Radiation-Induced Breast Angiosarcoma: Case Report

Abstract

Background: Breast sarcomas represent less than 1% of breast neoplasms, and among their histological subtypes, we have angiosarcomas. Angiosarcomas can be primary or secondary, with secondary cases occurring after radiotherapy treatment, presenting between 3 to 12 years post-exposure. They are rare diseases with a poor prognosis and a high recurrence rate. Case report: A 75-year-old woman was diagnosed with breast cancer in 2016, classified as stage IIB, Luminal B. She underwent initial primary surgery, followed by adjuvant chemotherapy and radiotherapy at a public health service, and developed bone metastasis in 2021. She started palliative treatment with hormone therapy and later developed liver metastases and progression of bone disease in 2023, leading to a change in treatment to capecitabine. Due to toxicity, her palliative chemotherapy was switched to paclitaxel. After the 9th cycle, she experienced progression of high-volume liver disease, and a nodule appeared in her left breast, which rapidly evolved into circumscribed purple, flat lesions. A biopsy was performed, confirming angiosarcoma. Days later, a new lesion appeared at the edge of her surgical scar, leading to the decision for a left mastectomy. The pathological and immunohistochemical studies confirmed the diagnosis of angiosarcoma. The patient returned to palliative oncological treatment after a good surgical recovery.

Conclusion: This case aims to assist in the early recognition of angiosarcomas, a disease that often presents with an innocuous initial clinical appearance. In this reported case, the challenge was even greater due to the progression of breast cancer with extensive liver disease, requiring prompt surgical intervention to prevent clinical deterioration of the patient.