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

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Abstract

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.

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References

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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. 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):245–249

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  6. Monroe AT, Feigenberg SJ, Mendenhall NP (2003) Angiosarcoma after breast-conserving therapy. Cancer 97(8):1832–1840. doi:10.1002/cncr.11277

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):983–996

    PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  16. Stewart FW, Treves N (1948) Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Cancer 1(1):64–81

    Article  PubMed  CAS  Google Scholar 

  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):284–299

    Article  PubMed  CAS  Google Scholar 

  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):479–483

    CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):781–788

    Article  PubMed  Google Scholar 

  23. West J, Liao SY, Cho D (2008) Angiosarcoma after breast conservation: diagnostic pitfalls. Clin Breast Cancer 8(1):94–96

    Article  PubMed  Google Scholar 

  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. Georgiannos SN, Sheaff M (2003) Angiosarcoma of the breast: a 30 year perspective with an optimistic outlook. Br J Plast Surg 56(2):129–134

    Article  PubMed  CAS  Google Scholar 

  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):101–109

    Article  PubMed  CAS  Google Scholar 

  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. 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

    Article  PubMed  Google Scholar 

  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):620–626

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):64–69

    Google Scholar 

  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):152–156

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):2926–2932

    PubMed  CAS  Google Scholar 

  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. 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):997–1003

    Article  PubMed  CAS  Google Scholar 

  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

    PubMed  CAS  Google Scholar 

  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):115–121

    Article  PubMed  Google Scholar 

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Acknowledgments

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.

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The authors declare that they have no conflict of interest.

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Correspondence to Helenice Gobbi.

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Fraga-Guedes, C., Gobbi, H., Mastropasqua, M.G. et al. Primary and secondary angiosarcomas of the breast: a single institution experience. Breast Cancer Res Treat 132, 1081–1088 (2012). https://doi.org/10.1007/s10549-011-1931-2

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