Variable presentations of radiation-associated angiosarcoma in patients treated for breast cancer

Abstract

Introduction: Radiation-associated angiosarcoma is a rare and late complication of radiotherapy in breast cancer. Its incident is reported in the range of 0.03–0.3%. It carries a poor prognosis with a 5-year survival rate of 43–54%. Due to its non-specific presentation, diagnosis is often delayed. Case Report Case 1: A 60-year-old female presented six years after her breast cancer treatment with a history of bruising over the breast following trauma. Initial imaging and punch biopsy only showed inflammatory change. Her breast symptoms progressed and repeat biopsy revealed angiosarcoma. She was treated with chemotherapy followed by mastectomy. Case 2: A 60-year-old female treated for breast cancer, presented two and a half years later with subtle erythema over the breast. Imaging was normal. Punch biopsy showed angiosarcoma and she underwent mastectomy. Case 3: A 90-year-old female presented eight years after treatment for breast cancer. Her symptoms included blisters over the breast that bled at times. Punch biopsy showed angiosarcoma. There was rapid disease progression with convergence of the blisters into a large necrotic mass. She underwent a mastectomy for local control. The angiosarcoma recurred a year later and she died within three months of recurrence. Conclusion: Radiation-associated angiosarcoma is rare but carries a poor prognosis. Due to its non-specific presentation, diagnosis is often delayed. A high level of suspicion is needed in patients presenting with unusual breast symptoms and changes post-treatment.