Breast Cancer Research and Treatment

, Volume 132, Issue 3, pp 1081–1088 | Cite as

Primary and secondary angiosarcomas of the breast: a single institution experience

  • Conceição Fraga-Guedes
  • Helenice GobbiEmail author
  • Mauro Giuseppe Mastropasqua
  • Edoardo Botteri
  • Alberto Luini
  • Giuseppe Viale
Clinical Trial


Angiosarcomas of the breast (ASB) are rare, representing <1% of breast malignancies. They can develop as a primary or secondary malignancy, also called post-radiation angiosarcoma. The aim of the this study is to discuss diagnosis, treatment, and outcome of primary and secondary ASB patients, diagnosed and treated in a single institution, over a 10-year period and to further compare the two conditions. We retrieved 28 consecutive cases of ASB, diagnosed from 1999 to 2009 at the European Institute of Oncology. Clinical and pathologic findings and survival analyses were performed. Of the 28 cases (27 women and 1 man), eight were primary breast angiosarcomas (PBA) and 20 were secondary breast angiosarcomas (SBA). Median follow-up was 23 months (range 1–112 months). Type of treatment (conservative or radical surgery) did not affect survival in both types of angiosarcomas. The clinical course observed was characterized by a high rate of local recurrence rather than distant metastasis or death from disease. There was a correlation between histological grade and prognosis of angiosarcomas with high-grade tumors presenting worse prognosis. SBA had a poorer prognosis compared to PBA. Our data indicate that primary and secondary ASB are distinct clinical and pathological features. SBA showed worse prognosis and was more often diagnosed in the study period compared to PBA. Physicians who care for patients who have been treated with radiation must be aware of its potential to induce angiosarcoma and stay vigilant in its detection.


Angiosarcoma Breast neoplasms Radiation therapy Radiation-induced neoplasms Breast conserving surgery 



We are grateful to Sandra J. Olson for revising the English manuscript. This study was supported partially by grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa de Minas Gerais (FAPEMIG), and European Institute of Oncology.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    West JG, Qureshi A, West JE, Chacon M, Sutherland ML, Haghighi B, Harrison J (2005) Risk of angiosarcoma following breast conservation: a clinical alert. Breast J 11(2):115–123. doi: 10.1111/j.1075-122X.2005.21548.x PubMedCrossRefGoogle Scholar
  2. 2.
    Abraham JA, Hornicek FJ, Kaufman AM, Harmon DC, Springfield DS, Raskin KA, Mankin HJ, Kirsch DG, Rosenberg AE, Nielsen GP, Desphpande V, Suit HD, DeLaney TF, Yoon SS (2007) Treatment and outcome of 82 patients with angiosarcoma. Ann Surg Oncol 14(6):1953–1967. doi: 10.1245/s10434-006-9335-y PubMedCrossRefGoogle Scholar
  3. 3.
    Majeski J, Austin RM, Fitzgerald RH (2000) Cutaneous angiosarcoma in an irradiated breast after breast conservation therapy for cancer: association with chronic breast lymphedema. J Surg Oncol 74(3):208–212; discussion 212–203. doi: 10.1002/1096-9098(200007)74:3<208::AID-JSO10>3.0.CO;2-2
  4. 4.
    Nakamura R, Nagashima T, Sakakibara M, Nakano S, Tanabe N, Fujimoto H, Arai M, Kadowaki M, Oide T, Tanizawa T, Miyazaki M (2007) Angiosarcoma arising in the breast following breast-conserving surgery with radiation for breast carcinoma. Breast Cancer 14(2):245–249PubMedCrossRefGoogle Scholar
  5. 5.
    Biswas T, Tang P, Muhs A, Ling M (2009) Angiosarcoma of the breast: a rare clinicopathological entity. Am J Clin Oncol 32(6):582–586. doi: 10.1097/COC.0b013e3181967f09 PubMedCrossRefGoogle Scholar
  6. 6.
    Monroe AT, Feigenberg SJ, Mendenhall NP (2003) Angiosarcoma after breast-conserving therapy. Cancer 97(8):1832–1840. doi: 10.1002/cncr.11277 PubMedCrossRefGoogle Scholar
  7. 7.
    Shet T, Malaviya A, Nadkarni M, Kakade A, Parmar V, Badwe R, Chinoy R (2006) Primary angiosarcoma of the breast: observations in Asian Indian women. J Surg Oncol 94(5):368–374. doi: 10.1002/jso.20593 PubMedCrossRefGoogle Scholar
  8. 8.
    Pandey M, Mathew A, Abraham EK, Rajan B (2004) Primary sarcoma of the breast. J Surg Oncol 87(3):121–125. doi: 10.1002/jso.20110 PubMedCrossRefGoogle Scholar
  9. 9.
    Nascimento AF, Raut CP, Fletcher CD (2008) Primary angiosarcoma of the breast: clinicopathologic analysis of 49 cases, suggesting that grade is not prognostic. Am J Surg Pathol 32(12):1896–1904. doi: 10.1097/PAS.0b013e318176dbc7 PubMedCrossRefGoogle Scholar
  10. 10.
    Mery CM, George S, Bertagnolli MM, Raut CP (2009) Secondary sarcomas after radiotherapy for breast cancer: sustained risk and poor survival. Cancer 115(18):4055–4063. doi: 10.1002/cncr.24462 PubMedCrossRefGoogle Scholar
  11. 11.
    Abbott R, Palmieri C (2008) Angiosarcoma of the breast following surgery and radiotherapy for breast cancer. Nat Clin Pract Oncol 5(12):727–736. doi: 10.1038/ncponc1242 PubMedCrossRefGoogle Scholar
  12. 12.
    Brenn T, Fletcher CD (2005) Radiation-associated cutaneous atypical vascular lesions and angiosarcoma: clinicopathologic analysis of 42 cases. Am J Surg Pathol 29(8):983–996PubMedGoogle Scholar
  13. 13.
    Huang J, Mackillop WJ (2001) Increased risk of soft tissue sarcoma after radiotherapy in women with breast carcinoma. Cancer 92(1):172–180. doi: 10.1002/1097-0142(20010701)92:1<172:AID-CNCR1306>3.0.CO;2-K PubMedCrossRefGoogle Scholar
  14. 14.
    Glazebrook KN, Magut MJ, Reynolds C (2008) Angiosarcoma of the breast. AJR Am J Roentgenol 190(2):533–538. doi: 10.2214/AJR.07.2909 PubMedCrossRefGoogle Scholar
  15. 15.
    Luini A, Gatti G, Diaz J, Botteri E, Oliveira E, Sahium Cecilio, de Almeida R, Veronesi P, Intra M, Pagani G, Naninato P, Viale G (2007) Angiosarcoma of the breast: the experience of the European Institute of Oncology and a review of the literature. Breast Cancer Res Treat 105(1):81–85. doi: 10.1007/s10549-006-9429-z PubMedCrossRefGoogle Scholar
  16. 16.
    Stewart FW, Treves N (1948) Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Cancer 1(1):64–81PubMedCrossRefGoogle Scholar
  17. 17.
    Stewart FW, Treves N (1981) Classics in oncology: lymphangiosarcoma in postmastectomy lymphedema: a report of six cases in elephantiasis chirurgica. CA Cancer J Clin 31(5):284–299PubMedCrossRefGoogle Scholar
  18. 18.
    Body G, Sauvanet E, Calais G, Fignon A, Fetissof F, Lansac J (1987) Cutaneous angiosarcoma of the breast following surgery and irradiation of breast adenocarcinoma. J Gynecol Obstet Biol Reprod (Paris) 16(4):479–483Google Scholar
  19. 19.
    Hodgson NC, Bowen-Wells C, Moffat F, Franceschi D, Avisar E (2007) Angiosarcomas of the breast: a review of 70 cases. Am J Clin Oncol 30(6):570–573. doi: 10.1097/COC.0b013e3181131d6200000421-200712000-00002 PubMedCrossRefGoogle Scholar
  20. 20.
    Wang XY, Jakowski J, Tawfik OW, Thomas PA, Fan F (2009) Angiosarcoma of the breast: a clinicopathologic analysis of cases from the last 10 years. Ann Diagn Pathol 13(3):147–150. doi: 10.1016/j.anndiagpath.2009.02.001 PubMedCrossRefGoogle Scholar
  21. 21.
    Vorburger SA, Xing Y, Hunt KK, Lakin GE, Benjamin RS, Feig BW, Pisters PW, Ballo MT, Chen L, Trent J III, Burgess M, Patel S, Pollock RE, Cormier JN (2005) Angiosarcoma of the breast. Cancer 104(12):2682–2688. doi: 10.1002/cncr.21531 PubMedCrossRefGoogle Scholar
  22. 22.
    Billings SD, McKenney JK, Folpe AL, Hardacre MC, Weiss SW (2004) Cutaneous angiosarcoma following breast-conserving surgery and radiation: an analysis of 27 cases. Am J Surg Pathol 28(6):781–788PubMedCrossRefGoogle Scholar
  23. 23.
    West J, Liao SY, Cho D (2008) Angiosarcoma after breast conservation: diagnostic pitfalls. Clin Breast Cancer 8(1):94–96PubMedCrossRefGoogle Scholar
  24. 24.
    Palta M, Morris CG, Grobmyer SR, Copeland EM III, Mendenhall NP Angiosarcoma after breast-conserving therapy: long-term outcomes with hyperfractionated radiotherapy. Cancer 116 (8):1872–1878. doi: 10.1002/cncr.24995
  25. 25.
    Georgiannos SN, Sheaff M (2003) Angiosarcoma of the breast: a 30 year perspective with an optimistic outlook. Br J Plast Surg 56(2):129–134PubMedCrossRefGoogle Scholar
  26. 26.
    Strobbe LJ, Peterse HL, van Tinteren H, Wijnmaalen A, Rutgers EJ (1998) Angiosarcoma of the breast after conservation therapy for invasive cancer, the incidence and outcome. An unforseen sequela. Breast Cancer Res Treat 47(2):101–109PubMedCrossRefGoogle Scholar
  27. 27.
    Gladdy RA, Qin LX, Moraco N, Edgar MA, Antonescu CR, Alektiar KM, Brennan MF, Singer S (2010) Do radiation-associated soft tissue sarcomas have the same prognosis as sporadic soft tissue sarcomas? J Clin Oncol 28 (12):2064–2069. doi: 10.1200/JCO.2009.25.1728 Google Scholar
  28. 28.
    Sher T, Hennessy BT, Valero V, Broglio K, Woodward WA, Trent J, Hunt KK, Hortobagyi GN, Gonzalez-Angulo AM (2007) Primary angiosarcomas of the breast. Cancer 110(1):173–178. doi: 10.1002/cncr.22784 PubMedCrossRefGoogle Scholar
  29. 29.
    Feigenberg SJ, Mendenhall NP, Reith JD, Ward JR, Copeland EM III (2002) Angiosarcoma after breast-conserving therapy: experience with hyperfractionated radiotherapy. Int J Radiat Oncol Biol Phys 52(3):620–626PubMedCrossRefGoogle Scholar
  30. 30.
    Mobini N (2009) Cutaneous epithelioid angiosarcoma: a neoplasm with potential pitfalls in diagnosis. J Cutan Pathol 36(3):362–369. doi: 10.1111/j.1600-0560.2008.01052.x PubMedCrossRefGoogle Scholar
  31. 31.
    Muzumder S, Das P, Kumar M, Bhasker S, Sarkar C, Medhi K, Iyer VK, Rath GK (2010) Primary epithelioid angiosarcoma of the breast masquerading as carcinoma. Curr Oncol 17(1):64–69Google Scholar
  32. 32.
    Farina MC, Casado V, Renedo G, Estevez L, Martin L, Requena L (2003) Epithelioid angiosarcoma of the breast involving the skin: a highly aggressive neoplasm readily mistaken for mammary carcinoma. J Cutan Pathol 30(2):152–156PubMedCrossRefGoogle Scholar
  33. 33.
    Fodor J, Orosz Z, Szabo E, Sulyok Z, Polgar C, Zaka Z, Major T (2006) Angiosarcoma after conservation treatment for breast carcinoma: our experience and a review of the literature. J Am Acad Dermatol 54(3):499–504. doi: 10.1016/j.jaad.2005.10.017 PubMedCrossRefGoogle Scholar
  34. 34.
    Komdeur R, Hoekstra HJ, Molenaar WM, Van Den Berg E, Zwart N, Pras E, Plaza-Menacho I, Hofstra RM, Van Der Graaf WT (2003) Clinicopathologic assessment of postradiation sarcomas: KIT as a potential treatment target. Clin Cancer Res 9(8):2926–2932PubMedGoogle Scholar
  35. 35.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717. doi: 10.1016/S0140-6736(05)66544-0 Google Scholar
  36. 36.
    Veronesi U, Marubini E, Mariani L, Galimberti V, Luini A, Veronesi P, Salvadori B, Zucali R (2001) Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 12(7):997–1003PubMedCrossRefGoogle Scholar
  37. 37.
    Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106. doi: 10.1016/S0140-6736(05)67887-7 PubMedGoogle Scholar
  38. 38.
    Vinh-Hung V, Verschraegen C (2004) Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst 96(2):115–121PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Conceição Fraga-Guedes
    • 1
    • 2
  • Helenice Gobbi
    • 1
    Email author
  • Mauro Giuseppe Mastropasqua
    • 3
  • Edoardo Botteri
    • 4
  • Alberto Luini
    • 2
  • Giuseppe Viale
    • 3
  1. 1.Department of Anatomic PathologyFederal University of Minas GeraisBelo HorizonteBrazil
  2. 2.Department of Breast SurgeryEuropean Institute of OncologyMilanItaly
  3. 3.Department of PathologyEuropean Institute of Oncology, and University of Milan School of MedicineMilanItaly
  4. 4.Department of Epidemiology and Biostatistics, European Institute of Oncology, and ‘G.A. Maccacaro’ Institute of Biometry and Statistical MedicineUniversity of MilanMilanItaly

Personalised recommendations