DOI:10.2214/AJR.07.2909
AJR 2008; 190:533-538
© American Roentgen Ray Society
Angiosarcoma of the Breast
Katrina N. Glazebrook1,
Maureen J. Magut1 and
Carol Reynolds2
1 Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN
55905.
2 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester,
MN.
Received July 20, 2007;
accepted after revision September 13, 2007.
Address correspondence to K. N. Glazebrook.
CME
This article is available for CME credit. See
www.arrs.org
for more information.
Abstract
OBJECTIVE. This article describes the imaging findings, pathologic
correlation, and clinical presentation of rare primary and secondary
angiosarcomas of the breast.
CONCLUSION. With the increasing use of breast conservation therapy
for breast cancer, reports of postirradiation angiosarcoma have increased.
Both primary and secondary angiosarcomas may present with bruiselike skin
discoloration, which may delay the diagnosis. Imaging findings are
nonspecific. MRI may be used to determine lesion extent by showing rapid
enhancement and washout in high-grade tumors.
Keywords: angiosarcoma • breast • mammography • MRI • sonography
Introduction
Angiosarcomas are rare malignant tumors that arise from endothelial cells
lining vascular channels [1,
2]. The breast is one of the
most common sites in the body to develop angiosarcoma
[3]. Primary angiosarcomas of
the breast occur sporadically in young women and usually present as palpable
masses. Secondary angiosarcomas occur most frequently after breast
conservation therapy with radiation therapy; the average latency period is
5–6 years [4].
In this article, we describe the clinical presentation and imaging findings
of primary and secondary angiosarcomas of the breast. We also describe
pathologic correlation of the clinical and imaging findings. Cases were
identified by a retrospective review of the surgical pathology database at our
institution. Of approximately 2,500 breast biopsies performed from January
2004 through June 2006, six cases of angiosarcoma of the breast were
identified that had imaging studies available for review: four were primary
angiosarcomas and two were secondary.
Primary Angiosarcoma
Primary angiosarcomas are rare and account for 0.04% of all malignant
breast tumors [5]. Three grades
of angiosarcoma are described
[2]. Low-grade tumors consist
of anastomosing vascular channels that invade the surrounding breast tissue.
Intermediate-grade tumors have more solid neoplastic vascular growth and an
increased mitotic rate. High-grade lesions have frankly sarcomatous areas, as
well as areas of necrosis, hemorrhage, and infarction. Multiple grades may
exist in the same tumor, so grading from a core biopsy specimen may not be
possible. Complete excision and careful histiologic evaluation are needed to
accurately determine the tumor grade
[1].
Primary lesions arise in younger women, usually during the third and fourth
decades of life; these lesions are unlike breast carcinomas, which typically
arise later in life. Although angiosarcoma has been reported to present during
pregnancy [2], no evidence
supports the hypothesis that these tumors are hormone-dependent
[1]. Patients with primary
angiosarcoma present with a palpable mass that may be growing rapidly. Bluish
skin discoloration occurs
[1–7]
in up to a third of patients and is thought to be attributable to the vascular
nature of the tumor (Fig. 1A,
1B,
1C,
1D). In the series by Yang et
al. [5], the mean tumor size of
the mass at presentation was 5.9 cm.
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.
|
|
Mammographically, the appearance is nonspecific. An ill-defined,
noncalcified mass or focal asymmetry is the most common finding
[5] (Fig.
2A,
2B,
2C,
2D,
2E,
2F). Many women with primary
breast angiosarcoma are young, and the dense breast parenchyma that is
characteristic of young women may obscure visualization of a mass. Liberman et
al. [6] reported that 33% of
angiosarcomas in their series were not detectable mammographically. Nineteen
percent of patients in the study by Yang et al.
[5] had tumors that were not
visible mammographically but were visible with sonography and MRI. The
presence of fat in mammographic abnormalities has been reported
[5], which raises questions
about the differential diagnosis of hemangioma and angiolipoma.
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)
|
|
Sonography is useful for confirmation of a mass when a palpable abnormality
is found. Masses may be circumscribed or ill-defined. Diffuse, abnormal, mixed
hyperechogenic and hypoechogenic regions without a discrete mass were noted in
38% of patients in the series of Yang et al.
[5] (Fig.
2A,
2B,
2C,
2D,
2E,
2F). Hyperechoic, ill-defined
masses also have been reported
[4]. Color Doppler sonography
shows hypervascularity [5]
(Fig. 2A,
2B,
2C,
2D,
2E,
2F).
PET with 18F-FDG may be used for staging of angiosarcoma. Case
reports show focal, intense accumulation of FDG in angiosarcomas of the chest
wall, heart, pleura, and liver, with standard uptake values up to 7.5
[8–10]
(Fig. 1A,
1B,
1C,
1D). To our knowledge, no
report of PET in angiosarcoma of the breast has been published previously.
MRI of angiosarcoma shows a heterogeneous mass with low signal intensity on
T1-weighted images, but signal intensity is high in images that are heavily
T2-weighted [5,
6]. Irregular areas of high T1
signal may be seen in the higher-grade lesions; these represent hemorrhage or
venous lakes (Fig. 2A,
2B,
2C,
2D,
2E,
2F). Enhancement of the mass
depends on the tumor grade. Low-grade angiosarcomas show progressive
enhancement. High-grade angiosarcomas show rapid enhancement and washout, and
large draining vessels may be visualized
[7] (Fig.
2A,
2B,
2C,
2D,
2E,
2F). MRI is useful in
determining tumor extent and in planning surgery. It also may detect residual
disease after incisional biopsy.
Secondary Angiosarcoma
Secondary angiosarcomas usually are found in older women who have undergone
breast cancer treatment. The mean age at presentation is the late 60s
[4]. There are two types of
secondary angiosarcoma: lymphedema-associated cutaneous angiosarcoma and
postirradiation angiosarcoma.
Lymphedema-associated cutaneous angiosarcoma was first described in 1948 by
Stewart and Treves [11]; it
develops on lymphedematous limbs and the chest wall after mastectomy and
axillary lymph node dissection. Increased use of breast conservation therapy
and sentinel lymph node sampling has lowered the incidence of
treatment-related lymphedema
[4].
Postirradiation angiosarcoma generally occurs after breast conservation
therapy and radiation therapy and only rarely occurs after mastectomy. It
usually affects the dermis of the breast within the radiation field but may
occasionally develop in the breast parenchyma. The incidence of
postirradiation angiosarcoma appears to be low, ranging from 0.09–0.16%
[12,
13]. A recent study, however,
suggests that the incidence may be considerably higher (> 0.3%)
[14]. Multi-centricity is seen
in up to a third of patients. The mean tumor size is 7.5 cm but may vary from
0.4–20 cm [15,
16]. The average time between
radiation therapy and the development of angiosarcoma is 6 years, although
several reports indicate that angiosarcoma may occur as early as 1–2
years or as late as 41 years after treatment
[15,
16].
Patients with secondary angiosarcomas present with red plaques or nodules
or with areas of skin discoloration (Fig.
3A,
3B,
3C,
3D,
3E), which may be mistaken for
bruising and may delay the correct diagnosis. These tumors typically are high
grade. Mammographically, changes due to breast conservation therapy and prior
radiation therapy are visible. Skin thickening due to angiosarcoma may be
masked or misinterpreted as skin changes that occur after radiation therapy.
The subgroup of cases with parenchymal involvement may present with
ill-defined, asymmetric masses (Fig.
4A,
4B,
4C,
4D,
4E). Sonographically, the
dermal lesions may be difficult to differentiate from postradiotherapy skin
thickening. Intraparenchymal masses are seen as heterogeneous areas with
alteration of the normal tissue planes
[3]. MRI shows rapid gadolinium
enhancement and plateau or washout with delayed imaging; this is similar to
the imaging characteristics of primary angiosarcoma
[5] (Figs.
3A,
3B,
3C,
3D,
3E and
4A,
4B,
4C,
4D,
4E).
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)
|
|
Treatment
Surgical resection with mastectomy is the usual treatment for both forms of
angiosarcoma. For small, grade 1 primary lesions, breast conservation therapy
may be indicated. Chemotherapy may reduce the local recurrence rate. Docetaxel
shows promise for treating secondary angiosarcomas
[17]. Although data are
limited, hyperfractionated radiation therapy of secondary high-grade
angiosarcomas has resulted in reduced cell repopulation of rapidly growing
tumors [18].
Prognosis
The prognosis for patients with primary angiosarcoma depends on the tumor
grade. The estimated probability of disease-free survival 5 years after
initial treatment is 76% for patients with grade 1 tumors; for patients with
grade 3 tumors, the probability is 15%
[2]. Patients with grade 1
tumors typically have more than 15 years before disease recurrence, whereas
those with grade 3 tumors have an average of 15 months before recurrence
[2]. Metastases occur most
frequently to bones, lungs, and liver. Metastases to the contralateral breast
also have been reported
[1–4].
Secondary angiosarcomas tend to have a poor prognosis, although 5-year
survival rates may be better than those of other forms of cutaneous
angiosarcoma. Outcome is affected by the completeness of surgical resection.
Local recurrence is an adverse prognostic indicator and is often accompanied
by distant metastases [4].
Conclusion
Primary and secondary angiosarcomas are rare. Both may manifest with skin
discoloration, skin plaques or nodules, a palpable mass, or a combination of
these signs. Discoloration may be mistaken for bruising, thereby delaying
diagnosis. Mammographic findings are nonspecific for angiosarcoma.
Sonographically, angiosarcoma typically presents as a heterogeneous,
hyperechoic, hypervascular mass that is associated with disruption of the
normal breast architecture. MRI may be used to determine lesion extent by
showing a rapidly enhancing heterogeneous mass with hemorrhage or blood lakes,
especially in high-grade tumors. With increasing use of breast conservation
therapy for breast cancer, reports of postirradiation angiosarcoma have
increased. Recognition of this entity is needed to institute early
therapy.
Acknowledgments
Editing, proofreading, and reference verification were provided by the
Section of Scientific Publications, Mayo Clinic.
References
- Donnell RM, Rosen PP, Lieberman PH, et al. Angiosarcoma and other
vascular tumors of the breast. Am J Surg Pathol1981; 5:629
–642[Medline]
- Rosen PP, Kimmel M, Ernsberger D. Mammary angiosarcoma: the
prognostic significance of tumor differentiation.
Cancer 1988; 62:2145
–2151[CrossRef][Medline]
- Chen KT, Kirkegaard DD, Bocian JJ. Angiosarcoma of the breast.
Cancer 1980; 46:368
–371[CrossRef][Medline]
- Brenn T, Fletcher CD. Postradiation vascular proliferations: an
increasing problem. Histopathology 2006;48
: 106–114[CrossRef][Medline]
- Yang WT, Hennessy BT, Dryden MJ, Valero V, Hunt KK, Krishnamurthy
S. Mammary angiosarcomas: imaging findings in 24 patients.
Radiology 2007;242
: 725–734[Abstract/Free Full Text]
- Liberman L, Dershaw DD, Kaufman RJ, Rosen PP. Angiosarcoma of the
breast. Radiology 1992;183
: 649–654[Abstract/Free Full Text]
- Glazebrook KN, Morton MJ, Reynolds C. Vascular tumors of the
breast: mammographic, sonographic, and MRI appearances.
AJR 2005; 184:331
–338[Free Full Text]
- Del Frate C, Mortele K, Zanardi R, et al. Pseudomesotheliomatous
angiosarcoma of the chest wall and pleura. J Thorac
Imaging 2003; 18:200
–203[CrossRef][Medline]
- Maeda T, Tateishi U, Hasegawa T, Ojima H, Arai Y, Sugimura K.
Primary hepatic angiosarcoma on coregistered FDG PET and CT images.
AJR 2007; 188:1615
–1617[Free Full Text]
- Freudenberg LS, Rosenbaum SJ, Schulte-Herbruggen J, et al.
Diagnosis of a cardiac angiosarcoma by fluorine-18 fluorodeoxyglucose positron
emission tomography. Eur Radiol 2002;12
[suppl 3]:S158
–S161. Epub 2002 Jun 25[Medline]
- Stewart FW, Treves N. Lymphangiosarcoma in postmastectomy
lymphedema: a report of six cases in elephantiasis chirurgica.
Cancer 1948; 1:64
–81[CrossRef]
- Marchal C, Weber B, de Lafontan B, et al. Nine breast angiosarcomas
after conservative treatment for breast carcinoma: a survey from French
comprehensive cancer centers. Int J Radiat Oncol Biol
Phys 1999; 44:113
–119[CrossRef][Medline]
- Strobbe LJ, Peterse HL, van Tinteren H, Wijnmaalen A, Rutgers EJ.
Angiosarcoma of the breast after conservation therapy for invasive cancer, the
incidence and outcome: an unforeseen sequela. Breast Cancer Res
Treat 1998; 47:101
–109[CrossRef][Medline]
- West JG, Qureshi A, West JE, et al. Risk of angiosarcoma following
breast conservation: a clinical alert. Breast J2005; 11:115
–123[CrossRef][Medline]
- Billings SD, McKenney JK, Folpe AL, Hardacre MC, Weiss SW.
Cutaneous angiosarcoma following breast-conserving surgery and radiation: an
analysis of 27 cases. Am J Surg Pathol2004; 28:781
–788[CrossRef][Medline]
- Brenn T, Fletcher CD. Radiation-associated cutaneous atypical
vascular lesions and angiosarcoma: clinicopathologic analysis of 42 cases.
Am J Surg Pathol 2005;29
: 983–996[Medline]
- Mano MS, Fraser G, Kerr J, et al. Radiation-induced angiosarcoma of
the breast shows major response to docetaxel after failure of
anthracycline-based chemotherapy. Breast2006; 15:117
–118. Epub 2004 Dec 25[CrossRef][Medline]
- Feigenberg SJ, Mendenhall NP, Reith JD, Ward JR, Copeland EM III.
Angiosarcoma after breast-conserving therapy: experience with
hyperfractionated radiotherapy. Int J Radiat Oncol Biol
Phys 2002; 52:620
–626[CrossRef][Medline]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Top
Abstract
Introduction
