Angiosarcoma of the breast

Rare process with an estimated incidence of postradiation sarcoma of soft tissues following radiation to the breast ranges from .01% to 0.02% per year (Vorburger SA).

Post treatment lymphedema associated with soft tissue angiosarcomas (Luini A).

In general, breast angiosarcomas may appear de novo or is a complication of chronic lymphedema or radio therapy.

BRCA1 and BRCA2 positive patients have an increase in post radiation angiosarcoma of the breast (West JG).

Lesions are of higher grade than angiosarcomas not treated to radiation (Vorburger SA).

Radiation associated angiosarcomas seen in patients older than those with angiosarcomas unrelated to radiation.

Median interval from radiation to breast angiosarcoma is 7 years (Vorburger SA).

Diagnostic imaging is nonspecific.

Biopsy material staining for vimentin, CD31, CD34 and factor VIII support the diagnosis.

Lesions frequently have infiltrative margins.

Adverse prognosis associated with high grade, positive margins, premenopausal status, metastases ans size of greater than 5 cm in size (Bosquet G).

Resection treatment of choice, meaning mastectomy, since lesions are in irradiated breasts.

Typically, for sarcomas lymph node metastases do not occur and axillary lymph node dissection is not needed.

Two and 5 year survival rates 64% and 38%, respectively and 38% of patients have a recurrence by 3.6 years(Vorburger SA).

Median survival reported 2.3 years with a 5 year survival in the 30% range (Yap J).

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