RADIATION INDUCED ANGIOSARCOMA OF THE BREAST FOUR YEARS AFTER BREAST CONSERVATION THERAPY

Objectives: Breast angiosarcomas are a rare type of neoplasm with a high rate of recurrence. They can be either primary or secondary. Secondary angiosarcomas are associated with radiation therapy with median occurrence happening approximately 10 years after radiation exposure. Due to the rare nature of these tumors, there is no standard treatment strategy for breast angiosarcomas. This case report describes the resection of a secondary angiosarcoma that occurred four years after breast conserving therapy. A 69-year-old female with a history of left sided ductal carcinoma in situ underwent breast conservation therapy with lumpectomy, sentinel lymph node biopsy, and radiation in February 2018. She was followed routinely with clinical exams and imaging studies. In January 2022, she noticed progressive skin changes. A punch biopsy was performed that confirmed angiosarcoma in the left breast. The patient underwent left breast mastectomy with wide margins in February 2022. The final pathology was angiosarcoma with widely negative margins. She continued to have close follow-up, and at 5 months was noted to have a recurrent lesion that required further operative intervention. Although median development of secondary angiosarcoma is approximately 10 years, patients should be regularly monitored for skin changes and swelling. Prognosis tends to be linked with the tumor grade and margin status of the resection, with negative margins having significantly improved disease-free survival time. In conclusion, this case report details the surgical treatment of a secondary breast angiosarcoma that developed four years after initial breast conservation therapy for DCIS.

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