Radiation Induced Angiosarcoma Of The Breast In A 74 Year-Old Female
Radiation induced angiosarcoma (RIA) of breast is a rare, but serious complication of breast conserving therapy for breast carcinoma.
This is case of a 74 year-old-female with history of invasive ductal carcinoma status-post left breast lumpectomy and axillary dissection with adjuvant radiation therapy in 2012. She then presented in July 2018 with a 5.5 x 3.0 cm purpuric lesion on left chest of six month that started bleeding after minor trauma to chest. Subsequent shave biopsy revealed a grade 3 angiosarcoma. She underwent a simple left breast mastectomy with 1.0 cm negative margins.
With increased overall survival and adoption of breast conserving therapy, majority of RIA of chest wall presents in patients with history of breast cancer. The estimated incidence of RIA of breast is around 0.05-0.3% with an average latency period between 4-7 years after radiation therapy. The molecular pathophysiology is thought to be related to an amplification of MYC. Diagnostic criteria was proposed by to include 1) previous history of radiation therapy, 2) development of sarcoma with histologic confirmation in previously irradiated or surrounding tissues, and 3) latency period of 4+ years. Primary treatment of choice is surgical resection with negative margins. However, patients with RIA of breast have a poor prognosis, despite R0 resection, and high recurrence rate with 5-year overall survival at 43% and 5-year disease-free-survival around 32%.
Due to the rare but aggressive nature of RIA and increased prevalence of breast conserving therapy for breast cancer, high level of suspicion is necessary for early detection.