Rare case of bilateral primary breast angiosarcoma and review of literature

Primary angiosarcoma of the breast is very rare, accounting for 0.05% of all malignant breast tumors, and it usually occurs in younger individuals. To the best of our knowledge, bilateral primary angiosarcoma is extremely rare, with only 16 cases reported in the published literature. The imaging features might give a false impression of a benign lesion, delaying diagnosis. We report a case of a 34-year-old woman with a left breast lump. Her initial core needle biopsy was negative, and she was briefly lost to follow-up. However, when she returned with worsening symptoms, a vacuum-assisted biopsy revealed angiosarcoma. After undergoing surgery, she received radiation therapy but subsequently developed angiosarcoma in the contralateral breast. Our case is unique because we present the variable imaging appearances of angiosarcoma using imaging modalities such as mammography, ultrasound, MRI, and PET-CT, at the time of initial presentation, final diagnosis, and recurrence. We also report the successful use of a vacuum-assisted breast biopsy following a non-diagnostic core needle biopsy without experiencing overt bleeding during the procedure in a case of angiosarcoma. There have been very few reported cases in which vacuum-assisted biopsy has been performed in cases of angiosarcoma, indicating that it can be used in hypervascular masses without the risk of excessive bleeding, especially when an initial core biopsy is discordant.