Angiosarcoma of the breast: A rare clinicopathological entity

21504 Background: Angiosarcoma (AS) of the breast accounts for fewer than 1% of all malignant breast neoplasms and can be primary or secondary. Primary AS usually occurs in younger women, primarily involves the breast parenchyma. Secondary AS in the breast could be as a result of persistent lymph edema following radical mastectomy and lymph node dissection, so called Stewart-Treves syndrome and in more recent years following breast conserving therapy for primary breast cancer. We report our institutional experience of angiosarcomas of the breast that were diagnosed and treated between 1996 and 2007. Methods: This study is a retrospective review of patients with a diagnosis of angiosarcoma of the breast. All female patients with a diagnosis of angiosarcoma of the breast were identified from the pathology data-base. Their hospital records were retrieved to gather information on treatment, tumor response, failure and survival. Results: Of 2,500 breast cancers diagnosed at our institute during the study period, only 8 patients (0.3%) were identified who had a histologically confirmed diagnosis of angiosarcoma of the breast. Median age was 70.3 years at diagnosis (range 35.6–85.7 years). Seven (87%) patients had a history of prior radiation to the breast, whereas 1 (13%) had primary AS. The detail of treatment and the outcome is shown in the Table. All patients received initial surgical resection. No patient received adjuvant radiotherapy. Only one patient was treated with neoadjuvant and adjuvant chemotherapy. 87% patients suffered tumor recurrence. The median overall survival (OS) was 37.4 months (8.7–92.8 months) and relapse-free survival (RFS) was 17.9 months (2.5–69.4 months). Conclusions: Even though AS of the breast is still a rare neoplasm, it is being increasingly recognized most probably as result of more breast-conserving therapy. High clinical suspicion and MRI may help for early diagnosis. These tumors tend to behave aggressively and needs multidisciplinary approach to improve the outcome. Treatment and Clinical Outcome Patient (age in yrs.) Initial Tx Salvage Tx Relapse RFS (months) OS (months) 1 (85.7) Mastectomy Excision & Radiation to chest wall Local recurrence 3.22 8.75 2 (68) Neoadjuvant chemo, Mastectomy, adjuvant chemo Excision, more chemo 4 local recurrences 17.88 28.04 3 (72.5) Mastectomy Not applicable No 32.19 32.19 4 (73.1) Mastectomy Chemotherapy, palliative surgery and radiation Distant failure in liver & stomach 42.67 17.95 5 (57.2) Wide excision Re-excision 2 local recurrences 5.85 56.42 6 (63.6) Wide excision Mastectomy & radiation to chest wall Local recurrence 44.38 67.43 7 (35.6) Mastectomy Chemo, radiation Both local and distant in liver & bones 69.4 92.81 8 (85.2) Mastectomy Excision Local recurrence in the medial quadrant of opposite breast 15.19 2.53 Median 17.9 37.4 No significant financial relationships to disclose.