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Case Reports
. 2024 Sep 6;16(9):e68782.
doi: 10.7759/cureus.68782. eCollection 2024 Sep.

Radiation-Induced Angiosarcoma Arising in Bilateral Breast: A Case Report

Wakako Tsuji  1 , Katsuhiro Yoshikawa  2 , Fumie Fujisawa  3 , Chikako Yamauchi  4 , Akihiko Sugimoto  5
Affiliations
Case Reports

Radiation-Induced Angiosarcoma Arising in Bilateral Breast: A Case Report

Wakako Tsuji et al. Cureus. .

Abstract

Radiation-induced angiosarcoma is a highly aggressive malignancy. We encountered a case of angiosarcoma arising in the bilateral breast seven years after partial mastectomy and the last radiation therapy. As recommended, wide resection with skin grafting was performed to ensure negative surgical margins. After surgery, taxane-based chemotherapy was administered. However, adjuvant chemotherapy was discontinued because of drug-induced institutional pneumonia. Eighteen months postoperatively, angiosarcoma recurred in subcutaneous, lymph nodes, lungs, and bones. The disease progressed too rapidly, and the patient died two months after recurrence.

Keywords: bilateral radiation-induced angiosarcoma; breast-conserving therapy; recurrence; surgical resection with an adequate margin; taxane; wide skin grafting.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of Shiga General Hospital issued approval 240226-01. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Clinical photograph.
Irregular skin redness and multiple nodules are observed on both breasts.
Figure 2
Figure 2. Microscopic pathological findings.
Microscopic pathological findings from a skin biopsy (low- and high-power field of hematoxylin and eosin (H&E) staining, podoplanin, CD31). H&E staining shows vascular spaces lined by atypical cells with markedly pleomorphic vesicular nuclei and moderate eosinophilic cytoplasm in the deep derma. Immunohistochemical analyses show strong and diffuse membrane positivity for CD31 and podoplanin.
Figure 3
Figure 3. Chest CT imaging.
Chest CT imaging shows bilateral breast skin thickness and multiple nodules (arrows). No distant metastasis is observed.
Figure 4
Figure 4. Skin incision design before surgery.
Skin incision was drawn at least 3 cm margin from the skin disease.
Figure 5
Figure 5. Appearance after resection and skin grafting.
Bilateral total mastectomies were performed with a margin of 3 cm, and a skin graft was transplanted from the bilateral inguinal region.
Figure 6
Figure 6. PET-CT imaging.
PET-CT imaging shows recurrence in the left axilla, multiple lymph nodes, lung, and bone (arrows).
See this image and copyright information in PMC

References

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