Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Case Report

Primary Breast Angiosarcoma: Utilisation of Pre-surgical Magnetic Resonance Imaging (MRI) for Accurate Tumour Characterization and Planning – A Case Report and Literature Review

Author(s): Nazimah Ab Mumin*, Kartini Rahmat*, Marlina Tanty Ramli Hamid, Wei Lin Ng, Wai Yee Chan, Xin Ying Cheah, Mee Hoong See and Cheng Har Yip

Volume 17, Issue 4, 2021

Published on: 07 October, 2020

Page: [552 - 558] Pages: 7

DOI: 10.2174/1573405616666201007161119

Price: $65

Abstract

Background: Primary breast angiosarcoma is a rare malignancy with non-specific clinical and radiological findings.

Case Report: A 30-year-old lady presented with left breast pain and lumpiness for over one year. She has had several breast ultrasounds (US) and was treated for acute mastitis and abscess. Subsequently, in view of the rapid growth of the lump and worsening pain, she was re-investigated with US, elastography, digital breast tomosynthesis (DBT) and MRI. MRI raised the suspicion of angiosarcoma. The diagnosis was confirmed after biopsy and she underwent mastectomy.

Discussion: Literature review on imaging findings of breast angiosarcoma, especially on MRI, is discussed. MRI features showed heterogeneous low signal intensity on T1 and high signal intensity on T2. Dynamic contrast enhancement (DCE) features included either early enhancement with or without washout in the delayed phase, and some reported central areas of non-enhancement.

Conclusion: This case report emphasises on the importance of MRI in clinching the diagnosis of breast angiosarcoma, and hence, should be offered sooner to prevent diagnostic delay.

Keywords: Breast angiosarcoma, magnetic resonance imaging (MRI), ultrasound elastography, digital breast tomosynthesis( DBT), primary breast angiosarcoma, breast cancer.

Graphical Abstract

[1]
O’Neill AC, D’Arcy C, McDermott E, O’Doherty A, Quinn C, McNally S. Magnetic resonance imaging appearances in primary and secondary angiosarcoma of the breast. J Med Imaging Radiat Oncol 2014; 58(2): 208-12.
[http://dx.doi.org/10.1111/1754-9485.12100] [PMID: 24112469]
[2]
Marchant LK, Orel SG, Perez-Jaffe LA, Reynolds C, Schnall MD. Bilateral angiosarcoma of the breast on MR imaging. AJR Am J Roentgenol 1997; 169(4): 1009-10.
[http://dx.doi.org/10.2214/ajr.169.4.9308452] [PMID: 9308452]
[3]
Kikawa Y, Konishi Y, Nakamoto Y, et al. Angiosarcoma of the breast - specific findings of MRI. Breast Cancer 2006; 13(4): 369-73.
[http://dx.doi.org/10.2325/jbcs.13.369] [PMID: 17146165]
[4]
Liberman L, Dershaw DD, Kaufman RJ, Rosen PP. Angiosarcoma of the breast. Radiology 1992; 183(3): 649-54.
[http://dx.doi.org/10.1148/radiology.183.3.1584913] [PMID: 1584913]
[5]
Grant EG, Holt RW, Chun B, Richardson JD, Orson LW, Cigtay OS. Angiosarcoma of the breast: sonographic, xeromammographic, and pathologic appearance. AJR Am J Roentgenol 1983; 141(4): 691-2.
[http://dx.doi.org/10.2214/ajr.141.4.691] [PMID: 6604419]
[6]
Liu H, Peng W. Morphological manifestations of nonpuerperal mastitis on magnetic resonance imaging. J Magn Reson Imaging 2011; 33(6): 1369-74.
[http://dx.doi.org/10.1002/jmri.22464] [PMID: 21591005]
[7]
Le-Petross HT, Cristofanilli M, Carkaci S, et al. MRI features of inflammatory breast cancer. AJR Am J Roentgenol 2011; 197(4): W769-76.
[http://dx.doi.org/10.2214/AJR.10.6157] [PMID: 21940550]
[8]
Tomich J, Grove Nigro K, Barr RG. Primary Angiosarcoma of the breast: a case report and review of the literature. Ultrasound Q 2017; 33(1): 46-8.
[http://dx.doi.org/10.1097/RUQ.0000000000000274] [PMID: 28234720]
[9]
Aslan H, Pourbagher A, Ezer A, et al. Ultrasound elastography and magnetic resonance imaging findings of breast angiosarcoma mimicking a benign lesion by elastography: A case report 2017.
[http://dx.doi.org/10.5812/ircmj.62060]
[10]
Iacoponi S, Calleja J, Hernandez G, Sainz de la Cuesta R. Primary breast angiosarcoma in a young woman. Int J Surg Case Rep 2016; 24: 101-3.
[http://dx.doi.org/10.1016/j.ijscr.2016.05.015] [PMID: 27232295]
[11]
Glazebrook KN, Magut MJ, Reynolds C. Angiosarcoma of the breast. AJR Am J Roentgenol 2008; 190(2): 533-8.
[http://dx.doi.org/10.2214/AJR.07.2909] [PMID: 18212243]
[12]
Murakam S, Nagano H, Okubo K, et al. Angiosarcoma of the breast: report of a case and its findings of MRI. Breast Cancer 2001; 8(3): 254-8.
[http://dx.doi.org/10.1007/BF02967519] [PMID: 11668251]
[13]
Cucci E, Ciuffreda M, Tambaro R, Aquilani L, Barrassi M, Sallustio G. MRI findings of large low-grade angiosarcoma of the breast with subsequent bone metastases: a case report. J Breast Cancer 2012; 15(2): 255-7.
[http://dx.doi.org/10.4048/jbc.2012.15.2.255] [PMID: 22807947]
[14]
Dashevsky BZ, Charnoff-Katz K, Shin SJ, Babagbemi K, Rosenblatt R. A case of primary breast angiosarcoma. Radiol Case Rep 2015; 8(3): 741.
[http://dx.doi.org/10.2484/rcr.v8i3.741] [PMID: 27330634]
[15]
Sasahara A, Tanabe M, Hayashi K, et al. A case of primary breast angiosarcoma with multiple discontinuous small lesions. Surg Case Rep 2019; 5(1): 157.
[http://dx.doi.org/10.1186/s40792-019-0704-8] [PMID: 31654286]
[16]
Varghese B, Deshpande P, Dixit S, Koppiker CB, Jalnapurkar N. Primary angiosarcoma of the breast: a case report. J Radiol Case Rep 2019; 13(2): 15-25.
[http://dx.doi.org/10.3941/jrcr.v13i2.3449] [PMID: 31565168]
[17]
Abdelhady AM, Neamaalla S, Gittens AS, Germaine P. Primary angiosarcoma of the breast: Case report of a rare vascular tumor. Radiol Case Rep 2020; 15(4): 339-43.
[http://dx.doi.org/10.1016/j.radcr.2019.12.015] [PMID: 31993096]
[18]
Bayramoglu Z, Yılmaz R, Demir AA, et al. Imaging findings of a rare breast malignancy: bilateral metachronous primary angiosarcoma of breast. Breast J 2017; 23(5): 596-9.
[http://dx.doi.org/10.1111/tbj.12804] [PMID: 28332744]
[19]
Brown AL, Wahab RA. MRI of primary angiosarcoma of the breast. Radiology 2020; 0(0): 201377.
[http://dx.doi.org/10.1148/radiol.2020201377] [PMID: 32720871]
[20]
Bennani A, Chbani L, Lamchahab M, et al. Primary angiosarcoma of the breast: a case report. Diagn Pathol 2013; 8(1): 66.
[http://dx.doi.org/10.1186/1746-1596-8-66] [PMID: 23607567]
[21]
Johnson CM, Garguilo GA. Angiosarcoma of the breast: A case report and literature review. Curr Surg 2002; 59(5): 490-4.
[http://dx.doi.org/10.1016/S0149-7944(02)00629-3] [PMID: 15727796]
[22]
Wu WH, Ji QL, Li ZZ, Wang QN, Liu SY, Yu JF. Mammography and MRI manifestations of breast angiosarcoma. BMC Womens Health 2019; 19(1): 73.
[http://dx.doi.org/10.1186/s12905-019-0769-3] [PMID: 31182098]
[23]
Farrokh D, Modoodi E, Fallah Rastegar Y. Breast angiosarcoma with exophytic growth. Arch Iran Med 2016; 19(11): 812-5.
[PMID: 27845552]
[24]
Fujita T, Taira N, Ogasawara Y, Omori M, Doihara H. Bilateral angiosarcoma of the breast detected by magnetic resonance imaging during pregnancy. Int J Clin Oncol 2009; 14(6): 560-3.
[http://dx.doi.org/10.1007/s10147-009-0895-2] [PMID: 19967497]
[25]
Wang L, Lao IW, Yu L, Yang W, Wang J. Primary breast angiosarcoma: A retrospective study of 36 cases from a single chinese medical institute with clinicopathologic and radiologic correlations. Breast J 2017; 23(3): 282-91.
[http://dx.doi.org/10.1111/tbj.12731] [PMID: 27933680]
[26]
Wienbeck S, Meyer HJ, Herzog A, et al. Imaging findings of primary breast sarcoma: Results of a first multicenter study. Eur J Radiol 2017; 88: 1-7.
[http://dx.doi.org/10.1016/j.ejrad.2016.12.020] [PMID: 28189193]
[27]
Chikarmane SA, Gombos EC, Jagadeesan J, Raut C, Jagannathan JP. MRI findings of radiation-associated angiosarcoma of the breast (RAS). J Magn Reson Imaging 2015; 42(3): 763-70.
[http://dx.doi.org/10.1002/jmri.24822] [PMID: 25504856]
[28]
NCCN Guidelines of Soft Tissue Sarcoma Management. https://www.nccn.org/professionals/physician_gls/pdf/sarcoma.pdf
[29]
Sher T, Hennessy BT, Valero V, et al. Primary angiosarcomas of the breast. Cancer 2007; 110(1): 173-8.
[http://dx.doi.org/10.1002/cncr.22784] [PMID: 17541936]
[30]
Johnstone PA, Pierce LJ, Merino MJ, Yang JC, Epstein AH, DeLaney TF. Primary soft tissue sarcomas of the breast: local-regional control with post-operative radiotherapy. Int J Radiat Oncol Biol Phys 1993; 27(3): 671-5.
[http://dx.doi.org/10.1016/0360-3016(93)90395-C] [PMID: 8226163]
[31]
Georgiannos SN, Sheaff M. Angiosarcoma of the breast: a 30 year perspective with an optimistic outlook. Br J Plast Surg 2003; 56(2): 129-34.
[http://dx.doi.org/10.1016/S0007-1226(03)00025-0] [PMID: 12791356]
[32]
Pervaiz N, Colterjohn N, Farrokhyar F, Tozer R, Figueredo A, Ghert M. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer 2008; 113(3): 573-81.
[http://dx.doi.org/10.1002/cncr.23592] [PMID: 18521899]
[33]
Frustaci S, Gherlinzoni F, De Paoli A, et al. Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: results of the Italian randomized cooperative trial. J Clin Oncol 2001; 19(5): 1238-47.
[http://dx.doi.org/10.1200/JCO.2001.19.5.1238] [PMID: 11230464]
[34]
Torres KE, Ravi V, Kin K, et al. Long-term outcomes in patients with radiation-associated angiosarcomas of the breast following surgery and radiotherapy for breast cancer. Ann Surg Oncol 2013; 20(4): 1267-74.
[http://dx.doi.org/10.1245/s10434-012-2755-y] [PMID: 23224828]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy