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Dhafir Alazawi
Case 1HS 37 yr GP referral 2 day history of Left breast lump.No relevant past medical history
OPD - Palpable lump in the central part of left breast just below the areola (S4) Right breast & axillae NAD.
Risk factor OCP x 4 years.
Mammogram no mass/calcifications.
US - 9 oclock position 35mm hyperechoic mass, ?haematoma but no Hx of trauma. Axillary LN NAD.
Core Bx extensive infiltration of atypical endothelial cells Low Grade Angiosarcoma (B5)
AngiosarcomaBreast parenchymaFat
Vasoformative pattern (well formed vascular channels, lined by a single layer of endothelial cells).
Tumour infiltrates the breast parenchyma
Sieve-like pattern. (Vascular channels are lined by a Predominantly single layer of plump, hyperchromatic endothelial cells.)
The endothelial cells are bland.No significant mitoses.
Breast parenchymaBreast lobule
Case 1
MRI Left Breast bulk of mass in lower inner quadrant extending deep to nipple. Axillary LN NAD.
Grade I Primary Angiosarcoma resected tumour with clear margins.
Gross description:
Tumour : Retro-areolar. Size: 6.9 x 3.4 x 2.8cm.Moderately poorly circumscribed, firm, white, dense cut surface with focal areas of haemorrhage, adjacent to breast tissue.
Case 1Prof. Chris Fletcher Centre for Sarcoma & Bone Oncology; Bringham & Womens Hosp Boston USA
American Journal of Pathology (Dec 2008)
Primary angiosarcoma of the breast: clinicopathologic analysis of 49 cases, suggesting that grade is not prognostic.
American Journal of Surgical Pathology49 female patients with Primary Angiosarcoma.Graded using Rosens 3 tier system into Low (I) Intermediate (II) and High (III) grades.3 patients Hx of Breast CaOf these, 2 had prior RTX8 lost to follow upConclusion; Lack of correlation between histologic grade and outcome.
OutcomeLocal Recurrence (10)Metastasis (24)Low Grade = 3 (median 36mnths post Dx)Intermediate Grade = 5 (42.5mnths)High Grade = 2 (23mnths)Low Grade = 6 (21 months)Intermediate Grade = 11 (43 months)High Grade = 6 (17.5mnths)Unkown = 1
Case 2
HS 68 yr old femalePrevious Hx of Left Breast Ca WLE & RTX in 2002
Presented with increasing change to a Haemangioma on surface of left breast despite previous biopsy of the lesion in 2007 was benign.
M. Angiosarcoma, high grade:
Large vascular cisterns (blood lakes)
Areas of necrosis (pink areas)
MRI Left Breast ; mass in medial part of Left breast.
Mastectomy revealed a high grade Angiosarcoma .
The majority of the tumour is in the dermis and subcutaneous tissue, with extension into adjacent breast parenchyma.
Margins are clear by at least 10mm.
Vascular lesion, 2.5 x 2cm 1.5cm from the nipple between 7 & 9 oclock. Tumour, 4 x 4.5 x 4.4cm in the medial breast, the tumour is haemorrhagic and sclerotic, poorly circumscribed, firm and invading epidermis. Focal necrosis is present.
Breast Angiosarcoma
Primary is defined as malignant vascular neoplasm arising within breast parenchyma with or without minor extension into overlying skin.
Usually diagnosed in young females.
Aggressive tumour - 5 year disease free survival 33%
DiagnosisDefinitive Dx can be difficult.Mammography non specific mass & can be confused with a benign lesion as uncalcified.MRI best imaging modality; gadolinium enhanced images.FNA & Punch Bx generally not diagnostic.Full thickness incisional or excisional Bx should be conclusive.
TreatmentSimple mastectomy.Accompanied by hyperfractionated radiation therapyIncreasing role for adjuvant & neo-adjuvant therapy.Data suggest that multidisciplinary therapeutic approach should be employed in high-risk patients with large primary tumours.
ReferencesHuang J, Mackillop WJ. Increased risk of soft tissue sarcoma after radiotherapy in women with breast carcinoma.Cancer. 2001;92:172180.LibermanL, DershawDD, KaufmanRJ, RosenPP. Angiosarcoma of the breast. Radiology. 1992;183:649654. DonnellRM, RosenPP, LiebermanPH, KaufmanRJ, KayS, BraunDW, et al. Angiosarcoma and other vascular tumors of the breast. Pathologic analysis as a guide to prognosis. Am J Surg Pathol. 1981;5:629642. MerinoMJ, CarterD, BermanM. Angiosarcoma of the breast. Am J Surg Pathol. 1983;7:5360. RosenPP, ErnsbergerDL. Grading mammary angiosarcoma. Prognostic study of 62 cases (abstract). Lab Invest. 1988;58:78A. Vorburger SA, Xing Y, Hunt KK, et al. Angiosarcoma of the breast. Cancer 2005;104:26822688.Sher Taimur, Hennessy Bryan. Primary Angiosarcoma of the Breast. Cancer 2007;110;173-178MonroeAT, Feigenberg SJ, Price Mendenhall N. Angiosarcoma after breast-conserving therapy. Cancer 2003; 97(8): 18321840.
ReferencesLim R. Angiosarcoma of the Breast. RadioGraphics, October 2007 27, S125-S130.Sturgis EM, Potter BO.Sarcomas of the head and neck region.Curr Opin Oncol.May2003;15(3):239-52.Soft Tissue Tumors.Enzinger FM, Weiss SW, eds.Soft Tissue Tumors.3rd ed.St. Louis, Mo:Mosby;1995:648-77.Toro JR, Travis LB, Wu HJ, Zhu K, Fletcher CD, Devesa SS.Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978-2001: An analysis of 26,758 cases.Int J Cancer.Dec 152006;119(12):2922-30.Lezama-del Valle P, Gerald WL, Tsai J, et al.Malignant vascular tumors in young patients.Cancer.Oct 151998;83(8):1634-9.Mark RJ, Poen JC, Tran LM, Fu YS, Juillard GF.Angiosarcoma. A report of 67 patients and a review of the literature.Cancer.Jun 11996;77(11):2400-6.Schottenfeld D, Fraumeni J, eds.Cancer. Epidemiology and Prevention.3rd ed.New York:Oxford University Press;2006:763-786/959-974.Meis-Kindblom JM, Kindblom LG.Angiosarcoma of soft tissue: a study of 80 cases.Am J Surg Pathol.Jun1998;22(6):683-97.Wenger DE, Wold LE.Malignant vascular lesions of bone: radiologic and pathologic features.Skeletal Radiol.Nov2000;29(11):619-31.
Morgan MB, Swann M, Somach S, et al.Cutaneous angiosarcoma: a case series with prognostic correlation.J Am Acad Dermatol.Jun2004;50(6):867-74.DeVita VT Jr, Hellman S, Rosenberg SA, eds.Cancer: Principles & Practice of Oncology.8th ed.Philadelphia, Pa:Lippincott Williams & Wilkins;2008.Virtanen A, Pukkala E, Auvinen A.Angiosarcoma after radiotherapy: a cohort study of 332 163 Finnish cancer patients.The British Journal of Cancer.Jul 2007;97:115.Patton KT, Deyrup AT, Weiss SW.Atypical vascular lesions after surgery and radiation of the breast: a clinicopathologic study of 32 cases analyzing histologic heterogeneity and association with angiosarcoma.Am J Surg Pathol.Jun2008;32(6):943-50.Huang J, Mackillop WJ.Increased risk of soft tissue sarcoma after radiotherapy in women with breast carcinoma.Cancer.2001;Jul 1;92(1):172-80.USA: National Cancer Institute (NCI); 2000-2004.The Surveillance, Epidemiology, and End Results (SEER) Program.Mullamitha SA, Ton NC, Parker GJ, Jackson A, Julyan PJ, Roberts C, et al.Phase I evaluation of a fully human anti-alphav integrin monoclonal antibody (CNTO 95) in patients with advanced solid tumors.Clin Cancer Res.Apr 2007;13(7):2128-35.
Budd GT.Management of Angiosarcoma.Curr Oncol Rep.2002;4(6):515-519.Kibitz KM, Haddad PA.Paclitaxel and pegylated-liposomal doxorubicin are both active in angiosarcoma.Cancer.Jul 152005;104(2):361-6.Vogt T, Hafner C, Bross K, et al.Antiangiogenetic therapy with pioglitazone, rofecoxib, and metronomic trofosfamidein patients with advanced malignant vascular tumors.Cancer.Nov 152003;98(10):2251-6.Liekens S, Verbeken E, De Clercq E, Neyts J.Potent inhibition of hemangiosarcoma development in mice by cidofovir.Int J Cancer.Apr 152001;92(2):161-7.Espat NJ, Lewis JJ, Woodruff JM, Antonescu C, Xia J, Leung D, et al.Confirmed angiosarcoma: prognostic factors and outcome in 50 prospectively followed patients.Sarcoma.2000;4(4):173-7.Kantarjian H, Wolff R, Koller C.MD Anderson Manual of Medical Oncology.New York, NY:McGraw Hill;2006.NCCN.National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology.Adami H, Hunter D, Trichopoulos D, eds.Textbook of Cancer Epidemiology
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