Mammary angiosarcomas: imaging findings in 24 patients

Abstract

Purpose: To retrospectively evaluate the clinical, imaging, and pathologic findings of mammary angiosarcomas in 24 patients.

Materials and methods: The institutional review board approved this HIPAA-compliant study and waived informed consent. Twenty-four patients with records in the surgical pathology database who had a diagnosis of mammary angiosarcoma (n = 26) and who underwent preoperative imaging with mammography, ultrasonography (US), or magnetic resonance (MR) imaging were included. Mean and median ages at time of diagnosis were 40 and 38 years, respectively (range, 15-77 years). Images were reviewed in consensus by two radiologists with the American College of Radiology Breast Imaging Reporting and Data System lexicon and were compared with pathologic findings. Total length of follow-up (in months) was determined by the interval from the time of diagnosis to the time of last follow-up. Information on overall and disease-free survival was also obtained.

Results: Mean tumor size at time of diagnosis was 5.9 cm (range, 1-12 cm). Nineteen tumors manifested as a palpable mass, four manifested with progressive breast swelling, and three were asymptomatic. Mammograms of 16 tumors showed a noncalcified mass in eight, focal asymmetry in five, and no abnormality in three. All three mammographically occult tumors were visible at US and MR imaging. US images of 21 tumors showed a solid, frequently oval-shaped, and hyperechoic mass in 13 tumors and random mixed hyper- and hypoechogenicity with associated architectural distortion in eight tumors. Dynamic contrast material-enhanced MR imaging of nine tumors showed large, lobular, and intensely and heterogeneously enhancing masses with rapid enhancement and the washout characteristics of a malignant lesion.

Conclusion: A mass that shows homogeneous or heterogeneous hyperechogenicity at US (with associated architectural distortion) and has a hypervascular, hemorrhagic, and heterogeneous appearance and typical malignant enhancement characteristics at MR imaging should alert the radiologist to a possible diagnosis of angiosarcoma.