Giant breast angiosarcoma in a 20-year-old young adult female: a case report and review of literature

Introduction: Primary breast angiosarcoma (PAS) is an extremely rare vascular malignancy that typically presents as a breast mass or cutaneous changes. Given its highly aggressive nature, rapid progression and early metastasis that result in a poor prognosis, coupled with a lack of standardized treatment guidelines, there is an urgent need to develop novel, effective therapeutic strategies. Case presentation: This report focused on a 20-year-old Uyghur woman presenting with a painless, rapidly enlarging mass in the left breast. Staging evaluation with breast MRI, whole-body contrast-enhanced CT, and bone scintigraphy revealed a large (10 × 7 cm) primary tumor and bilateral axillary lymphadenopathy suspicious for metastasis, with no evidence of distant disease (cT3N1M0, Stage III). The high-grade angiosarcoma was confirmed through a core needle biopsy of the breast mass. With no remarkable medical or family history of breast cancer, the patient underwent complete surgical resection of the breast angiosarcoma, which provided a definitive pathological diagnosis. Given negative lymph node biopsy results, axillary lymph node dissection was not performed. Postoperatively, the patient received adjuvant chemotherapy with paclitaxel and bevacizumab. The regimen was well-tolerated, and no disease recurrence was observed during follow-up. This case exemplified a practical management strategy for PAS, emphasizing the key role of clinical presentation and conventional imaging in guiding surgical decisions, particularly in resource-limited settings. Conclusions: As a rare, highly malignant tumor, PAS requires early diagnosis and multidisciplinary management, including thorough metastasis evaluation and personalized therapy, to optimize survival and quality of life.