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Pasteris A, Pili N, Nonnis R, Marras V, Patetta R, Cossu A, Rubino C. A rare case of radiation-induced breast angiosarcoma: a case report. Case Reports Plast Surg Hand Surg 2023; 11:2296697. [PMID: 38179209 PMCID: PMC10763889 DOI: 10.1080/23320885.2023.2296697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
We describe a rare case of a 77-year-old woman with radiation-induced breast angiosarcoma (RIAS) in whom radical surgery with negative margins determined that at 14-month of follow-up there is no evidence of either local or systemic recurrence without having to resort to adjuvant chemotherapy.
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Affiliation(s)
- Andrea Pasteris
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Nicola Pili
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Rita Nonnis
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Vincenzo Marras
- Department of Biomedical Sciences,Institute of Pathology, University of Sassari, Sassari, Italy
| | | | - Antonio Cossu
- Department of Biomedical Sciences,Institute of Pathology, University of Sassari, Sassari, Italy
| | - Corrado Rubino
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
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Ramakrishnan N, Mokhtari R, Charville GW, Bui N, Ganjoo K. Cutaneous Angiosarcoma of the Head and Neck-A Retrospective Analysis of 47 Patients. Cancers (Basel) 2022; 14:cancers14153841. [PMID: 35954504 PMCID: PMC9367417 DOI: 10.3390/cancers14153841] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Cutaneous angiosarcoma (CAS) is a rare sarcoma with dismal prognosis. To better characterize this disease and elucidate potential treatments that improve overall survival (OS), we conducted a retrospective study exploring clinical characteristics and treatment outcomes of 47 patients with CAS of the head and neck treated at a tertiary academic center. We found that CAS continues to have a poor prognosis with high rates of recurrence even with current treatment modalities. Surgery was highly effective in improving OS in patients with disease that could be resected with low morbidity. Chemotherapy, radiotherapy (RT), and immunotherapy did not significantly improve OS. Our findings shed light on the current landscape of clinical characteristics and treatment of CAS and could prompt further research exploring new treatment options and role of immunotherapy in the management of this difficult disease. Abstract Cutaneous angiosarcoma (CAS) is a rare and aggressive malignant tumor with blood vessel or lymphatic-type endothelial differentiation. It has a poor prognosis with lack of standardized treatment options. This study retrospectively evaluated the clinical characteristics and treatment outcomes of 47 patients with CAS of the head and neck treated at an academic sarcoma center. Patient data were collected from the electronic medical records. 62% of patients were male with the scalp being the most commonly affected area (64%). The majority of patients presented with localized disease (53%). Median overall survival (OS) was 3.4 years with an OS of 36% at 5 years. There was a statistically significant increase in OS for patients who underwent surgery compared to those who did not (5.4 vs. 2.8 years). In contrast, radiotherapy (RT) or chemotherapy did not significantly increase OS. 45% of patients had recurrence of disease during their treatment course with a median time to recurrence of 22.8 months. There was not a significant difference in OS for patients who underwent immunotherapy compared to those who underwent chemotherapy, although only a few patients received immunotherapy. We found that surgery was an effective treatment modality in patients with easily resectable disease, while RT, chemotherapy, and immunotherapy did not significantly improve OS.
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Affiliation(s)
- Neeraj Ramakrishnan
- Department of Medicine, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
- Correspondence: ; Tel.: +1-707-569-4700
| | - Ryan Mokhtari
- Department of Medicine/Oncology, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Gregory W. Charville
- Department of Pathology, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Nam Bui
- Department of Medicine/Oncology, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Kristen Ganjoo
- Department of Medicine/Oncology, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
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Gan TS, Mohd Affandi A, Baharom ZF. Dusky patches in chronic leg lymphedema - An uncommon presentation of Stewart-Treves syndrome. Int J Dermatol 2022; 61:e396-e398. [PMID: 35775097 DOI: 10.1111/ijd.16327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/05/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Teck Sheng Gan
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | - Azura Mohd Affandi
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
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Akhtar K, Abrari A, Shehwar D. Case report of post radiation angiosarcoma with “Dabska tumor” like features. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_197_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Cozzi S, Najafi M, Bardoscia L, Ruggieri MP, Giaccherini L, Blandino G, Botti A, Ciammella P, Iotti C. Radiation-induced breast angiosarcoma: report of two patients after accelerated partial breast irradiation (APBI) and review of the literature. Rep Pract Oncol Radiother 2021; 26:827-832. [PMID: 34760317 DOI: 10.5603/rpor.a2021.0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background Angiosarcoma may rarely complicate radiotherapy of breast cancer. This so-called radiation-induced angiosarcoma (RIAS) occurs in less than 0.3% of patients that underwent breast conservation surgeries, usually years after completion of radiotherapy. Case presentation we introduce two cases of invasive ductal carcinoma who underwent lumpectomy and accelerated partial breast irradiation (APBI) as an alternative protocol to whole breast irradiation (WBI). They received adjuvant partial breast radiotherapy on tumor cavity for a total dose of 38.5 Gy in 10 fractions in 5 days using 3D-external-beam RT. In both cases, RIAS occurred eight years after radiotherapy, in the sub-cicatricial area in one patient and outside the irradiated area in the other one. They both underwent radical surgery and chemotherapy was performed in one patient. Discussion The underlying mechanism for development of RIAS is not well known, but its incidence seems to be increasing. RIAS after partial breast irradiation is very rare and has been reported in two cases so far. As it may be suggested in case 2, it is still a matter of debate if the risk of radiation-induced sarcoma is radiation-dose dependent. Although mastectomy is considered as a standard treatment, choice of treatment should be made according to the patient's specifications. Conclusion There are very few studies in the literature that report RIAS after APBI. Present study is the only one reporting two cases after the external 3D technique APBI. Prognosis of RIAS remains poor. Only a careful evaluation in a multidisciplinary context can offer to the patients the best result in terms of local control and survival.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Masoumeh Najafi
- Department of Radiation Oncology Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran, Iran
| | - Lilia Bardoscia
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | | | | | - Gladys Blandino
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Department of Oncology and Advanced Technology, AUSL-IRCCS, Reggio Emilia, Italy
| | | | - Cinzia Iotti
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
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Venverloo S, Wehbe K, Brabencova E, Ceccato V, Hotton J, Dabiri C. Ecchymotic Purpura of the Breast Revealing a Locally Advanced Breast Cancer: An Exceptional Presentation of a Carcinomatous Mastitis. Case Rep Oncol 2021; 14:746-752. [PMID: 34177525 PMCID: PMC8216005 DOI: 10.1159/000510939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022] Open
Abstract
A 79-year-old woman was treated at our department for a neoplasm of the left breast. It was discovered following the spontaneous appearance of a localized ecchymotic lesion of the breast. The only clinical sign was this purpura, with no notion of trauma. The lesion was homogeneous, oval, and measuring 4 × 5 cm, and it was stable for 2 months. The patient had no history of thrombocytopenia and no known allergy. The physical examination was not very helpful and did not find any palpable breast lesion besides a 1-cm left axillary lymphadenopathy. Breast screening revealed a solid, poorly delineated structure of 11 mm. Biopsies were taken and revealed a NOS grade II invasive carcinoma, triple negative, with a Ki-67 proliferation index of 15%. The axillary cytology was positive. Faced with this atypical presentation, a skin biopsy was performed on the bruise in order to exclude skin invasion. Histology showed the presence of carcinomatous lymphatic dermal emboli which could correspond to a mammary origin as well as extravasation of blood in the dermis explaining this ecchymotic aspect. Bone scintigraphy found discrete uptake in the rib cage, spine, and pelvis, suspicious in this context, but a benign origin could not be ruled out. Neoadjuvant chemotherapy was initiated before mastectomy and left axillary node dissection. It was an atypical and rare clinical presentation of advanced breast cancer with no similar case found in the literature. Usually, the presence of emboli with carcinomatous cells obstructing the lymphatic vessels is related to inflammatory breast cancer or carcinomatous mastitis. The authors nevertheless point out that although the presence of tumor emboli in the dermal lymphatic vessels is favorable to the diagnosis, it is not required. In addition, dermal lymphatic invasion without a typical clinical presentation is not sufficient to confirm the diagnosis of carcinomatous mastitis. An important diagnostic criterion is the rapidity of aggravation of the symptoms, which, even if it was not obvious in our case, was present with progressive evolution of the skin lesion over several weeks. The skin lesion of our patient could also make us suspect a primary breast angiosarcoma. This possibility was quickly eliminated in the absence of vascular tumor proliferation on the various biopsies. Any acute purpura is a serious disease to be diagnosed urgently, and a skin biopsy is indicated.
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Affiliation(s)
- Saskia Venverloo
- Department of Surgical Oncology, Institute Godinot, Reims, France
| | - Karl Wehbe
- Department of Surgical Oncology, Institute Godinot, Reims, France
| | - Eva Brabencova
- Department of Pathology, Institute Godinot, Reims, France
| | - Vivien Ceccato
- Department of Surgical Oncology, Institute Godinot, Reims, France
| | - Judicael Hotton
- Department of Surgical Oncology, Institute Godinot, Reims, France
| | - Clement Dabiri
- Department of Surgical Oncology, Institute Godinot, Reims, France
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Unusual Presentation of Bilateral Radiation-Induced Angiosarcoma of the Breast. Case Rep Oncol Med 2020; 2020:5768438. [PMID: 32190394 PMCID: PMC7071809 DOI: 10.1155/2020/5768438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/22/2020] [Indexed: 11/17/2022] Open
Abstract
Radiation-induced sarcoma of the breast is an iatrogenic malignancy that occurs secondary to radiotherapy, which is most commonly given following breast conservation surgery. It has an incidence of 3.2 per 1,000 patients at 15 years and is associated with a poor prognosis. We report a 62-year-old female with a history of bilateral breast conservation surgery and radiotherapy 5 years ago presenting with bilateral angiosarcoma. This case report highlights the importance of considering radiation-induced angiosarcoma of the breast as a differential diagnosis in a patient with recurrent breast neoplasms. The challenges in the management with recent evidence on new treatment modalities are discussed.
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Goldust M, Giulini M, Weidenthaler‐Barth B, Gupta M, Grabbe S, Schepler H. Increased risk of angiosarcoma secondary to cancer radiotherapy: Case series and review of the treatment options. Dermatol Ther 2020; 33:e13234. [DOI: 10.1111/dth.13234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/24/2019] [Accepted: 01/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mohamad Goldust
- University of Rome Guglielmo Marconi Rome Rome Italy
- Department of Dermatology University Medical Center Mainz Mainz Germany
- University Hospital Basel Basel Switzerland
| | - Mario Giulini
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | | | - Mrinal Gupta
- Consultant Dermatologist Treatwell Skin Centre Jammu India
| | - Stephan Grabbe
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - Hadrian Schepler
- Department of Dermatology University Medical Center Mainz Mainz Germany
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Takeda K, Fujimura T, Lyu C, Tsukada A, Tsuchiyama K, Hashimoto A, Aiba S. PD-L1-Expressing Radiation-Associated Angiosarcoma after Primary Breast Cancer. Case Rep Oncol 2018; 11:330-335. [PMID: 29928212 PMCID: PMC6006628 DOI: 10.1159/000489628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 11/20/2022] Open
Abstract
Radiation-associated angiosarcoma (RAAS) is a type of radiation-associated sarcoma (RAS) that develops at the previous field of radiation in breast cancer patients. Although several reports have suggested a poor prognosis for RAAS, the 5-year overall survival of RAAS is better than that of cutaneous angiosarcoma (CAS), suggesting that the prognostic factors of RAAS and CAS might be different, at least in part. In this report, we describe a case of RAAS, and employed immunohistochemical (IHC) staining of PD-L1 and MMP9 as well as periostin, IL-4, and CD163. Interestingly, IHC staining revealed that the RAAS in our case was positive for PD-L1 and negative for MMP9. Moreover, the predominant stromal factor of our case was periostin, suggesting that TAMs in the present case was not immunosuppressive, but an inflammatory subtype. These results might explain, at least in part, the better prognosis of RAAS compared to CAS.
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Affiliation(s)
- Kana Takeda
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chunbing Lyu
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Tsukada
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichiro Tsuchiyama
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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