Abstract
A 59-year-old woman presented with erythema and pruritis of the breast 4.5 years after undergoing lumpectomy and radiation for breast cancer. Biopsy confirmed a diagnosis of angiosarcoma. This tumor stained positive for CD34 as well as 70% Ki67 prior to therapy initiation. A multidisciplinary approach yielded a plan for neoadjuvant chemoradiation and surgical resection including delayed completion transverse rectus abdominis flap for tissue coverage. Neoadjuvant therapy successfully decreased rates of cellular proliferation, as reflected by a Ki67 of 5%, at the time of resection. Pathophysiologically, angiosarcomas may be very aggressive and may develop following radiation for breast cancer. Such tumors may become more common as breast cancer therapies, which frequently include radiation therapy, improve with time. Early recognition of angiosarcoma is imperative for successful therapy. These tumors may present with a wide range of symptoms, but may be asymptomatic. Surgical resection is the preferred therapy, but early recognition is critical.
Highlights
Our patient is a very pleasant 59-year-old-female who underwent left breast lumpectomy and axillary lymph node dissection followed by adjuvant chemoradiation in 2006 for a lesion identified as part of her work-up for colon cancer
In order to determine the effect of the XRT on the angiosarcoma prior to surgery, immunohistochemistry was re-performed approximately six weeks following XRT
Angiosarcoma (AS) is a heterogenous, aggressive malignancy that arises from vascular endothelium that typically effects elderly white males, it is a recognized disease process following irradiation for breast cancer in women [1,2,3]
Summary
Our patient is a very pleasant 59-year-old-female who underwent left breast lumpectomy and axillary lymph node dissection followed by adjuvant chemoradiation in 2006 for a lesion identified as part of her work-up for colon cancer. In April 2011, the patient developed pruritus of the left breast associated with multiple skin lesions. H&E staining revealed dermal and subcutaneous tumor with poorly-formed vascular channels (Figure 1(a)). In order to determine the effect of the XRT on the angiosarcoma prior to surgery, immunohistochemistry was re-performed approximately six weeks following XRT. These studies revealed a significant decrease in tumor-associated vascularity, and both CD34 and Ki67 were markedly lower (Figures 2(a)-(c)). Over the open chest wall wound (Figure 3(b)) This was to be followed by a pedicled transverse rectus abdominis myocutaneous (TRAM) flap for definitive breast reconstruction once pathology confirmed local absence of malignnancy. Post-operative adjuvant chemotherapy had been initiated shortly after her first-stage STSG, as mentioned above
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