Radiation-induced angiosarcoma: case report

ABSTRACT Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named “radiogenic angiosarcoma of the breast”, which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.

摘要 乳腺血管肉瘤（Angiosarcoma of the breast）占乳腺肿瘤的比例不足1%。该肿瘤可分为原发性与继发性两类，其中继发性者多与既往放射治疗相关，又称“乳腺放射相关性血管肉瘤（radiogenic angiosarcoma of the breast）”，此类病变仍属罕见，且预后不佳。截至目前，全球已发表文献中仅报道过307例此类病例。
本次报告1例73岁女性患者，既往有右侧乳腺癌保乳治疗史，患侧乳房出现淡粉色皮肤改变。患者乳腺钼靶检查结果符合良性病变特征（BI-RADS 2）。切取活检标本的苏木精-伊红染色可见非典型血管病变，遂建议行免疫组化检查以明确诊断。随后患者接受了病灶切除术，术后组织病理学检查提示为放射相关性血管肉瘤，遂行单纯乳房切除术。免疫组化结果显示CD31、CD34相关抗原呈阳性，且C-MYC癌基因扩增，最终确诊为乳腺放疗诱导的血管肉瘤。
诊断延误是此类病例亟需关注的重要问题。乳腺放射相关性血管肉瘤的初始皮肤改变较为隐匿，易与毛细血管扩张症等良性皮肤病变相混淆。本案例着重阐述其临床特征，旨在提请临床医师注意：既往接受乳腺癌辅助放疗的患者，需警惕乳腺血管肉瘤的发生可能。术后16个月，患者仍无不适症状。