Two cases of cutaneous angiosarcoma developed after breast cancer surgery

Abstract

Several randomized trials have shown that breast-conserving therapy (BCT) is as effective as mastectomy and should be a standard treatment for early-stage breast cancer. Recently, there has been an increase in reports of angiosarcoma (AS) after BCT. Herein, we report a case of AS which developed after BCT and a case of Stewart-Treves syndrome with a focus on lymphedema. Chronic lymphedema is the primary risk factor for AS, which was first described in 1948 by Stewart and Treves [Cancer 1948;1:64-81]. Radiation therapy secondarily tends to induce the development of AS, since radiation therapy induces fibrosis and proliferation of lymphatic vessels via cytokines such as vascular endothelial growth factor, which is followed by subclinical chronic edema. It is suggested that axillary lymph node dissection predisposes patients to the development of AS, since it is closely associated with lymphedema. Breast surgeons and radiologists should be aware of skin changes in order to improve the early detection of AS during the follow-up of patients who have undergone BCT, and especially those treated with axillary lymph node dissection.

Keywords: Angiosarcoma; Axillary lymph node dissection; Breast cancer; Breast cancer surgery; Breast-conserving therapy; Lymphedema; Radiation; Stewart-Treves syndrome.

Fig. 1

a Clinical appearance with chronic edema and an erythematous purplish palpable mass on the right breast in case 1. b Histological examination revealed spindle-shaped cells with vascular differentiation. c Clinical appearance with chronic edema and purplish ecchymosed skin lesions on the right breast in case 2. d Histological examination revealed pleomorphic spindle-shaped cells with little vascular differentiation.