Breast angiosarcoma is a rare primary or secondary endothelial tumour. Optimal management differs according to the etiology.
The authors illustrate the diagnostic and therapeutic complexity of this type of cancer, based on two clinical cases. A recent review article sheds light on the management of this pathology.
The two types of angiosarcomas have different macroscopic appearances. An anatomopathological analysis enables a real diagnosis of this tumour, as do the immunohistological markers such as c-Myc and FLT4, which allow to differentiate between a primary or secondary angiosarcoma. (1)
Imaging tests such as ultrasound, mammography and (magnetic resonance imaging) MRI are not specific but can detect distant metastases and make the differential diagnosis with breast cancer recurrence. (2)
The specificity of post-radiation angiosarcoma surgical treatment lies in the width of the procedure. It is imperative to resect the entire irradiated skin area. Primary angiosarcoma, on the other hand, should be resected with a margin of 1cm to 2cm for tumours which are ≤ 5cm in diameter. (3) Indeed, the irradiated bed is the breeding ground for subsequent recurrence.
What is already known about the topic?
Post-radiation angiosarcoma of the breast is an endothelial tumour that occurs in 0.1% of patients who have had adjuvant breast irradiation approximately 8 years after the causative irradiation. (4) (8)
The first case of post-radiation angiosarcoma of the breast was reported in 1981 by J. Hamels et al. (6)
The two types of angiosarcoma can be distinguished by immunohistochemical markers such as c-Myc and FLT4, which are positive in post-radiation angiosarcoma. (2)
The treatment of angiosarcoma is mainly based on wide surgery. Axillary lymph node dissection is not routinely recommended as the tumour rarely invades the lymph nodes. (5)
Chemotherapy protocols have already been tested but the results remain controversial in existing studies.
What does this article bring up for us?
Through the presentation of two clinical cases of post-radiation angiosarcoma of the breast, this article provides a better understanding of such types of cancer. The literature review provides diagnostic and therapeutic leads.
Key Words
Angiosarcoma, breast cancer, radiotherapy