Contrast-Enhanced Mammography in the Diagnosis of Breast Angiosarcoma

Figures

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  Figure 1. (a–d) Bilateral LE images in a craniocaudal (CC) and medial oblique (MLO) views. Posttreatment changes at the right inner breast are best appreciated on the CC view (arrow, (a)). A separate tissue marker is demonstrated in the right upper outer quadrant is related to a previous benign biopsy.

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  Figure 2. (a–c) Right LE image in a craniocaudal view (a) compared to the previous craniocaudal view from 2D mammography exams from one year ((b), 2019), and 3 years ((c), 2017) before show new mild skin thickening (arrow, (a)) and trabecular thickening (arrowhead, (a)).

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  Figure 3. (a–d) Bilateral recombined images in a craniocaudal (CC) and medial oblique (MLO) views. There is minimal background parenchymal enhancement. Marked nonmass enhancement is noted predominantly within the inner aspect of the right breast, especially in the subcutaneous peripheral areas (yellow arrows, (a, c)).

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  Figure 4. (a–c) Selected ultrasound exam on the right breast shows marked skin thickening measuring up to 7.2 mm, in the area of concern (a), associated with increased flow (b).

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  Figure 5. (a–d) Hematoxylin and eosin (H&E) stained section ((a), ×40 magnification) showing skin with underlying dermis containing an infiltrative vasoformative neoplasm. The endothelial cells lining these vascular spaces are cytologically atypical (inset, H&E ×400 magnification). Immunohistochemistry staining (×200 magnification) showed diffuse positivity in the malignant cells for CD31 (b), patchy staining for C-MYC (c), and nuclear immunoreactivity for ERG (d).

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  Figure 6. (a–c) This is a different case. An 80-year-old patient with remote history of right breast lumpectomy and radiation treatment due to breast malignancy. Patient presented with similar clinical symptoms of skin changes and discoloration. Axial T1 with fat suppression (FS), postcontrast injection (+C) MRI (Figure 6(a)), and MIP reconstruction (Figure 6(b)) demonstrating marked skin thickening and enhancement. Corresponding right CC mammographic view (Figure 6(c)) demonstrating marked skin thickening with no discreet mass within the breast.