Primary epithelioid angiosarcoma of the breast masquerading as carcinoma
Identifieur interne : 003270 ( Pmc/Checkpoint ); précédent : 003269; suivant : 003271Primary epithelioid angiosarcoma of the breast masquerading as carcinoma
Auteurs : S. Muzumder [Inde] ; P. Das [Inde] ; M. Kumar [Inde] ; S. Bhasker [Inde] ; C. Sarkar [Inde] ; K. Medhi [Inde] ; V. K. Iyer [Inde] ; G. K. Rath [Inde]Source :
- Current Oncology [ 1198-0052 ] ; 2010.
Abstract
Here we report a case of primary epithelioid angiosarcoma (
Url:
PubMed: 20179806
PubMed Central: 2826780
Affiliations:
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PMC:2826780Le document en format XML
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<author><name sortKey="Medhi, K" sort="Medhi, K" uniqKey="Medhi K" first="K." last="Medhi">K. Medhi</name>
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<author><name sortKey="Rath, G K" sort="Rath, G K" uniqKey="Rath G" first="G. K." last="Rath">G. K. Rath</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Primary epithelioid angiosarcoma of the breast masquerading as carcinoma</title>
<author><name sortKey="Muzumder, S" sort="Muzumder, S" uniqKey="Muzumder S" first="S." last="Muzumder">S. Muzumder</name>
<affiliation wicri:level="1"><nlm:aff id="af1-conc17-1-64"> Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea> Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi</wicri:regionArea>
<wicri:noRegion>New Delhi</wicri:noRegion>
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<author><name sortKey="Das, P" sort="Das, P" uniqKey="Das P" first="P." last="Das">P. Das</name>
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<country xml:lang="fr">Inde</country>
<wicri:regionArea> Department of Pathology, All India Institute of Medical Sciences, New Delhi</wicri:regionArea>
<wicri:noRegion>New Delhi</wicri:noRegion>
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<author><name sortKey="Kumar, M" sort="Kumar, M" uniqKey="Kumar M" first="M." last="Kumar">M. Kumar</name>
<affiliation wicri:level="1"><nlm:aff id="af1-conc17-1-64"> Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea> Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi</wicri:regionArea>
<wicri:noRegion>New Delhi</wicri:noRegion>
</affiliation>
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<author><name sortKey="Bhasker, S" sort="Bhasker, S" uniqKey="Bhasker S" first="S." last="Bhasker">S. Bhasker</name>
<affiliation wicri:level="1"><nlm:aff id="af1-conc17-1-64"> Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea> Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi</wicri:regionArea>
<wicri:noRegion>New Delhi</wicri:noRegion>
</affiliation>
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<author><name sortKey="Sarkar, C" sort="Sarkar, C" uniqKey="Sarkar C" first="C." last="Sarkar">C. Sarkar</name>
<affiliation wicri:level="1"><nlm:aff id="af2-conc17-1-64"> Department of Pathology, All India Institute of Medical Sciences, New Delhi, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea> Department of Pathology, All India Institute of Medical Sciences, New Delhi</wicri:regionArea>
<wicri:noRegion>New Delhi</wicri:noRegion>
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<author><name sortKey="Medhi, K" sort="Medhi, K" uniqKey="Medhi K" first="K." last="Medhi">K. Medhi</name>
<affiliation wicri:level="1"><nlm:aff id="af3-conc17-1-64"> Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea> Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi</wicri:regionArea>
<wicri:noRegion>New Delhi</wicri:noRegion>
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<author><name sortKey="Iyer, V K" sort="Iyer, V K" uniqKey="Iyer V" first="V. K." last="Iyer">V. K. Iyer</name>
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<country xml:lang="fr">Inde</country>
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<wicri:noRegion>New Delhi</wicri:noRegion>
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<author><name sortKey="Rath, G K" sort="Rath, G K" uniqKey="Rath G" first="G. K." last="Rath">G. K. Rath</name>
<affiliation wicri:level="1"><nlm:aff id="af1-conc17-1-64"> Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea> Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi</wicri:regionArea>
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<series><title level="j">Current Oncology</title>
<idno type="ISSN">1198-0052</idno>
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<front><div type="abstract" xml:lang="en"><p>Here we report a case of primary epithelioid angiosarcoma (<sc>eas</sc>
) of the breast occurring in a 30-year-old woman. Following fine-needle asspiration cytology (<sc>fnac</sc>
) and tru-cut biopsy, the patient was initially diagnosed with mammary carcinoma and thereafter underwent modified radical mastectomy. Postoperative histopathologic examination and immunohistochemistry revealed a diagnosis of primary epithelioid angiosarcoma of the breast. The patient received postoperative radiotherapy to the chest wall and was started on adjuvant thalidomide. Preoperatively, <sc>eas</sc>
can be mistaken for carcinoma because it is difficult to appreciate the typical morphology on <sc>fnac</sc>
or tru-cut biopsy. Indeed, this is an area of potential diagnostic error because, nowadays, neoadjuvant therapy is often instituted after core biopsy of a breast mass. This case is being reported not only for its diagnostic difficulty, but also because of its rarity in English literature.</p>
</div>
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<pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Curr Oncol</journal-id>
<journal-id journal-id-type="publisher-id">CO</journal-id>
<journal-title-group><journal-title>Current Oncology</journal-title>
</journal-title-group>
<issn pub-type="ppub">1198-0052</issn>
<issn pub-type="epub">1718-7729</issn>
<publisher><publisher-name>Multimed Inc.</publisher-name>
<publisher-loc>66 Martin St. Milton, ON, Canada L9T 2R2</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">20179806</article-id>
<article-id pub-id-type="pmc">2826780</article-id>
<article-id pub-id-type="publisher-id">conc17-1-64</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group><article-title>Primary epithelioid angiosarcoma of the breast masquerading as carcinoma</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Muzumder</surname>
<given-names>S.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="af1-conc17-1-64">*</xref>
<xref ref-type="corresp" rid="c1-conc17-1-64"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Das</surname>
<given-names>P.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="af2-conc17-1-64">†</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kumar</surname>
<given-names>M.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="af1-conc17-1-64">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bhasker</surname>
<given-names>S.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="af1-conc17-1-64">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sarkar</surname>
<given-names>C.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="af2-conc17-1-64">†</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Medhi</surname>
<given-names>K.</given-names>
</name>
<degrees>DM</degrees>
<xref ref-type="aff" rid="af3-conc17-1-64">‡</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Iyer</surname>
<given-names>V.K.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="af2-conc17-1-64">†</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rath</surname>
<given-names>G.K.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="af1-conc17-1-64">*</xref>
</contrib>
</contrib-group>
<aff id="af1-conc17-1-64"><label>*</label>
Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India</aff>
<aff id="af2-conc17-1-64"><label>†</label>
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India</aff>
<aff id="af3-conc17-1-64"><label>‡</label>
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India</aff>
<author-notes><corresp id="c1-conc17-1-64">Correspondence to: Sandeep Muzumder, Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029 India., E-mail:
<email>sandeepradonc@hotmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>2</month>
<year>2010</year>
</pub-date>
<volume>17</volume>
<issue>1</issue>
<fpage>64</fpage>
<lpage>69</lpage>
<permissions><copyright-statement>2010 Multimed Inc.</copyright-statement>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.5/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>Here we report a case of primary epithelioid angiosarcoma (<sc>eas</sc>
) of the breast occurring in a 30-year-old woman. Following fine-needle asspiration cytology (<sc>fnac</sc>
) and tru-cut biopsy, the patient was initially diagnosed with mammary carcinoma and thereafter underwent modified radical mastectomy. Postoperative histopathologic examination and immunohistochemistry revealed a diagnosis of primary epithelioid angiosarcoma of the breast. The patient received postoperative radiotherapy to the chest wall and was started on adjuvant thalidomide. Preoperatively, <sc>eas</sc>
can be mistaken for carcinoma because it is difficult to appreciate the typical morphology on <sc>fnac</sc>
or tru-cut biopsy. Indeed, this is an area of potential diagnostic error because, nowadays, neoadjuvant therapy is often instituted after core biopsy of a breast mass. This case is being reported not only for its diagnostic difficulty, but also because of its rarity in English literature.</p>
</abstract>
<kwd-group><kwd>Breast</kwd>
<kwd>primary epithelioid angiosarcoma</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group><fig id="f1-conc17-1-64" position="float"><label>FIGURE 1</label>
<caption><p>(a,b) Fine-needle aspiration cytology of the breast lesion showed singly-lying epithelioid cells with irregular pleomorphic nuclei and moderate-to-abundant bluish cytoplasm [Giemsa stain: (a) 200×, (b) 400×]. (c,d) Tru-cut biopsy of the breast showed irregular cords and singly-lying pleomorphic cells with moderate cytoplasm and focal necrosis [hematoxylin and eosin stain: (c) 40×, (d) 100×]. (d, inset) The cells were immunopositive for cytokeratin (40×).</p>
</caption>
<graphic xlink:href="conc17-1-64f1"></graphic>
</fig>
<fig id="f2-conc17-1-64" position="float"><label>FIGURE 2</label>
<caption><p>(a) Low-power photomicrograph of the resected tissue shows an infiltrating malignant tumour entrapping the residual ductules (hematoxylin and eosin stain, 40×). (b) The tumour is highly vascular, comprising many large and slit-like vascular spaces (hematoxylin and eosin stain, 200×). (c) The slit-like spaces are lined by pleomorphic epithelioid malignant cells. Few giant cells are noted (hematoxylin and eosin stain, 400×). (d) The tumour cells are strongly immunopositive for CD31 (200×). (d, inset) Immunostaining for the human epidermal growth factor receptor (<sc>her</sc>
2/<italic>neu</italic>
) was positive in tumour cells (200×).</p>
</caption>
<graphic xlink:href="conc17-1-64f2"></graphic>
</fig>
<table-wrap id="tI-conc17-1-64" position="float"><label>TABLE I</label>
<caption><p>Cases of primary epithelioid angiosarcoma of the breast<xref ref-type="table-fn" rid="tfn1-conc17-1-64">a</xref>
</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="2" colspan="1">Reference</th>
<th colspan="2" align="center" rowspan="1">Patient</th>
<th align="center" valign="top" rowspan="2" colspan="1">Treatment</th>
<th align="center" valign="top" rowspan="2" colspan="1">Immunohistochemistry [positive (+), negative (−)]</th>
<th align="center" valign="top" rowspan="2" colspan="1">Outcome</th>
</tr>
<tr><th align="center" rowspan="1" colspan="1">Age (years)</th>
<th align="center" rowspan="1" colspan="1">Sex</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Martinez <italic>et al.,</italic>
1997<xref ref-type="bibr" rid="b13-conc17-1-64">13</xref>
</td>
<td align="center" rowspan="1" colspan="1">26</td>
<td align="center" rowspan="1" colspan="1">F</td>
<td align="center" rowspan="1" colspan="1">Modified radical mastectomy, postoperative radiotherapy (4860 cGy), doxorubicin and dacarbazine</td>
<td align="center" rowspan="1" colspan="1">Vimentin+, factor <sc>viii</sc>
+, CD31+, cytokeratin−</td>
<td align="center" rowspan="1" colspan="1">Alive at 7 months, with local recurrence</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Farina <italic>et al.,</italic>
2003<xref ref-type="bibr" rid="b14-conc17-1-64">14</xref>
</td>
<td align="center" rowspan="1" colspan="1">49</td>
<td align="center" rowspan="1" colspan="1">F</td>
<td align="center" rowspan="1" colspan="1">Modified radical mastectomy, no adjuvant</td>
<td align="center" rowspan="1" colspan="1">Vimentin+, factor <sc>viii</sc>
+, CD31+, CD34+, cytokeratin−</td>
<td align="center" rowspan="1" colspan="1">Died at 15 months of metastasis</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Carter <italic>et al.,</italic>
2005<xref ref-type="bibr" rid="b15-conc17-1-64">15</xref>
</td>
<td align="center" rowspan="1" colspan="1">33</td>
<td align="center" rowspan="1" colspan="1">F</td>
<td align="center" rowspan="1" colspan="1">Simple mastectomy, no adjuvant</td>
<td align="center" rowspan="1" colspan="1"><sc>nr</sc>
</td>
<td align="center" rowspan="1" colspan="1">Alive at 7 months, with axillary recurrence</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Wang <italic>et al.,</italic>
2007<xref ref-type="bibr" rid="b16-conc17-1-64">16</xref>
</td>
<td align="center" rowspan="1" colspan="1">20</td>
<td align="center" rowspan="1" colspan="1">M</td>
<td align="center" rowspan="1" colspan="1">Complete excision, no adjuvant</td>
<td align="center" rowspan="1" colspan="1">Vimentin+, factor <sc>viii</sc>
+, CD31+, CD34+, cytokeratin+</td>
<td align="center" rowspan="1" colspan="1">Died at 6 months of metastasis</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Muzumder <italic>et al.</italic>
(present case)</td>
<td align="center" rowspan="1" colspan="1">30</td>
<td align="center" rowspan="1" colspan="1">F</td>
<td align="center" rowspan="1" colspan="1">Modified radical mastectomy, postoperative radiotherapy (5000 cGy), thalidomide</td>
<td align="center" rowspan="1" colspan="1">Vimentin+, CD31+, CD34−, <sc>her</sc>
2/<italic>neu</italic>
(erbB-2)+, <sc>er</sc>
−, <sc>pr</sc>
−, cytokeratin−</td>
<td align="center" rowspan="1" colspan="1">Alive at 9 months, free of disease; on thalidomide</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="tfn1-conc17-1-64"><label>a</label>
<p>Excludes cases mentioned by Nascimento <italic>et al.,</italic>
2008.<xref ref-type="bibr" rid="b3-conc17-1-64">3</xref>
</p>
</fn>
<fn id="tfn2-conc17-1-64"><p>F = female; M = male; <sc>nr</sc>
= not reported; <sc>her</sc>
2/<italic>neu</italic>
= human epidermal growth factor receptor; <sc>er</sc>
= estrogen receptor; <sc>pr</sc>
= progesterone receptor.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>Inde</li>
</country>
</list>
<tree><country name="Inde"><noRegion><name sortKey="Muzumder, S" sort="Muzumder, S" uniqKey="Muzumder S" first="S." last="Muzumder">S. Muzumder</name>
</noRegion>
<name sortKey="Bhasker, S" sort="Bhasker, S" uniqKey="Bhasker S" first="S." last="Bhasker">S. Bhasker</name>
<name sortKey="Das, P" sort="Das, P" uniqKey="Das P" first="P." last="Das">P. Das</name>
<name sortKey="Iyer, V K" sort="Iyer, V K" uniqKey="Iyer V" first="V. K." last="Iyer">V. K. Iyer</name>
<name sortKey="Kumar, M" sort="Kumar, M" uniqKey="Kumar M" first="M." last="Kumar">M. Kumar</name>
<name sortKey="Medhi, K" sort="Medhi, K" uniqKey="Medhi K" first="K." last="Medhi">K. Medhi</name>
<name sortKey="Rath, G K" sort="Rath, G K" uniqKey="Rath G" first="G. K." last="Rath">G. K. Rath</name>
<name sortKey="Sarkar, C" sort="Sarkar, C" uniqKey="Sarkar C" first="C." last="Sarkar">C. Sarkar</name>
</country>
</tree>
</affiliations>
</record>
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