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Angiosarcoma of the Breast

¹ Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.
² Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —51-year-old woman with high-grade primary angiosarcoma who presented with progressively enlarging discoloration of left breast for 6 months. Although breast had clinical appearance of bruising, patient denied history of trauma. Photograph shows discoloration in inferior and lateral left breast.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —51-year-old woman with high-grade primary angiosarcoma who presented with progressively enlarging discoloration of left breast for 6 months. Although breast had clinical appearance of bruising, patient denied history of trauma. PET scans show large hypermetabolic region in left breast and two hypermetabolic left axillary lymph nodes (direct invasion, not metastases; confirmed by pathologic evaluation of mastectomy specimen).

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —51-year-old woman with high-grade primary angiosarcoma who presented with progressively enlarging discoloration of left breast for 6 months. Although breast had clinical appearance of bruising, patient denied history of trauma. Photomicrograph of histopathologic specimen shows high-grade angiosarcoma with anastomosing vascular channels in breast parenchyma. Vascular channels are lined by plump, malignant endothelial cells (arrows). (H and E, x40)

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —51-year-old woman with high-grade primary angiosarcoma who presented with progressively enlarging discoloration of left breast for 6 months. Although breast had clinical appearance of bruising, patient denied history of trauma. Sonogram of palpable lesion in contralateral breast 1 year after left breast mastectomy shows ill-defined hypoechoic mass with posterior enhancement. Percutaneous core biopsy revealed high-grade angiosarcoma identical to primary tumor in left breast.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —41-year-old woman with intermediate-grade primary angiosarcoma who presented with fullness and engorgement of right breast. (Parts B and D reprinted from Glazebrook KN, Morton MJ, Reynolds C. Vascular tumors of the breast: mammographic, sonographic, and MRI appearances. AJR 2005; 184:331–338 [7]) Bilateral craniocaudal mammograms show ill-defined, asymmetric, and dense region (arrow) in central region of right breast (L, left side; R, right side).

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —41-year-old woman with intermediate-grade primary angiosarcoma who presented with fullness and engorgement of right breast. (Parts B and D reprinted from Glazebrook KN, Morton MJ, Reynolds C. Vascular tumors of the breast: mammographic, sonographic, and MRI appearances. AJR 2005; 184:331–338 [7]) Color Doppler sonogram of right breast shows subtle increase in echogenicity and some posterior shadows but no discrete mass. Note prominent vascularity throughout region.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —41-year-old woman with intermediate-grade primary angiosarcoma who presented with fullness and engorgement of right breast. (Parts B and D reprinted from Glazebrook KN, Morton MJ, Reynolds C. Vascular tumors of the breast: mammographic, sonographic, and MRI appearances. AJR 2005; 184:331–338 [7]) Sagittal, fast spin-echo, T1-weighted MR image of right breast shows poorly defined mass in superior breast and focal area of increased T1-signal, consistent with large blood lake (arrow).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —41-year-old woman with intermediate-grade primary angiosarcoma who presented with fullness and engorgement of right breast. (Parts B and D reprinted from Glazebrook KN, Morton MJ, Reynolds C. Vascular tumors of the breast: mammographic, sonographic, and MRI appearances. AJR 2005; 184:331–338 [7]) Three-dimensional sagittal gadolinium-enhanced fast spoiled gradient-echo MR image of right breast shows multiple nodular areas of rapid and intense contrast enhancement in 7-cm mass. Note draining vein (arrow).

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —41-year-old woman with intermediate-grade primary angiosarcoma who presented with fullness and engorgement of right breast. (Parts B and D reprinted from Glazebrook KN, Morton MJ, Reynolds C. Vascular tumors of the breast: mammographic, sonographic, and MRI appearances. AJR 2005; 184:331–338 [7]) Cross section of pathology specimen shows poorly defined hemorrhagic mass (7.3 x 6.2 x 4.3 cm).

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —41-year-old woman with intermediate-grade primary angiosarcoma who presented with fullness and engorgement of right breast. (Parts B and D reprinted from Glazebrook KN, Morton MJ, Reynolds C. Vascular tumors of the breast: mammographic, sonographic, and MRI appearances. AJR 2005; 184:331–338 [7]) Photomicrograph of histopathologic specimen shows intermediate-grade angiosarcoma with distinct open, anastomosing vascular channels that surround and invade lobules. Vascular channels show infiltration into fat. Malignant endothelial cells lining vascular channels are flat, and most nuclei are pale and small. (H and E, x10)

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —79-year-old woman with high-grade secondary angiosarcoma who presented with extensive discoloration of right breast. She had undergone breast conservation radiation therapy for 1.5-cm grade 2 node-negative, estrogen receptor–and progesterone receptor–positive invasive ductal carcinoma 5 years earlier. Sonogram of palpable, soft-tissue nodule shows only diffuse skin thickening (arrow) but no discrete mass.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —79-year-old woman with high-grade secondary angiosarcoma who presented with extensive discoloration of right breast. She had undergone breast conservation radiation therapy for 1.5-cm grade 2 node-negative, estrogen receptor–and progesterone receptor–positive invasive ductal carcinoma 5 years earlier. Contrast-enhanced CT scan of chest shows skin thickening of right breast and enhancing subcutaneous nodule (arrow) in medial aspect of same breast.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —79-year-old woman with high-grade secondary angiosarcoma who presented with extensive discoloration of right breast. She had undergone breast conservation radiation therapy for 1.5-cm grade 2 node-negative, estrogen receptor–and progesterone receptor–positive invasive ductal carcinoma 5 years earlier. Three-dimensional, immediate sagittal postgadolinium-enhanced fast spoiled gradient-echo MR images of medial right breast show enhancement of mural nodule in breast (C) and peripheral enhancement of a second tumor nodule (D).

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —79-year-old woman with high-grade secondary angiosarcoma who presented with extensive discoloration of right breast. She had undergone breast conservation radiation therapy for 1.5-cm grade 2 node-negative, estrogen receptor–and progesterone receptor–positive invasive ductal carcinoma 5 years earlier. Three-dimensional, immediate sagittal postgadolinium-enhanced fast spoiled gradient-echo MR images of medial right breast show enhancement of mural nodule in breast (C) and peripheral enhancement of a second tumor nodule (D).

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —79-year-old woman with high-grade secondary angiosarcoma who presented with extensive discoloration of right breast. She had undergone breast conservation radiation therapy for 1.5-cm grade 2 node-negative, estrogen receptor–and progesterone receptor–positive invasive ductal carcinoma 5 years earlier. Mastectomy specimen shows skin discoloration and raised red tumor nodule (1.0 x 1.0 x 0.7 cm, curved arrow). Incisional biopsy was performed for second tumor nodule (straight arrow).

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —81-year-old woman with high-grade secondary angiosarcoma who presented with pain and discoloration of right breast. She had 5-mm grade 3 node-negative, estrogen receptor– and progesterone receptor–positive invasive ductal carcinoma 6 years earlier. At that time, she underwent breast conservation surgery and radiation therapy but had severe skin reaction. Right craniocaudal mammogram shows ill-defined mass immediately underneath nipple and skin thickening of nipple–areolar complex.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —81-year-old woman with high-grade secondary angiosarcoma who presented with pain and discoloration of right breast. She had 5-mm grade 3 node-negative, estrogen receptor– and progesterone receptor–positive invasive ductal carcinoma 6 years earlier. At that time, she underwent breast conservation surgery and radiation therapy but had severe skin reaction. Fast spin-echo T1-weighted sagittal MR image of right breast shows skin thickening and irregular heterogeneous mass extending to nipple.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —81-year-old woman with high-grade secondary angiosarcoma who presented with pain and discoloration of right breast. She had 5-mm grade 3 node-negative, estrogen receptor– and progesterone receptor–positive invasive ductal carcinoma 6 years earlier. At that time, she underwent breast conservation surgery and radiation therapy but had severe skin reaction. Axial 3D delayed gadolinium-enhanced fast spoiled gradient-echo MR image of right breast shows peripheral enhancement of spiculated mass and nipple–areolar complex.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —81-year-old woman with high-grade secondary angiosarcoma who presented with pain and discoloration of right breast. She had 5-mm grade 3 node-negative, estrogen receptor– and progesterone receptor–positive invasive ductal carcinoma 6 years earlier. At that time, she underwent breast conservation surgery and radiation therapy but had severe skin reaction. Cross section of pathology specimen shows ill-defined red tumor mass (12.0 x 7.7 x 6.3 cm) beneath nipple and surrounding skin.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4E —81-year-old woman with high-grade secondary angiosarcoma who presented with pain and discoloration of right breast. She had 5-mm grade 3 node-negative, estrogen receptor– and progesterone receptor–positive invasive ductal carcinoma 6 years earlier. At that time, she underwent breast conservation surgery and radiation therapy but had severe skin reaction. Photomicrograph of histopathology specimen shows solid proliferation of spindle cells and a number of slitlike spaces containing RBCs. Nuclei have vesicular chromatin and prominent nucleoli. Numerous mitotic figures are visible. (H and E, x40)

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