Skip to main content


Log in

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

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript


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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Holmberg L (1989) Sector resection with and without radiotherapy in early breast cancer. Acta Oncol 28:927–929

    Article  CAS  PubMed  Google Scholar 

  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 82:277–282

    Article  Google Scholar 

  3. Fitzal F, Gnant M (2006) Breast conservation: evolution of surgical strategies. Breast J 12:165–173

    Article  Google Scholar 

  4. Lowenstein S (1906) Der atiologische Zusammenhand zwischen akutem einmaligem Trauma and Sarkom. Beitrage zur Klinsichen Chirurgie 48:780–824

    Google Scholar 

  5. Stewart FW, Treves N (1948) Lymphangiosarcoma in post-mastectomy lymphoedema. Report of six cases in elephantiasis chirurgica. Cancer 1:64–81

    Article  CAS  PubMed  Google Scholar 

  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 38:25–31

    Article  CAS  PubMed  Google Scholar 

  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 34:2068–2075

    Article  CAS  PubMed  Google Scholar 

  8. Ruocco V, Schwartz RA, Ruocco E (2002) Lymphedema: an immunologically vulnerable site for development of neoplasms. J Am Acad Dermatol 47:124–127

    Article  PubMed  Google Scholar 

  9. Billings SD, McKenny JK, Folpe AL, Hardacre MC, Weiss SW (2004) Cutaneous angiosarcoma following breast-conserving surgery and radiation. Am J Surg Pathol 28:781–788

    Article  PubMed  Google Scholar 

  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 33:749–755

    Article  CAS  PubMed  Google Scholar 

  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 16:479–483

    CAS  Google Scholar 

  12. Brenn T, Fletcher CDM (2005) Radiation-associated cutaneous atypical vascular lesions and angiosarcoma: clinicopathological analysis of 42 cases. Am J Surg Pathol 29:983–996

    PubMed  Google Scholar 

  13. Brodie C, Provenzano E (2008) Vascular proliferations of the breast. Histopathology 52:30–44

    Article  CAS  PubMed  Google Scholar 

  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 35:654–659

    Google Scholar 

  15. Monroe AT, Feigenberg SJ, Mendenhall NP (2002) Angiosarcoma after breast-conserving therapy. Cancer 97:1832–1840

    Article  Google Scholar 

  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 322–323

    Google Scholar 

  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 47:101–109

    Article  CAS  PubMed  Google Scholar 

  18. Vorburger SA, Xing Y, Hunt KK et al (2005) Angiosarcoma of the breast. Cancer 104:2682–2688

    Article  PubMed  Google Scholar 

  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 30:570–573

    Article  PubMed  Google Scholar 

  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 32:943–950

    Article  PubMed  Google Scholar 

Download references


Pär-Ola Bendahl is acknowledged for statistical advice and review. The study was financially supported by the Swedish Cancer Fund, the Swedish Children’s Cancer Fund, and the Swedish Research Council.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Emelie Styring.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Styring, E., Fernebro, J., Jönsson, PE. et al. Changing clinical presentation of angiosarcomas after breast cancer: from late tumors in edematous arms to earlier tumors on the thoracic wall. Breast Cancer Res Treat 122, 883–887 (2010).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: