Abstract
Vascular proliferations may arise in the breast following radiation treatment for a primary breast adenocarcinoma. A post-radiation vascular proliferation can usually be classified as angiosarcoma or as an atypical vascular lesion (AVL). Angiosarcomas with a “low-grade” morphology, behave aggressively but exhibit substantial histomorphologic overlap with AVLs, which have a generally benign clinical course. We present a case of a post-radiation angiosarcoma of the breast with histologic features that mimic an atypical vascular lesion and discuss this challenging differential diagnosis. In addition to histologic mimicry, the lesion exhibited only patchy amplification of the avian myelocytomatosis viral oncogene homolog (MYC) gene by present fluorescence in-situ hybridization (FISH), and patchy MYC overexpression by immunohistochemistry. These features further complicate the distinction between AVL and angiosarcoma, and would be particularly problematic on a small biopsy. We believe that the morphologic and immunohistochemical overlap between these entities is suggestive of a biologic spectrum, and thus that, at least in some instances, angiosarcoma may arise from a pre-existing AVL or AVL-like lesion.
Highlights
There have long been reports of vascular neoplasia arising in the female breast following therapy for a primary breast carcinoma
The earliest of these reports focused on chronic lymphedema-associated angiosarcoma—the so-called Stewart-Treves syndrome [1]
The most critical distinction in this context is between a post-radiation atypical vascular lesion (AVL) and post-radiation angiosarcoma
Summary
There have long been reports of vascular neoplasia arising in the female breast following therapy for a primary breast carcinoma. Beginning with the earliest description roughly 20 years ago, it was noted that a subset of post-radiation vascular proliferations had clinicopathologic features that were distinct from those of the typically aggressive angiosarcomas [4]. These were termed atypical vascular lesions (AVL). We present a case study that highlights the challenge of distinguishing between these entities on a morphologic basis We believe that it provides evidence for a biologic relationship between the two entities, and that, at least in some instances, angiosarcoma may arise from a pre-existing AVL or AVL-like lesion
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