Radiation-Induced Angiosarcoma after Breast-Cancer Treatment
A 72-year-old woman presented with skin changes on her left breast; 5 years earlier, she had undergone lumpectomy and radiation therapy for breast cancer. Physical examination revealed an area of skin 10 cm in diameter, medial to the areola, that had an ecchymotic appearance (Panel A). The area contained no underlying mass or nodular tissue. Punch biopsy findings were consistent with angiosarcoma. She underwent mastectomy, and final pathological testing revealed a grade 2 angiosarcoma larger than 10 cm that involved the dermis and breast parenchyma (Panel B). Radiation-induced angiosarcoma is a rare complication after breast-cancer treatment. Patients frequently present with asymptomatic skin changes, which can be difficult to differentiate from radiation-induced skin changes. Angiosarcomas may also manifest as cutaneous or subcutaneous, flat or nodular, or localized or multifocal lesions and can have an appearance similar to that of benign angiomas or atypical telangiectasis. Aggressive surgery is the standard of care and usually involves mastectomy to obtain wide margins. Recurrence rates are high, and the benefits of adjuvant therapy are unclear. The patient underwent scanning to stage the cancer, and the results showed no metastatic disease. She then underwent chemotherapy, and at 1-year follow-up, she had no evidence of disease.
