Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. Katherine Fomchenko
This case is a middle-aged female with a breast mass.
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1. Question
This case is a middle-aged female with a breast mass.
Correct
Answer: D. Angiosarcoma
Histology: The lesion is an infiltrative neoplasm composed of a vascular proliferation with anastomosing vessels, blood lakes, nuclear atypia and endothelial mitotic activity. Vascular spaces infiltrate irregularly through fat and around and through breast terminal duct lobular units.
Discussion: Angiosarcoma is a malignant vascular neoplasm. There are broadly to types of angiosarcoma in the breast: primary angiosarcoma and secondary (post-radiation) sarcoma. Primary angiosarcomas of the breast typically present as breast masses in pre-menopausal females, and the lesions are generally centered in the breast parenchyma. Secondary, or post-radiation, angiosarcomas of the breast typically present as skin changes in post-menopausal females approximately 7-10 years after breast radiation, and the lesions are generally centered in the dermis. Primary and secondary angiosarcomas of the breast may be widely infiltrative, and although the mainstay of treatment is complete surgical resection with widely clear margins, they frequently recur and cause significant morbidity and mortality.
The differential diagnosis of angiosarcoma includes benign vascular proliferations and other spindle cell lesions of the breast such as metaplastic carcinoma. Unlike atypical vascular lesions and hemangiomas, angiosarcomas display nuclear atypia, endothelial cell multilayering, mitotic activity, and infiltrative growth. Immunohistochemical stains can be used to classify spindle cell lesions of the breast. Angiosarcomas will label for markers used for endothelial differentiation, such as CD34, CD31, and ERG. Unlike breast carcinomas, angiosarcomas are typically negative for cytokeratins.
Esposito E, Avino F, di Giacomo R, Donzelli I, Marone U, Melucci MT, Rinaldo C, Ruffolo F, Saponara R, Siani C, Tortoriello R, Botti G, Rinaldo M, Fucito A. Angiosarcoma of the breast, the unknown-a review of the current literature. Transl Cancer Res. 2019 Oct;8(Suppl 5):S510-S517. doi: 10.21037/tcr.2019.07.38. PMID: 35117129; PMCID: PMC8798946.
Incorrect
Answer: D. Angiosarcoma
Histology: The lesion is an infiltrative neoplasm composed of a vascular proliferation with anastomosing vessels, blood lakes, nuclear atypia and endothelial mitotic activity. Vascular spaces infiltrate irregularly through fat and around and through breast terminal duct lobular units.
Discussion: Angiosarcoma is a malignant vascular neoplasm. There are broadly to types of angiosarcoma in the breast: primary angiosarcoma and secondary (post-radiation) sarcoma. Primary angiosarcomas of the breast typically present as breast masses in pre-menopausal females, and the lesions are generally centered in the breast parenchyma. Secondary, or post-radiation, angiosarcomas of the breast typically present as skin changes in post-menopausal females approximately 7-10 years after breast radiation, and the lesions are generally centered in the dermis. Primary and secondary angiosarcomas of the breast may be widely infiltrative, and although the mainstay of treatment is complete surgical resection with widely clear margins, they frequently recur and cause significant morbidity and mortality.
The differential diagnosis of angiosarcoma includes benign vascular proliferations and other spindle cell lesions of the breast such as metaplastic carcinoma. Unlike atypical vascular lesions and hemangiomas, angiosarcomas display nuclear atypia, endothelial cell multilayering, mitotic activity, and infiltrative growth. Immunohistochemical stains can be used to classify spindle cell lesions of the breast. Angiosarcomas will label for markers used for endothelial differentiation, such as CD34, CD31, and ERG. Unlike breast carcinomas, angiosarcomas are typically negative for cytokeratins.
Esposito E, Avino F, di Giacomo R, Donzelli I, Marone U, Melucci MT, Rinaldo C, Ruffolo F, Saponara R, Siani C, Tortoriello R, Botti G, Rinaldo M, Fucito A. Angiosarcoma of the breast, the unknown-a review of the current literature. Transl Cancer Res. 2019 Oct;8(Suppl 5):S510-S517. doi: 10.21037/tcr.2019.07.38. PMID: 35117129; PMCID: PMC8798946.
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