January 25, 2025CureusOpen Access

Secondary Breast Angiosarcoma Five Years After Radiation Therapy for Ductal Carcinoma In Situ

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Why the study?

Radiation-induced angiosarcoma of the breast is a rare and aggressive late complication of radiation therapy lacking standardized management guidelines.

Structured PICO

Population

A 56-year-old woman with a history of high-grade ductal carcinoma in situ (DCIS) of the breast, previously treated with lumpectomy, sentinel lymph node biopsy, radiation therapy, and anastrozole.

Intervention

Extended left simple mastectomy with 3-cm margins, application of a biodegradable temporizing matrix, and wound vacuum-assisted closure (VAC).

Outcome

Diagnosis and complete surgical excision of radiation-induced angiosarcoma (RIAS) with negative margins.

Radiation-induced angiosarcoma is a rare, aggressive late complication of breast radiation therapy that requires high clinical suspicion for new skin changes and aggressive surgical resection with wide margins.

Limitations

Rarity of RIAS limits literature to case reports and small case series
Lack of standardized treatment guidelines

Implication

Alerts clinicians to RIAS in delayed post-radiation skin changes; leaves open standardized long-term surveillance protocols.

Abstract

Radiation-induced angiosarcoma (RIAS) of the breast is a rare and aggressive malignancy that emerges as a late complication of radiation therapy for primary breast cancer. We present the case of a 56-year-old woman with a history of high-grade ductal carcinoma in situ (DCIS) of the breast, previously treated with lumpectomy, sentinel lymph node biopsy, radiation therapy, and anastrozole. Five years after treatment, she developed new skin changes on her breast, including bruising and blistering following tanning bed use. Imaging studies showed diffuse skin thickening without discrete masses or lymphadenopathy. Biopsies confirmed the diagnosis of angiosarcoma. An extended mastectomy with wide surgical margins was performed. Pathological examination confirmed angiosarcoma with negative margins and no lymph node involvement. Additional excisions were undertaken to achieve 3 cm gross margins to ensure complete tumor removal due to the aggressive nature of the tumor. Patients presenting with new skin changes in previously irradiated areas, even many years after treatment, require careful evaluation. Nonspecific clinical and imaging findings necessitate prompt biopsy for accurate diagnosis. Surgical excision with wide margins remains the primary treatment modality, but standardized guidelines are lacking due to the rarity of RIAS. A multidisciplinary approach involving surgical oncology, pathology, radiology, and reconstructive surgery is essential for optimal patient management. Educating patients about potential late complications of radiation therapy and advising against additional risk factors, such as ultraviolet 2 exposure from tanning beds, are important. Further research is needed to establish evidence-based guidelines for the diagnosis, treatment, and follow-up of RIAS.