Breast Cancer Research and Treatment

, Volume 122, Issue 3, pp 883–887 | Cite as

Changing clinical presentation of angiosarcomas after breast cancer: from late tumors in edematous arms to earlier tumors on the thoracic wall

  • Emelie Styring
  • Josefin Fernebro
  • Per-Ebbe Jönsson
  • Anna Ehinger
  • Jacob Engellau
  • Pehr Rissler
  • Anders Rydholm
  • Mef Nilbert
  • Fredrik Vult von Steyern
Epidemiology

Abstract

Angiosarcoma is a rare complication of breast cancer treatment. In order to define predictors, clinical presentation, and outcome, we characterized a population-based 50-year cohort of angiosarcomas after breast cancer. Clinical data were collected from all females with previous breast cancer who developed angiosarcomas/lymphangiosarcomas on the thoracic wall/upper extremity between 1958 and 2008 in the Southern Swedish health care region. In total, 31 angiosarcomas developed at a median age of 71 years. The patients formed two distinct groups; 14 females treated for breast cancer with radical mastectomy and radiotherapy 1949–1988 developed angiosarcomas in edematous arms (Stewart–Treves syndrome) after median 11 years, and 17 females treated by segmental resection, anti-hormonal treatment and radiotherapy 1980–2005 developed angiosarcomas in the irradiated field on the thoracic wall after median 7.3 years. The clinical presentations were heterogeneous and included hematoma-like lesions, multiple bluish-reddish nodules, and asymptomatic lumps. The overall 5-year survival was 16%. In this population-based cohort, the early angiosarcomas developed in edematous arms after radical mastectomies, whereas more recent cases occurred after a shorter time period in the irradiated fields following breast conserving surgery. We conclude that the clinical presentation of angiosarcomas has changed, parallel with altered treatment principles for breast cancer.

Keywords

Soft tissue sarcoma Radiation-induced sarcoma Population-based Secondary sarcoma 

References

  1. 1.
    Holmberg L (1989) Sector resection with and without radiotherapy in early breast cancer. Acta Oncol 28:927–929CrossRefPubMedGoogle Scholar
  2. 2.
    The Uppsala-Örebro Breast Cancer Study Group (1990) Sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Natl Cancer Inst 82:277–282CrossRefGoogle Scholar
  3. 3.
    Fitzal F, Gnant M (2006) Breast conservation: evolution of surgical strategies. Breast J 12:165–173CrossRefGoogle Scholar
  4. 4.
    Lowenstein S (1906) Der atiologische Zusammenhand zwischen akutem einmaligem Trauma and Sarkom. Beitrage zur Klinsichen Chirurgie 48:780–824Google Scholar
  5. 5.
    Stewart FW, Treves N (1948) Lymphangiosarcoma in post-mastectomy lymphoedema. Report of six cases in elephantiasis chirurgica. Cancer 1:64–81CrossRefPubMedGoogle Scholar
  6. 6.
    Karlsson P, Holmberg E, Johansson K-A, Kindblom L-G, Carstensen J, Wallgren A (1996) Soft tissue sarcoma after treatment for breast cancer. Radiother Oncol 38:25–31CrossRefPubMedGoogle Scholar
  7. 7.
    Karlsson P, Holmberg E, Samuelsson A, Johansson K-A, Wallgren A (1998) Soft tissue sarcoma after treatment for breast cancer—a swedish population-based study. Eur J Cancer 34:2068–2075CrossRefPubMedGoogle Scholar
  8. 8.
    Ruocco V, Schwartz RA, Ruocco E (2002) Lymphedema: an immunologically vulnerable site for development of neoplasms. J Am Acad Dermatol 47:124–127CrossRefPubMedGoogle Scholar
  9. 9.
    Billings SD, McKenny JK, Folpe AL, Hardacre MC, Weiss SW (2004) Cutaneous angiosarcoma following breast-conserving surgery and radiation. Am J Surg Pathol 28:781–788CrossRefPubMedGoogle Scholar
  10. 10.
    Esler-Brauer L, Jaggernauth W, Zeitouni NC (2007) Angiosarcoma developing after conservative treatment for breast carcinoma: case report with review of the current literature. Dermatol Surg 33:749–755CrossRefPubMedGoogle Scholar
  11. 11.
    Body G, Sauvanet E, Calais G, Fignon A, Fetissof F, Lansa CJ (1987) Angiosarcome cutané du sein aprés adenocarcinome mammaire opéré et irradié. J Gynecol Obstet Biol Reprod 16:479–483Google Scholar
  12. 12.
    Brenn T, Fletcher CDM (2005) Radiation-associated cutaneous atypical vascular lesions and angiosarcoma: clinicopathological analysis of 42 cases. Am J Surg Pathol 29:983–996PubMedGoogle Scholar
  13. 13.
    Brodie C, Provenzano E (2008) Vascular proliferations of the breast. Histopathology 52:30–44PubMedCrossRefGoogle Scholar
  14. 14.
    Neuhaus SJ, Pinnock N, Giblin V, Fisher C, Thway K, Thomas JM, Hayes AJ (2009) Treatment and outcome of radiation-induced soft-tissue sarcomas at a specialist institution. Eur J Surg Oncol 35:654–659Google Scholar
  15. 15.
    Monroe AT, Feigenberg SJ, Mendenhall NP (2002) Angiosarcoma after breast-conserving therapy. Cancer 97:1832–1840CrossRefGoogle Scholar
  16. 16.
    Roessner A, Boehlind T (2002) Angiosarcoma. In: Fletcher C, Unni K, Mertens F (eds) World Health Organization classification of tumors, pathology and genetics of tumors of soft tissue and bone. IARC press, Lyon, pp 322–323Google Scholar
  17. 17.
    Strobbe LJA, Peterse HL, van Tinteren H, Wijnmaalen A, Rutgers EJT (1998) Angiosarcoma of the breast after conservation therapy for invasive cancer, the incidence and outcome. An unforeseen sequela. Breast Cancer Res Treat 47:101–109CrossRefPubMedGoogle Scholar
  18. 18.
    Vorburger SA, Xing Y, Hunt KK et al (2005) Angiosarcoma of the breast. Cancer 104:2682–2688CrossRefPubMedGoogle Scholar
  19. 19.
    Hodgson NC, Bowen-Wells C, Moffat F, Franceschi D, Avisar E (2007) Angiosarcoma of the breast—A review of 70 cases. Am J Clin Oncol 30:570–573CrossRefPubMedGoogle Scholar
  20. 20.
    Patton KT, Deyrup AT, Weiss SW (2008) Atypical vascular lesions after surgery and radiation of the breast: a clinicopathologic study of 32 cases analyzing histologic heterogeneity and association with angiosarcoma. Am J Surg Pathol 32:943–950CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Emelie Styring
    • 1
    • 2
  • Josefin Fernebro
    • 2
  • Per-Ebbe Jönsson
    • 3
    • 4
  • Anna Ehinger
    • 5
  • Jacob Engellau
    • 2
  • Pehr Rissler
    • 6
  • Anders Rydholm
    • 1
  • Mef Nilbert
    • 2
    • 7
  • Fredrik Vult von Steyern
    • 1
  1. 1.Department of OrthopedicsLund University HospitalLundSweden
  2. 2.Department of Oncology, Institute of Clinical SciencesLund University HospitalLundSweden
  3. 3.Department of SurgeryHelsingborg HospitalHelsingborgSweden
  4. 4.Department of Surgery, Institute of Clinical SciencesLund UniversityMalmöSweden
  5. 5.Department of PathologyHelsingborg HospitalHelsingborgSweden
  6. 6.Department of Pathology, Institute of Clinical SciencesLund University HospitalLundSweden
  7. 7.Clinical Research CentreHvidovre Hospital, Copenhagen UniversityCopenhagenDenmark

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