathways, is also associated with the growth of these tumors. In this review, we discuss the current standard therapies of cutaneous sarcoma and the recent advances and ongoing investigations into cutaneous sarcoma biology.
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Hollmig TS, Sachdev R, Cockerell CJ, Posten W, Chiang M, Kim J. Spindle Cell Neoplasms Encountered in Dermatologic Surgery: A Review. Dermatol Surg 2012; 38:825-50. [DOI: 10.1111/j.1524-4725.2012.02296.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Sheth GR, Cranmer LD, Smith BD, Grasso-LeBeau L, Lang JE. Radiation-induced sarcoma of the breast: a systematic review. Oncologist 2012; 17:405-18. [PMID: 22334455 PMCID: PMC3316927 DOI: 10.1634/theoncologist.2011-0282] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/30/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Radiation-induced sarcoma (RIS) is a rare, aggressive malignancy. Breast cancer survivors treated with radiotherapy constitute a large fraction of RIS patients. To evaluate evidenced-based practices for RIS treatment, we performed a systematic review of the published English-language literature. METHODS We performed a systematic keyword search of PubMed for original research articles pertaining to RIS of the breast. We classified and evaluated the articles based on hierarchical levels of scientific evidence. RESULTS We identified 124 original articles available for analysis, which included 1,831 patients. No randomized controlled trials involving RIS patients were found. We present the best available evidence for the etiology, comparative biology to primary sarcoma, prognostic factors, and treatment options for RIS of the breast. CONCLUSION Although the evidence to guide clinical practice is limited to single institutional cohort studies, registry studies, case-control studies, and case reports, we applied the available evidence to address clinically relevant questions related to best practice in patient management. Surgery with widely negative margins remains the primary treatment of RIS. Unfortunately, the role of adjuvant and neoadjuvant chemotherapy remains uncertain. This systematic review highlights the need for additional well-designed studies to inform the management of RIS.
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Affiliation(s)
- Grishma R. Sheth
- Department of Surgery, Division of Surgical Oncology
- Arizona Cancer Center
| | - Lee D. Cranmer
- Arizona Cancer Center
- Department of Medicine, Division of Hematology-Oncology, and
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Julie E. Lang
- Department of Surgery, Division of Surgical Oncology
- Arizona Cancer Center
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Karkouche R, Carbonnelle-Puscian A, Rivet J, Fraitag S, Moulonguet I, Carlotti A, Havard S, Vérola O, Cavelier-Balloy B. [Post-radiation atypical vascular lesions and angiosarcoma: 11 cases]. Ann Dermatol Venereol 2012; 139:109-17. [PMID: 22325749 DOI: 10.1016/j.annder.2011.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/11/2011] [Accepted: 11/04/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Post-radiation atypical vascular lesions of the skin display clinical and morphological overlap with well-differentiated angiosarcomas, and correct diagnosis may be difficult. PATIENTS AND METHODS We studied clinical, histological and immuno-histochemical aspects (CD31, CD34, D2-40 and VEGFR-3) of eight post-radiation atypical vascular lesions comparatively with three post-radiation angiosarcomas. RESULTS All patients were female and received radiation therapy for breast carcinoma. On average, atypical vascular lesions occurred 4.3 years after radiation therapy and presented as small papulonodules or erythematous plaques. The clinical course after simple excision was benign. Histologically, they were relatively circumscribed lesions and showed slit-like vessels dissecting dermal collagen in all cases. On average, angiosarcomas occurred 5 years after radiation therapy and presented as more extensive lesions with a more aggressive clinical course. The lesions showed histological overlap with atypical vascular lesions, but were poorly circumscribed, with deeper invasion, cytological atypia and mitosis. Although the immuno-histochemical profiles were similar, expression of VEGFR-3 was greater in two cases of angiosarcoma. CONCLUSION Post-radiation atypical vascular lesions are benign lesions that display clinical, histological and immuno-phenotypic overlap with well-differentiated angiosarcoma, and diagnosis requires good clinicopathological correlation. VEGFR-3 may be useful for differential diagnosis, as well as amplification of the MYC gene.
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Affiliation(s)
- R Karkouche
- Service d'anatomie et cytologie pathologiques, université Paris-Descartes, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Albores-Saavedra J, Schwartz AM, Henson DE, Kostun L, Hart A, Angeles-Albores D, Chablé-Montero F. Cutaneous angiosarcoma. Analysis of 434 cases from the Surveillance, Epidemiology, and End Results Program, 1973-2007. Ann Diagn Pathol 2011; 15:93-7. [DOI: 10.1016/j.anndiagpath.2010.07.012] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 07/21/2010] [Indexed: 11/24/2022]
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Voutsadakis IA, Zaman K, Leyvraz S. Breast sarcomas: current and future perspectives. Breast 2011; 20:199-204. [PMID: 21398126 DOI: 10.1016/j.breast.2011.02.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/04/2011] [Accepted: 02/14/2011] [Indexed: 12/16/2022] Open
Abstract
Breast sarcomas are rare neoplasms of the breast that need to be clearly distinguished from the very common breast carcinomas and treated in a multidisciplinary manner modelled after treatment paradigms in other sarcoma locations. An increasing need to differentiate sarcoma sub-types based on molecular characteristics that will also be depicted in differential treatment sensitivities and development of specifically targeted therapies are equally valid in sarcomas in general and in breast sarcomas in particular. Of special interest in breast are sarcomas developing after breast irradiation for a previous breast carcinoma, a scenario that is increasingly common, given the increasing trends of breast conservation in the surgical treatment of breast carcinoma that necessitates the adjuvant use of radiotherapy.
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Affiliation(s)
- Ioannis A Voutsadakis
- Centre Pluridisciplinaire d'Oncologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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47
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Surgical management of radiation-associated cutaneous breast angiosarcoma. J Plast Reconstr Aesthet Surg 2011; 64:1036-42. [PMID: 21377947 DOI: 10.1016/j.bjps.2011.02.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/09/2010] [Accepted: 02/13/2011] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to investigate the surgical management of radiation-associated cutaneous breast angiosarcoma with an emphasis on surgical margins and choice of reconstruction. Nine cases of angiosarcoma were identified in patients earlier treated with radiotherapy for breast cancer. Breast angiosarcoma was diagnosed a median of 5.25 years following radiotherapy. Median age at diagnosis was 60 years. Surgical treatment consisted of radical mastectomy (four cases), simple mastectomy (two cases) and wide local excision (three cases). Defect reconstruction involved three latissimus dorsi flap reconstructions and four skin grafts. Clear histological margins were achieved in all cases. Median follow-up was 81 months. Six patients were alive and disease-free at the end of the study period. Aggressive surgical resection with wide margins is essential to reduce local recurrence and improve survival.
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Abstract
Although secondary angiosarcomas (AS) are relatively rare neoplasms, they are increasingly recognized as the result of more breast conserving therapy (BCT) followed by radiotherapy. The diagnosis of this very aggressive and rapidly spreading tumour is based on the immunohystochemical characteristics of the biopsy specimen. Only radical surgical intervention can provide successful treatment. Authors present a case of a 56-y-old woman who underwent BCT and radiotherapy. 10 years later secondary AS occurred in the remaining breast.
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Affiliation(s)
- Gergely Vertse
- Fovárosi Onkormányzat Károlyi Sándor Kórház és Rendelointézet Altalános Sebészeti Osztály 1041 Budapest Nyár u. 103.
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50
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Weissferdt A, Kalhor N, Suster S, Moran CA. Primary angiosarcomas of the anterior mediastinum:. Hum Pathol 2010; 41:1711-7. [DOI: 10.1016/j.humpath.2010.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 05/09/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
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