Track: Case Reports

Abstract:

Angiosarcoma (AS) is a rare, aggressive tumor that arises from endothelial cells. Angiosarcomas can arise spontaneously or in the context of chronic lymphedema or radiation therapy. Because lesions may appear as benign ecchymoses, they may not be diagnosed as quickly. Thus, a low index of suspicion should be maintained for diagnostic workup of radiation-indued angiosarcoma in the years following breast radiation. Here, we describe a case of a woman in her 50s who presented with multiple areas of bruising on residual left breast tissue. Importantly, she had a history of T1 N0 hormone receptor positive invasive ductal carcinoma (IDC) of the right breast treated with lumpectomy, axillary dissection, and radiation. This treatment regimen was followed by five separate occurrences of angiosarcoma in the chest wall and residual breast tissue managed with surgical resection only. The most recent diagnosis of angiosarcoma presented with bruising of left breast tissue overlying three palpable breast masses. Ultrasound-guided biopsy revealed recurrent angiosarcoma. She underwent mastectomy and elected to start pembrolizumab. She has not had a recurrence since beginning immunotherapy. Management of angiosarcomas is not well-established given the rarity of the disease. The current treatment is mainly surgical, although true negative margins are rarely achieved with surgery alone as the tumor is typically multifocal in nature. As indicated with this case, a multidisciplinary approach with both surgery and systemic therapies would be a more adequate treatment approach for achieving more profound responses.

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Benjamin Powers