Angiosarcoma Following Radiation Therapy for Breast Cancer:Case Presentation and Clinical Management Considerations

A 59-year-old woman presented with erythema and pruritis of the breast 4.5 years after undergoing lumpectomy and radiation for breast cancer. Biopsy confirmed a diagnosis of angiosarcoma. This tumor stained positive for CD34 as well as 70% Ki67 prior to therapy initiation. A multidisciplinary approach yielded a plan for neoadjuvant chemoradiation and surgical resection including delayed completion transverse rectus abdominis flap for tissue coverage. Neoadjuvant therapy successfully decreased rates of cellular proliferation, as reflected by a Ki67 of 5%, at the time of resection. Pathophysiologically, angiosarcomas may be very aggressive and may develop following radiation for breast cancer. Such tumors may become more common as breast cancer therapies, which frequently include radiation therapy, improve with time. Early recognition of angiosarcoma is imperative for successful therapy. These tumors may present with a wide range of symptoms, but may be asymptomatic. Surgical resection is the preferred therapy, but early recognition is critical.