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Case Reports
. 2024 Jul-Sep;65(3):523-529.
doi: 10.47162/RJME.65.3.15.

Lymph node involvement in secondary breast angiosarcoma - a case presentation

Adriana Irina Ciuvică  1 , Tiberiu Augustin Georgescu, Andrei Dennis Voichiţoiu, Angela Arsene, Luchian Marinescu, George Ionuţ Bucur, Livia Iordache, Nahedd Saba
Affiliations
Case Reports

Lymph node involvement in secondary breast angiosarcoma - a case presentation

Adriana Irina Ciuvică et al. Rom J Morphol Embryol. 2024 Jul-Sep.

Abstract

Angiosarcoma represents a group of rare tumors originating from vascular and lymphatic endothelial cells, characterized by marked aggressiveness, rapid growth and poor clinical outcome. The incidence of breast angiosarcoma accounts for approximately 0.05% of all malignant breast tumors and less than 1% of all sarcomas. In this article, we report the case of a 67-year-old female patient who presented to our Clinic due to a rapidly evolving, non-painful, vegetating mass, encompassing almost her entire left breast. Imaging studies revealed diffuse skin thickening in all quadrants and an intensely opaque axillary lymph node (LN). Interestingly, the patient had prior medical history of breast carcinoma treated conservatively in 2007 with limited breast resection and left axillary lymphadenectomy, followed by post-operative chemotherapy and radiotherapy. At the current presentation, we performed a radical mastectomy with ipsilateral lymphadenectomy. The histopathological examination revealed a secondary angiosarcoma with LN involvement mimicking an atypical vascular lesion. In this article, we report the clinicopathological particularities of this case and discuss the challenge of diagnosing LN involvement in angiosarcoma.

Keywords: breast angiosarcoma; epithelioid angiosarcoma; secondary angiosarcoma.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Figure 1
Figure 1
(A and B) Macroscopic aspect of the surgically resected specimen, featuring secondary breast angio-sarcoma (approximately 15 years post-radiotherapy).
Figure 2
Figure 2
(A and B) Mammographic appearance of secondary breast angiosarcoma
Figure 3
Figure 3
(A and B) CT appearance of secondary breast angiosarcoma post-radiotherapy. CT: Computed tomography
Figure 4
Figure 4
Histopathological appearance of the vascular proliferation with a tubulo-cystic, papillary, and solid pattern from the left breast skin. Hematoxylin–Eosin (HE) staining, ×400
Figure 5
Figure 5
Post-operative aspect: left radical mastectomy, the Madden technique
Figure 6
Figure 6
The macroscopic aspect of the cut surface of the surgical resection specimen
Figure 7
Figure 7
Tumor cells show diffuse immunoreactivity for CD31. Immunohistochemical staining with DAB chromogen, ×200. CD31: Cluster of differentiation 31; DAB: 3,3’-Diaminobenzidine
Figure 8
Figure 8
Tumor cells show diffuse immunoreactivity for ERG. Immunohistochemical staining with DAB chromogen, ×40
Figure 9
Figure 9
Microscopic appearance of an axillary lymph node with metastasis from secondary post-irradiation breast angiosarcoma. HE staining, ×100
Figure 10
Figure 10
The atypical vascular proliferation within the axillary lymph node showed diffuse nuclear immuno-reactivity for c-Myc. Immunohistochemical staining with DAB chromogen, ×200
Figure 11
Figure 11
Wound appearance: three months post-operation
See this image and copyright information in PMC

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