Angiosarcoma of the breast: A review

Hypoxia-driven angiogenesis and metabolic reprogramming in vascular tumors

Hypoxia is a hallmark of the tumor microenvironment (TME), and it plays a crucial role in the occurrence and progression in vascular tumors. Under hypoxic conditions, hypoxia-inducible factor 1-alpha (HIF-1α) is stabilized, inducing changes in the expression of various target genes involved in angiogenesis, metabolism, and cell survival. This includes the upregulation of pro-angiogenic factors like VEGF, which promotes the formation of dysfunctional blood vessels, contributing to the worsening of the hypoxic microenvironment. At the same time, hypoxia induces a metabolic shift toward glycolysis, even in the presence of oxygen, supporting tumor cell survival and proliferation by providing necessary energy and biosynthetic precursors. This review discusses the molecular mechanisms by which hypoxia regulates angiogenesis and metabolic reprogramming in vascular tumors, highlighting the intricate link between these processes, and explores potential therapeutic strategies to target these pathways in order to develop effective treatment strategies for patients.

Dermatologic diseases of the breast, areola and nipple

The range of dermatologic diseases of the breast, nipple, and areola (BNA) skin comprises various inflammatory and neoplastic alterations. BNA skin represents a unique functional unit with considerable emotional, sexual, and cosmetic importance. A specialized approach and adequate sensitivity are required for the diagnosis and treatment of dermatologic diseases in this area. This article reviews the normal anatomy of the breast, common inflammatory, infectious, and benign or malignant proliferative diseases or harmatomas that can present in the breast and nipple skin. Skin diseases in the breast area may be specific to this location or not, and can be classified into proliferative diseases, including malformations and neoplasms, and inflammatory diseases, which encompass both infectious and non-infectious inflammations. Benign proliferations include nipple adenoma, fibrous papules, seborrheic keratoses, gynecomastia, benign subcutaneous tumors, melanocytic and epidermal nevi. Malignant neoformations comprise Paget's disease, invasive breast cancer, inflammatory breast cancer, metastases, melanoma, and non-melanoma skin cancers including Merkel cell carcinoma, but also sarcomas. Inflammatory conditions are atopic, irritant, or allergic nipple eczema, radiation dermatitis, mastopathy and Koebner reactions of other skin diseases due to friction in this area. Infections include bacterial, fungal, and viral entities that might be typical for this area such as borrelial lymphocytoma.

Genomic landscape and preclinical models of angiosarcoma

Angiosarcoma is a cancer that develops in blood or lymphatic vessels that presents a significant clinical challenge due to its rarity and aggressive features. Clinical outcomes have not improved in decades, highlighting a need for innovative therapeutic strategies to treat the disease. Genetically, angiosarcomas exhibit high heterogeneity and complexity with many recurrent mutations. However, recent studies have identified some common features within anatomic and molecular subgroups. To identify potential therapeutic vulnerabilities, it is essential to understand and integrate the mutational landscape of angiosarcoma with the models that exist to study the disease. In this review, we will summarize the insights gained from reported genomic alterations in molecular and anatomic subtypes of angiosarcoma, discuss several potential actionable targets, and highlight the preclinical disease models available in the field.

Nomogram construction for overall survival in breast angiosarcoma based on clinicopathological features: a population-based cohort study

BACKGROUND

Breast angiosarcoma (BAS) is a rare, aggressive malignancy with a poor prognosis, often challenging to assess due to its unique biology. This study aimed to develop a nomogram to predict 3- and 5-year overall survival (OS) for BAS patients using key clinicopathological factors.

METHODS

Data from 450 BAS patients diagnosed between 2000 and 2021 were extracted from SEER database. Key variables, including age, tumor size, tumor grade, and distant metastasis status, were identified through univariate and multivariate Cox regression analyses. These factors were incorporated into a nomogram for OS prediction. The model was validated internally and externally using the concordance index (C-index), calibration curves, and decision curve analysis (DCA) to assess its predictive accuracy and clinical utility.

RESULTS

The nomogram demonstrated good predictive accuracy, with a C-index of 0.68 in the training set and 0.72 in the test set. ROC analysis indicated strong short-term predictive power, with AUC values of 0.81 and 0.75 for 1-year survival in the training and test sets, respectively, though predictive performance declined over time. DCA showed substantial clinical benefit for 12-month predictions, which diminished over longer time frames. The model effectively distinguished high-risk BAS patients and provided individualized survival estimates, supporting its potential use in clinical decision-making.

CONCLUSION

This study presents the first BAS nomogram for OS prediction, showing robust short-term accuracy. The long-term utility is limited by heterogeneity and sample size, highlighting the need for external validation to confirm generalizability and clinical applicability.

Unexpected Discovery of Small Bowel Angiosarcoma Amidst the Management of Severe Polytrauma: A Case Report

Angiosarcoma is a rare, soft tissue tumor arising from lymphatic and vascular endothelial cells with high malignancy potential. While commonly observed in cutaneous and subcutaneous tissues, gastrointestinal subtypes are exceedingly rare. A 47-year-old male initially presented for the management of extensive burn injuries sustained in a motor vehicle collision. Throughout an extended hospital stay, he developed melanotic stools and progressive microcytic anemia. Following institutional burn protocol, the patient received multiple blood transfusions. Physical examination revealed a toxic appearance with abdominal distention. A push enteroscopy identified an ulcerated mass in the proximal jejunum. Surgical resection of the mass was performed, and pathological analysis confirmed the diagnosis of gastrointestinal angiosarcoma. The study concludes that patients presenting with unidentifiable melena and anemia after imaging and routine scopes should be considered for having a gastrointestinal lesion, including a gastrointestinal angiosarcoma, despite its rarity. Early recognition of such conditions may facilitate timely diagnosis and intervention, potentially improving survival outcomes. Furthermore, in the complexity of this case in relation to other existing medical conditions and traumatic injuries, weighing risk and benefit to tailor treatment including utilization of chemotherapy and radiation should be individualized.

Trends in the incidence, survival, and prognostic nomogram of angiosarcoma in the United States

This study aimed to investigate the epidemiological trends of angiosarcoma and to establish a tool to estimate its prognosis. Data from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) were used to assess trends in the epidemiology of angiosarcoma, and a nomogram was established based on independent prognostic factors. The age-adjusted incidence of angiosarcoma gradually increased from 0.13/100,000 in 1975 to 0.33/100,000 in 2016 (annual percentage change [2.4]). The most significant increase was observed in patients aged ≥ 60 years. The same increasing trend was observed across all the stages and grades. The limited-duration prevalence increased from 0.0003% in 1992 to 0.0013% in 2016 (P < .05). In multivariable analyses, age, sex, marital status, grade, historical stage, surgery, site, and tumor size were independent prognostic factors for angiosarcoma. The concordance index of the nomogram was significantly higher than that of the American Joint Committee on Cancer (AJCC) 6th edition and the AJCC 7th edition (0.74 vs 0.61 vs 0.66, respectively). Calibration analysis showed optimal agreement between nomogram predictions and actual observations. The incidence and prevalence of angiosarcoma has increased over the past 40 years. We established a nomogram to predict the overall survival of patients with angiosarcoma.

Neoadjuvant chemotherapy for radiation associated angiosarcoma (RAAS) of the breast: A retrospective single center study

BACKGROUND

Radiation associated angiosarcoma (RAAS) of the breast is a rare malignancy with poor survival. Optimal treatment strategies remain uncertain due to a lack of data, and vary between surgery alone and a combination of surgery with (neo)adjuvant chemotherapy (NACT) and/or re-irradiation. The aim of this study was to evaluate the potential benefit of taxane based NACT.

METHODS

In this retrospective single center study, all patients with RAAS of the breast treated between 1994 and 2024 are included. Since 2018, NACT is considered a treatment option for this patient population in our institute. The difference in oncological outcomes of patients with and without NACT were compared.

RESULTS

Thirty-five women were included. Thirteen (37 %) received NACT of which five (39 %) also had neoadjuvant re-irradiation with hyperthermia. Eleven patients (85 %) received paclitaxel, the other two (15 %) had doxorubicine/docetaxel. Complete pathological response was found in 69 % (n = 9). Median follow up was 41 months (range 24-56) for patients with NACT and 44 (range 20-108) for patients without NACT. In the NACT group, only one patient developed a recurrence after 6.5 years. Patients with NACT had improved oncological outcomes compared to patients without NACT in terms of 3-year local recurrence free survival (100% vs. 63.9 %, p = 0.14), distant metastasis free survival (100 % vs. 47.5 %, p = 0.005), and overall survival (100% vs. 56.1 %, p = 0.016).

CONCLUSION

In this study, neoadjuvant taxanes for RAAS of the breast leads to improved distant metastasis free survival and overal survival in patients treated with NACT compared to no NACT.

Radiation-induced angiosarcoma of the breast: A case report

INTRODUCTION AND IMPORTANCE

Today, breast-conserving surgery (BCS) and adjuvant radiotherapy are preferred treatments for patients with early invasive breast cancer. Radiation-induced angiosarcoma (RIAS) of the breast is a rare but serious complication of radiotherapy.

CASE PRESENTATION

Seventy-one-year-old woman is presented to our department with a locally advanced dark red polypoid lesion on her left breast. She had left BCS, axillary dissection, and adjuvant radiotherapy for invasive breast cancer 8 years before presentation. A small tissue sample from the breast lesions was sent for histopathologic examination that the diagnosis was angiosarcoma of the breast. She had neoadjuvant chemotherapy. Following the completion of chemotherapy, a total mastectomy was performed as surgical treatment. The final histopathologic diagnosis was well-differentiated angiosarcoma.

CLINICAL DISCUSSION

RIAS of the breast is rare disease that develops after a several-year latency period. Locally advanced disease was initially treated with neoadjuvant chemotherapy which appears to be effective for significant disease regression. Patients who respond well to chemotherapy in vivo may have higher disease-specific survival rates. After chemotherapy-induced regression of locally advanced sarcoma, total mastectomy was performed for radical treatment.

CONCLUSION

RIAS of the breast is defined as the histological diagnosis of angiosarcoma in an irradiated region after a long latency period in a patient who has previously received radiotherapy for breast carcinoma. Based on clinical and nuclear imaging data, we may conclude that neoadjuvant chemotherapy can result in significant disease regression, and following neoadjuvant chemotherapy the treatment of angiosarcoma is completed by radical breast surgery.