Журнал клинических случаев

Metachronous Bilateral Angiosarcoma Post Breast Cancer Therapy: A Unique Case Report

Abstract

Bekkouche Soukaina*, Najem Salma, Naciri Sarah, Mrabti Hind, Saber Boutayeb and Errihani Hassan

Breast angiosarcoma is a severe and rare complication in the breast-preserving management of breast cancer through surgery and radiotherapy. Due to the few studies, there is no clear consensus regarding the optimal oncological management of radiation-induced angiosarcoma. However, aggressive surgical removal remains the gold standard. A 53-year-old woman had a history of medullary triple negative, metachronous bilateral breast cancer. The left tumor was treated with conservative surgery in 2000, while the right tumor was treated with radical surgery in 2004, followed in both by anthracycline-based chemotherapy, radiotherapy and brachytherapy. 21 years later after the first surgery, a locally advanced tumor appeared in her left breast. Radiation-induced angiosarcoma was impossible to diagnose with a core needle biopsy, which revealed an undifferentiated tumor. The patient received neoadjuvant chemotherapy before undergoing left mastectomy surgery and the pathological analysis yielded a diagnosis of angiosarcoma. 2 years later, a nodule appeared over the right mastectomy scar. A wide excision removing the pectoral muscle was carried out, revealing a contralateral breast angiosarcoma. Given the recurrence, the patient received adjuvant chemotherapy, despite the lack of a prospective trial study to determine whether adjuvant chemotherapy for resectable angiosarcoma should be recommended. Secondary breast angiosarcoma is a very rare and late malignant tumor induced by radiation used for the treatment of early breast cancer. Surgery is the cornerstone of therapy, however, adjuvant chemotherapy may be considered due to the risk of recurrence and distant metastasis. Prospective trials are required for more precise therapeutic strategies for this iatrogenic malignancy.