Angiosarcoma arising in the non-operated, sclerosing breast after primary irradiation, surviving 6 years post-resection: A case report and review of the Japanese literature
Identifieur interne : 002274 ( Pmc/Corpus ); précédent : 002273; suivant : 002275Angiosarcoma arising in the non-operated, sclerosing breast after primary irradiation, surviving 6 years post-resection: A case report and review of the Japanese literature
Auteurs : Takaaki Ito ; Kenichiro Tanaka ; Kiyoshi Suzumura ; Yoshichika Okamoto ; Koji Oda ; Syouji Hoshi ; Masaki TerasakiSource :
- International Journal of Surgery Case Reports [ 2210-2612 ] ; 2016.
Abstract
This is the first report of angiosarcoma occurring after radiation on a non-operated breast. The patient underwent mastectomy, surviving disease free for 6 years, despite the generally poor prognosis of angiosarcoma. The potential difficulties of diagnosing angiosarcoma against background fibrosis caused by radiation should be kept in mind. Kaplan-Meier analysis of 60 Japanese breast angiosarcoma patients showed significantly better prognosis in patients with a tumor 2 cm or smaller.
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DOI: 10.1016/j.ijscr.2016.05.001
PubMed: 27179333
PubMed Central: 4873600
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Angiosarcoma arising in the non-operated, sclerosing breast after primary irradiation, surviving 6 years post-resection: A case report and review of the Japanese literature</title><author><name sortKey="Ito, Takaaki" sort="Ito, Takaaki" uniqKey="Ito T" first="Takaaki" last="Ito">Takaaki Ito</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author><author><name sortKey="Tanaka, Kenichiro" sort="Tanaka, Kenichiro" uniqKey="Tanaka K" first="Kenichiro" last="Tanaka">Kenichiro Tanaka</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation><affiliation><nlm:aff id="aff0010">Department of Breast Surgery, Aichi Cancer Center, Aichi Hospital, 18 Kuriyado, Kakemachi, Okazaki, Aichi 444-0011, Japan</nlm:aff></affiliation></author><author><name sortKey="Suzumura, Kiyoshi" sort="Suzumura, Kiyoshi" uniqKey="Suzumura K" first="Kiyoshi" last="Suzumura">Kiyoshi Suzumura</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author><author><name sortKey="Okamoto, Yoshichika" sort="Okamoto, Yoshichika" uniqKey="Okamoto Y" first="Yoshichika" last="Okamoto">Yoshichika Okamoto</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author><author><name sortKey="Oda, Koji" sort="Oda, Koji" uniqKey="Oda K" first="Koji" last="Oda">Koji Oda</name><affiliation><nlm:aff id="aff0010">Department of Breast Surgery, Aichi Cancer Center, Aichi Hospital, 18 Kuriyado, Kakemachi, Okazaki, Aichi 444-0011, Japan</nlm:aff></affiliation></author><author><name sortKey="Hoshi, Syouji" sort="Hoshi, Syouji" uniqKey="Hoshi S" first="Syouji" last="Hoshi">Syouji Hoshi</name><affiliation><nlm:aff id="aff0015">Department of Pathology, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author><author><name sortKey="Terasaki, Masaki" sort="Terasaki, Masaki" uniqKey="Terasaki M" first="Masaki" last="Terasaki">Masaki Terasaki</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27179333</idno><idno type="pmc">4873600</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873600</idno><idno type="RBID">PMC:4873600</idno><idno type="doi">10.1016/j.ijscr.2016.05.001</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002274</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002274</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Angiosarcoma arising in the non-operated, sclerosing breast after primary irradiation, surviving 6 years post-resection: A case report and review of the Japanese literature</title><author><name sortKey="Ito, Takaaki" sort="Ito, Takaaki" uniqKey="Ito T" first="Takaaki" last="Ito">Takaaki Ito</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author><author><name sortKey="Tanaka, Kenichiro" sort="Tanaka, Kenichiro" uniqKey="Tanaka K" first="Kenichiro" last="Tanaka">Kenichiro Tanaka</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation><affiliation><nlm:aff id="aff0010">Department of Breast Surgery, Aichi Cancer Center, Aichi Hospital, 18 Kuriyado, Kakemachi, Okazaki, Aichi 444-0011, Japan</nlm:aff></affiliation></author><author><name sortKey="Suzumura, Kiyoshi" sort="Suzumura, Kiyoshi" uniqKey="Suzumura K" first="Kiyoshi" last="Suzumura">Kiyoshi Suzumura</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author><author><name sortKey="Okamoto, Yoshichika" sort="Okamoto, Yoshichika" uniqKey="Okamoto Y" first="Yoshichika" last="Okamoto">Yoshichika Okamoto</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author><author><name sortKey="Oda, Koji" sort="Oda, Koji" uniqKey="Oda K" first="Koji" last="Oda">Koji Oda</name><affiliation><nlm:aff id="aff0010">Department of Breast Surgery, Aichi Cancer Center, Aichi Hospital, 18 Kuriyado, Kakemachi, Okazaki, Aichi 444-0011, Japan</nlm:aff></affiliation></author><author><name sortKey="Hoshi, Syouji" sort="Hoshi, Syouji" uniqKey="Hoshi S" first="Syouji" last="Hoshi">Syouji Hoshi</name><affiliation><nlm:aff id="aff0015">Department of Pathology, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author><author><name sortKey="Terasaki, Masaki" sort="Terasaki, Masaki" uniqKey="Terasaki M" first="Masaki" last="Terasaki">Masaki Terasaki</name><affiliation><nlm:aff id="aff0005">Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Surgery Case Reports</title><idno type="eISSN">2210-2612</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Highlights</title><p><list list-type="simple"><list-item id="lsti0005"><label>•</label><p>This is the first report of angiosarcoma occurring after radiation on a non-operated breast.</p></list-item><list-item id="lsti0010"><label>•</label><p>The patient underwent mastectomy, surviving disease free for 6 years, despite the generally poor prognosis of angiosarcoma.</p></list-item><list-item id="lsti0015"><label>•</label><p>The potential difficulties of diagnosing angiosarcoma against background fibrosis caused by radiation should be kept in mind.</p></list-item><list-item id="lsti0020"><label>•</label><p>Kaplan-Meier analysis of 60 Japanese breast angiosarcoma patients showed significantly better prognosis in patients with a tumor 2 cm or smaller.</p></list-item></list></p></div></front><back><div1 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Surg Case Rep</journal-id><journal-id journal-id-type="iso-abbrev">Int J Surg Case Rep</journal-id><journal-title-group><journal-title>International Journal of Surgery Case Reports</journal-title></journal-title-group><issn pub-type="epub">2210-2612</issn><publisher><publisher-name>Elsevier</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27179333</article-id><article-id pub-id-type="pmc">4873600</article-id><article-id pub-id-type="publisher-id">S2210-2612(16)30120-1</article-id><article-id pub-id-type="doi">10.1016/j.ijscr.2016.05.001</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Angiosarcoma arising in the non-operated, sclerosing breast after primary irradiation, surviving 6 years post-resection: A case report and review of the Japanese literature</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ito</surname><given-names>Takaaki</given-names></name><email>takaakiito@hotmail.com</email><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Tanaka</surname><given-names>Kenichiro</given-names></name><email>ken.tanaka@acc-aichi.com</email><xref rid="aff0005" ref-type="aff">a</xref><xref rid="aff0010" ref-type="aff">b</xref><xref rid="cor0005" ref-type="corresp">⁎</xref></contrib><contrib contrib-type="author"><name><surname>Suzumura</surname><given-names>Kiyoshi</given-names></name><email>k156574@siz.saiseikai.or.jp</email><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Okamoto</surname><given-names>Yoshichika</given-names></name><email>y153575@siz.saiseikai.or.jp</email><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Oda</surname><given-names>Koji</given-names></name><email>k-oda@acc-aichi.com</email><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Hoshi</surname><given-names>Syouji</given-names></name><email>s100072@siz.saiseikai.or.jp</email><xref rid="aff0015" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Terasaki</surname><given-names>Masaki</given-names></name><email>m129348@siz.saiseikai.or.jp</email><xref rid="aff0005" ref-type="aff">a</xref></contrib></contrib-group><aff id="aff0005"><label>a</label>Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</aff><aff id="aff0010"><label>b</label>Department of Breast Surgery, Aichi Cancer Center, Aichi Hospital, 18 Kuriyado, Kakemachi, Okazaki, Aichi 444-0011, Japan</aff><aff id="aff0015"><label>c</label>Department of Pathology, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Surugaku, Shizuoka, Shizuoka 422-8527, Japan</aff><author-notes><corresp id="cor0005"><label>⁎</label>Corresponding author at:Department of Breast Surgery, Aichi Cancer Center, Aichi Hospital, 18 Kuriyado, Kakemachi, Okazaki, Aichi 444-0011, Japan.Department of Breast SurgeryAichi Cancer CenterAichi Hospital18 KuriyadoKakemachiOkazakiAichi444-0011Japan <email>ken.tanaka@acc-aichi.com</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>06</day><month>5</month><year>2016</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>06</day><month>5</month><year>2016</year></pub-date><volume>24</volume><fpage>26</fpage><lpage>31</lpage><history><date date-type="received"><day>4</day><month>2</month><year>2016</year></date><date date-type="rev-recd"><day>1</day><month>5</month><year>2016</year></date><date date-type="accepted"><day>1</day><month>5</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 The Author(s)</copyright-statement><copyright-year>2016</copyright-year><license license-type="CC BY-NC-ND" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p>This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).</license-p></license></permissions><abstract abstract-type="author-highlights" id="abs0005"><title>Highlights</title><p><list list-type="simple"><list-item id="lsti0005"><label>•</label><p>This is the first report of angiosarcoma occurring after radiation on a non-operated breast.</p></list-item><list-item id="lsti0010"><label>•</label><p>The patient underwent mastectomy, surviving disease free for 6 years, despite the generally poor prognosis of angiosarcoma.</p></list-item><list-item id="lsti0015"><label>•</label><p>The potential difficulties of diagnosing angiosarcoma against background fibrosis caused by radiation should be kept in mind.</p></list-item><list-item id="lsti0020"><label>•</label><p>Kaplan-Meier analysis of 60 Japanese breast angiosarcoma patients showed significantly better prognosis in patients with a tumor 2 cm or smaller.</p></list-item></list></p></abstract><abstract id="abs0010"><sec><title>Introduction</title><p>Angiosarcoma consists only 0.04% of all breast malignancies and has a poor prognosis. This is the first reported case of an angiosarcoma arising in the non-operated breast after primary irradiation for occult breast cancer. The patient underwent mastectomy, surviving disease free for 6 years.</p></sec><sec><title>Presentation of case</title><p>A 73-year-old woman with a past history of irradiation of the non-operated left breast complained of skin thickening and crust formation on the left nipple 8 years post-irradiation. Considering the clinical history and radiological studies, recurrent cancer was suspected and biopsy was performed. However, no proof of malignancy was obtained. As clinical symptoms continued to advance, informed consent was obtained and mastectomy was performed. Histological examination of the surgical specimen revealed angiosarcoma.</p></sec><sec><title>Discussion</title><p>In this case, angiosarcoma occurred after radiation on a non-operated breast. Preoperative diagnosis was not achieved even with two cytology specimen and one biopsy. Each showed only fibrosis and inflammatory changes. The background breast tissue inflammation should have been caused by radiation. Marked fibrosis and the rather small number of sarcoma cells in the breast tumor in this case may be why bioptic diagnosis was difficult. Kaplan-Meier analysis of 60 Japanese breast angiosarcoma patients showed significantly better prognosis in patients with a tumor 2 cm or smaller.</p></sec><sec><title>Conclusion</title><p>Angiosarcoma may occur in the non-operated breast, post irradiation. The potential difficulties of diagnosing angiosarcoma against background fibrosis should be kept in mind. Initial radical surgery currently represents the only effective treatment for improving survival in these patients.</p></sec></abstract><kwd-group id="kwd0005"><title>Abbreviation</title><kwd>FNAC, fine needle aspiration cytology</kwd></kwd-group><kwd-group id="kwd0010"><title>Keywords</title><kwd>Angiosarcoma</kwd><kwd>Radiation therapy</kwd><kwd>Breast surgery</kwd><kwd>Breast cancer</kwd><kwd>Occult breast cancer</kwd></kwd-group></article-meta></front><body><sec id="sec0005"><label>1</label><title>Introduction</title><p>Angiosarcoma represents less than 1% of soft-tissue sarcomas <xref rid="bib0005" ref-type="bibr">[1]</xref>. Angiosarcoma of the breast, which represents 0.04% of breast malignancies, can be divided into primary and secondary angiosarcoma. Factors that predispose individuals toward secondary angiosarcoma include radiotherapy, Stewart-Treves syndrome and chronic lymphedema <xref rid="bib0010" ref-type="bibr">[2]</xref>. Radiation-induced angiosarcoma is being reported with increasing frequency. Most cases occur in the setting of breast-conserving therapy and subsequent radiotherapy <xref rid="bib0005" ref-type="bibr">[1]</xref>. However, there has been no report about angiosarcoma after irradiation on a non-operated breast. Also, despite the generally poor prognosis of angiosarcoma, our case is disease free 6 years post-operation.</p></sec><sec id="sec0010"><label>2</label><title>Case report</title><p>A 73-year-old woman received fine needle aspiration cytology (FNAC) for a swelling left axillary lymph node in November 2001. FNAC showed metastatic carcinoma, and axillary lymph node dissection was performed. As FNAC revealed lymph node metastasis, sentinel lymph node biopsy was unnecessary. The diagnosis was comedo carcinoma, estrogen and progesterone receptor negative, and HER2/neu positive. As the primary disease could not be identified on radiological examination, occult breast cancer was suspected. Postoperatively, she received 3 courses of cyclophosphamide, epirubicin and 5-fluorouracil, with subsequent irradiation (50 Gy) to the left breast. We have also proposed the choice of mastectomy, which the patient refused.</p><p>In November 2007, ultrasonographic study showed a hypoechoic area in the left breast. Core needle biopsy revealed inflammatory pseudotumor.</p><p>Then, in May 2009, she complained of skin-thickening and crust formation at the left areola. Mammography revealed skin-thickening and distortion around the left nipple (<xref rid="fig0005" ref-type="fig">Fig. 1</xref>). Ultrasonography showed the hypoechoic area recognized in 2007, with thickening of the overlying skin on the left nipple. Magnetic resonance imaging showed a 3.5 cm mass with irregular margins. It was heterogeneous and hyperintense on T2-weighted imaging, hypointense on T1-weighted imaging, and gradually enhanced in a dynamic study (<xref rid="fig0010" ref-type="fig">Fig. 2</xref>). Marked enhancement was suggestive of malignancy, but the gradual enhancement was inconsistent with common breast malignancies. Computed tomography showed skin thickening and an enhanced area with obscure borders beneath the left nipple.</p><p>From radiological studies, primary breast cancer, recurrence or sarcoma was suspected. Given the clinical history, recurrence was strongly suspected. Even though FNAC, Vacuum-assisted biopsy (VACORA<sup>®</sup>; Bard Biopsy Systems, Tempe, AZ) and skin biopsy specimens were performed, diagnosis of malignant tumor was not obtained.</p><p>However, as skin thickening of the peri-nipple area continued to advance, clinically malignant tumor was suspected. After careful discussion with the patient, informed consent was obtained and simple mastectomy was performed in June 2009.</p><p>Macroscopically, an irregular shaped mass with crust formation and skin-thickening was observed in the areola region of the resected specimen (<xref rid="fig0015" ref-type="fig">Fig. 3</xref>).</p><p>Histopathological examination revealed oval-shaped neoplastic stromal cells arranged in sinusoidal pattern, accompanying mitoses and background fibrosis (<xref rid="fig0020" ref-type="fig">Fig. 4</xref>). The tumor was negative for estrogen, progesterone and HER2/neu receptors. Immunohistochemical staining yielded positive for CD34, vimentin and factor VIII, and negative for cytokeratin. The histological diagnosis was angiosarcoma of the breast.</p><p>Paclitaxel was administered as postoperative chemotherapy. Now, 6 years post-operation (February 2016), the patient is clinically free of disease.</p></sec><sec id="sec0015"><label>3</label><title>Discussion</title><p>Breast angiosarcoma is rare, and primary angiosarcoma of the breast makes up only 0.00005% of all breast malignancies <xref rid="bib0010" ref-type="bibr">[2]</xref>. The frequency of angiosarcoma increases to 0.16% after radiotherapy. This represents an approximately 3200-fold increase in relative risk for patients who undergo breast-conserving surgery <xref rid="bib0015" ref-type="bibr">[3]</xref>.</p><p>Angiosarcoma should thus be considered in any post-radiation patient with skin thickening or mammographic density <xref rid="bib0020" ref-type="bibr">[4]</xref>.</p><p>Angiosarcoma tend to present 5–6 years, after breast-conserving therapy and subsequent radiotherapy <xref rid="bib0025" ref-type="bibr">[5]</xref>.</p><p>According to the recent literature, (1) axillary lymph node detection (ALND) + radiotherapy and (2) ALND + mastectomy are both the treatment of choice in occult breast carcinoma. (1) and (2) have the same survival outcomes <xref rid="bib0030" ref-type="bibr">[6]</xref>, <xref rid="bib0035" ref-type="bibr">[7]</xref>. We would like to point out that one has to keep in mind the possibility of the development of angiosarcoma in the cases that received treatment choice (1).</p><p>The unique feature about this case is the cause of the angiosarcoma. In usual case reports, the patients receive both breast conservation surgery and radiotherapy. In the diagnostic imaging of angiosarcoma in these cases, it is hard to tell whether the back ground fibrosis was caused by surgery and radiotherapy, or the tumor itself. However, in our case, we had performed only radiotherapy, and it is reasonable to consider that angiosarcoma occurred from a radiation scar. This case is valuable in the respect that from its clinical course, rather intense fibrosis occurred in the breast caused by irradiation, and the development of angiosarcoma from the sclerosing breast was confirmed by the interpretation of the resected specimen.</p><p>In the reported cases, preoperative diagnosis of angiosarcoma is usually made by needle biopsy specimen <xref rid="bib0005" ref-type="bibr">[1]</xref>, <xref rid="bib0040" ref-type="bibr">[8]</xref>. However, due to the variety of pathological features, some angiosarcoma cases are misdiagnosed as hemangioma <xref rid="bib0045" ref-type="bibr">[9]</xref>.</p><p>In our case, preoperative diagnosis of angiosarcoma was not achieved even with two cytology specimen and one biopsy. Each showed only fibrosis and inflammatory changes.</p><p>Wijnmaalen et al. reported background breast tissue inflammation caused by radiation in 8 cases of angiosarcoma, also finding fibrosis in 7 (88%) <xref rid="bib0050" ref-type="bibr">[10]</xref>.</p><p>When angiosarcoma occurs against such a background, correct diagnosis may be difficult. Marked fibrosis and the rather small number of sarcoma cells in the breast tumor in the present case may be why bioptic diagnosis was difficult. In this case, the tumor was considered to be high grade from its clinically aggressive nature, and as histology revealed abundant mitosis.</p><p>The potential difficulties of diagnosing angiosarcoma against background fibrosis should be kept in mind, particularly in tumors consisted of rather small number of angiosarcoma cells, and marked fibrosis caused by radiation.</p><p>Concerning treatment, initial radical surgery currently represents the only effective treatment for achieving long-term survival in angiosarcoma patients <xref rid="bib0040" ref-type="bibr">[8]</xref>.</p><p>Other reports have indicated that hyperfractionated radiotherapy of secondary high-grade angiosarcoma has resulted in reduced cell repopulation <xref rid="bib0055" ref-type="bibr">[11]</xref>.</p><p>Adjuvant chemotherapy, paclitaxel for example, may also reduce the local recurrence rate <xref rid="bib0005" ref-type="bibr">[1]</xref>. In the present case, paclitaxel was performed.</p><p>Angiosarcoma has a poor prognosis, and median overall survival is 22–37 months <xref rid="bib0015" ref-type="bibr">[3]</xref>. Vorburger et al. reported that tumors 5 cm or smaller in diameter have a better prognosis than those larger than 5 cm <xref rid="bib0060" ref-type="bibr">[12]</xref>.</p><p>The clinicopathologic features of 60 reported Japanese angiosarcoma cases were reviewed. The relation between tumor diameter and prognosis was analyzed by Kaplan-Meier method (SPSS<sup>®</sup>; IBM, Armonk, NY).</p><p>The mean observation period was 22.7 months (2–84 months), the mean age was 41.5 years old (18–87). Mean tumor diameter was 7.8 cm (0.7–26 cm). The operations performed were mastectomy in 54 cases (90.0%), partial mastectomy in 6 cases (10.0%). Axillary dissection was performed in 28 cases (46.7%), but there were no lymph node metastasis. Distant metastasis was found in 32 (53.3%) cases (<xref rid="tbl0005" ref-type="table">Table 1</xref>). Kaplan-Meier analysis showed significantly better prognosis in patients with a tumor 2 cm or smaller in diameter (p = 0.0457) <xref rid="bib0065" ref-type="bibr">[13]</xref>.</p></sec><sec id="sec0020"><title>Conflict of interest</title><p>None.</p></sec><sec id="sec0025"><title>Funding</title><p>None.</p></sec><sec id="sec0030"><title>Ethical approval</title><p>This study has been approved by the ethics committee (Ethics and Compliance Committee of Shizuoka Saiseikai General Hospital). Reference No. 27-17-01.</p></sec><sec id="sec0035"><title>Consent</title><p>Written informed consent was obtained from the patient for publication of this case report and accompanying images. I can provide this should the Editor ask to see it.</p></sec><sec id="sec0040"><title>Author contribution</title><p>Takaaki Ito and Kenichiro Tanaka: study concept or design, writing the paper, operating surgeon.</p><p>Kiyoshi Suzumura: data analysis or interpretation, operating surgeon.</p><p>Shouji Hoshi: histological examination.</p><p>Yoshichika Okamoto, Koji Oda and Masaki Terasaki: study concept or design, critical revision.</p></sec><sec id="sec0045"><title>Guarantor</title><p>Takaaki Ito, Kenichiro Tanaka.</p></sec></body><back><ref-list><title>References</title><ref id="bib0005"><label>1</label><element-citation publication-type="journal" id="sbref0005"><person-group person-group-type="author"><name><surname>Monroe</surname><given-names>A.T.</given-names></name><name><surname>Feigenberg</surname><given-names>S.J.</given-names></name><name><surname>Mendenhall</surname><given-names>N.P.</given-names></name></person-group><article-title>Angiosarcoma after breast-conserving therapy</article-title><source>Cancer</source><volume>97</volume><issue>8</issue><year>2003</year><fpage>1832</fpage><lpage>1840</lpage><pub-id pub-id-type="pmid">12673708</pub-id></element-citation></ref><ref id="bib0010"><label>2</label><element-citation publication-type="journal" id="sbref0010"><person-group person-group-type="author"><name><surname>Hunter</surname><given-names>T.B.</given-names></name><name><surname>Martin</surname><given-names>P.C.</given-names></name><name><surname>Dietzen</surname><given-names>C.D.</given-names></name><name><surname>Tyler</surname><given-names>L.T.</given-names></name></person-group><article-title>Angiosarcoma of the breast. 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Jpn. Surg. Assoc.</source><volume>69</volume><year>2008</year><fpage>302</fpage><lpage>307</lpage></element-citation></ref></ref-list></back><floats-group><fig id="fig0005"><label>Fig. 1</label><caption><p>Mammography.</p><p>Mediolateral oblique view revealing skin thickening and distortion around the left nipple (arrow). No tumor or calcification is apparent.</p></caption><alt-text id="at0040">Fig. 1</alt-text><graphic xlink:href="gr1"></graphic></fig><fig id="fig0010"><label>Fig. 2</label><caption><p>Magnetic resonance imaging.</p><p>A mass with irregular margins. The mass shows heterogeneous hyperintensity on T2-weighted imaging (A), and hypointensity on T1-weighted imaging (B). Contrast-enhanced T1-weighted imaging shows enhancement of the mass (C).</p></caption><alt-text id="at0045">Fig. 2</alt-text><graphic xlink:href="gr2"></graphic></fig><fig id="fig0015"><label>Fig. 3</label><caption><p>Pathology (gross).</p><p>(A) The resected specimen, showing an irregular mass accompanied by crust formation and skin thickening at the areola (arrows). (B) Cross-section of the specimen (vertical arrow in A). A brownish irregular mass leading into the skin thickening is seen beneath the nipple.</p></caption><alt-text id="at0050">Fig. 3</alt-text><graphic xlink:href="gr3"></graphic></fig><fig id="fig0020"><label>Fig. 4</label><caption><p>Pathology (microscopy).</p><p>Microscopic examination of the surgically resected specimen, revealing oval-shaped cells arranged in the form of endovascular cells, accompanied by mitosis and background fibrosis.</p></caption><alt-text id="at0055">Fig. 4</alt-text><graphic xlink:href="gr4"></graphic></fig><table-wrap id="tbl0005" position="float"><label>Table 1</label><caption><p>Clinicopathologic features of 60 Japanese angiosarcoma cases.</p></caption><alt-text id="at0060">Table 1</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left">Author</th><th align="left">Year</th><th align="left">Age of patient at diagnosis</th><th align="left">Tumor diameter at diagnosis</th><th align="left">Operative method</th><th align="left">Site of recurrence</th><th align="left">Observation period (Months)</th><th align="left">Outcome</th></tr></thead><tbody><tr><td align="left">Sakaguchi</td><td align="left">1932</td><td align="left">27</td><td align="left">16</td><td align="left">Mastectomy</td><td align="left">Surgical site, Contralateral breast, Bilateral ovary</td><td align="left">37</td><td align="left">Dead</td></tr><tr><td align="left">Ishizuka/Watanabe</td><td align="left">1965/1974</td><td align="left">52</td><td align="left">12</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Lung, Bone</td><td align="left">51</td><td align="left">Dead</td></tr><tr><td align="left">Tanaka/Hamazaki</td><td align="left">1971/1978</td><td align="left">22</td><td align="left">13</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Surgical site, Lung, Liver</td><td align="left">37</td><td align="left">Dead</td></tr><tr><td align="left">Watanabe</td><td align="left">1973</td><td align="left">51</td><td align="left">3</td><td align="left">Mastectomy</td><td align="left">Stomach, Lung, Pharynx, Uterine Cervix, Chest wall</td><td align="left">14</td><td align="left">Dead</td></tr><tr><td align="left">Kunii</td><td align="left">1982</td><td align="left">42</td><td align="left">1</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">11</td><td align="left">Alive</td></tr><tr><td align="left">Koike</td><td align="left">1982</td><td align="left">21</td><td align="left">7.2</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Surgical site, Chest wall</td><td align="left">24</td><td align="left">Dead</td></tr><tr><td align="left">Shikama</td><td align="left">1986</td><td align="left">28</td><td align="left">18</td><td align="left">Mastectomy</td><td align="left">Contralateral breast, Bone, Lung, Bilateral ovary</td><td align="left">15</td><td align="left">Dead</td></tr><tr><td align="left">Sakuma</td><td align="left">1987</td><td align="left">19</td><td align="left">22</td><td align="left">Mastectomy</td><td align="left">Surgical site, Contralateral breast, Chest wall</td><td align="left">30</td><td align="left">Alive</td></tr><tr><td align="left">Yamashina</td><td align="left">1987</td><td align="left">71</td><td align="left">16</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Lung</td><td align="left">6</td><td align="left">Alive</td></tr><tr><td align="left">Tamura</td><td align="left">1987</td><td align="left">24</td><td align="left">9</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">26</td><td align="left">Alive</td></tr><tr><td align="left">Kawazu</td><td align="left">1988</td><td align="left">42</td><td align="left">7.3</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Skin</td><td align="left">12</td><td align="left">Alive</td></tr><tr><td align="left">Matoba/Shou</td><td align="left">1988</td><td align="left">25</td><td align="left">16</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Surgical site, Skin, Bilateral ovary</td><td align="left">27</td><td align="left">Alive</td></tr><tr><td align="left">Iseki</td><td align="left">1989</td><td align="left">60</td><td align="left">1.3</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">8</td><td align="left">Alive</td></tr><tr><td align="left">Yokoyama</td><td align="left">1990</td><td align="left">33</td><td align="left">9</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Surgical site, Skin</td><td align="left">21</td><td align="left">Alive</td></tr><tr><td align="left">Ishikawa</td><td align="left">1990</td><td align="left">26</td><td align="left">20</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Lung, Skin</td><td align="left">5</td><td align="left">Dead</td></tr><tr><td align="left">Nagahara</td><td align="left">1993</td><td align="left">19</td><td align="left">8</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Lung, Bone, Liver, Skin</td><td align="left">10</td><td align="left">Dead</td></tr><tr><td align="left">Okanobu</td><td align="left">1994</td><td align="left">34</td><td align="left">1.3</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">18</td><td align="left">Alive</td></tr><tr><td align="left">Hayashi</td><td align="left">1994</td><td align="left">52</td><td align="left">9</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Lung</td><td align="left">2.5</td><td align="left">Dead</td></tr><tr><td align="left">Hakata</td><td align="left">1995</td><td align="left">43</td><td align="left">1</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Skin</td><td align="left">15</td><td align="left">Alive</td></tr><tr><td align="left">Nakano</td><td align="left">1995</td><td align="left">82</td><td align="left">2</td><td align="left">Mastectomy</td><td align="left">Lung, Bone, Liver, Skin</td><td align="left">3</td><td align="left">Dead</td></tr><tr><td align="left">Ishizawa</td><td align="left">1995</td><td align="left">38</td><td align="left">4</td><td align="left">Lumpectomy</td><td align="left">Residual Breast, Liver</td><td align="left">39</td><td align="left">Dead</td></tr><tr><td align="left">Tachibana</td><td align="left">1996</td><td align="left">24</td><td align="left">10</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">10</td><td align="left">Alive</td></tr><tr><td align="left">Nagasawa</td><td align="left">1997</td><td align="left">64</td><td align="left">2</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">10</td><td align="left">Alive</td></tr><tr><td align="left">Murakawa</td><td align="left">1997</td><td align="left">46</td><td align="left">1.7</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">60</td><td align="left">Alive</td></tr><tr><td align="left">Michigami</td><td align="left">1997</td><td align="left">24</td><td align="left">10</td><td align="left">Lumpectomy</td><td align="left">Surgical site, Skin, Contralateral breast</td><td align="left">12</td><td align="left">Alive</td></tr><tr><td align="left">Kagawa</td><td align="left">1997</td><td align="left">35</td><td align="left">5.5</td><td align="left">Lumpectomy</td><td align="left">Surgical site, Skin, Chest wall, Lung, Mediastinum, Digestive tract, Thyroid, Kidney, Adrenal gland, Ovary, Gall bladder, Spleen, Bone</td><td align="left">6</td><td align="left">Dead</td></tr><tr><td align="left">Takanashi</td><td align="left">1997</td><td align="left">32</td><td align="left">10</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Head skin, Ovary, Lung, Liver</td><td align="left">8</td><td align="left">Dead</td></tr><tr><td align="left">Takanashi</td><td align="left">1997</td><td align="left">25</td><td align="left">15</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Ovary, Bone, Liver, Pelvis</td><td align="left">34</td><td align="left">Dead</td></tr><tr><td align="left">Shichinohe</td><td align="left">1998</td><td align="left">34</td><td align="left">0.7</td><td align="left">Partial mastectomy + Axillary dissectionn</td><td align="left">None</td><td align="left">60</td><td align="left">Alive</td></tr><tr><td align="left">Kiyono T</td><td align="left">1998</td><td align="left">64</td><td align="left">26</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">84</td><td align="left">Alive</td></tr><tr><td align="left">Yamamoto</td><td align="left">1998</td><td align="left">24</td><td align="left">6</td><td align="left">Mastectomy</td><td align="left">Ipsilateral breast, Lung, Liver, Bone</td><td align="left">29</td><td align="left">Dead</td></tr><tr><td align="left">Tanaka</td><td align="left">1999</td><td align="left">26</td><td align="left">8</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">12</td><td align="left">Alive</td></tr><tr><td align="left">Yamada</td><td align="left">1999</td><td align="left">42</td><td align="left">6</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Contralateral breast, Lung, Liver, Adrenal gland, Bone</td><td align="left">15</td><td align="left">Dead</td></tr><tr><td align="left">Yoshida</td><td align="left">2000</td><td align="left">41</td><td align="left">1.5</td><td align="left">Partial mastectomy + Axillary dissectionn</td><td align="left">None</td><td align="left">60</td><td align="left">Alive</td></tr><tr><td align="left">Abe</td><td align="left">2000</td><td align="left">79</td><td align="left">2</td><td align="left">Mastectomy</td><td align="left">Subcutaneous fat of ipsilateral breast</td><td align="left">6</td><td align="left">Alive</td></tr><tr><td align="left">Ueki</td><td align="left">2000</td><td align="left">19</td><td align="left">1.5</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">30</td><td align="left">Alive</td></tr><tr><td align="left">Tsumagari K</td><td align="left">2000</td><td align="left">52</td><td align="left">6</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">9</td><td align="left">Alive</td></tr><tr><td align="left">Tsumagari K</td><td align="left">2000</td><td align="left">26</td><td align="left">11</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">18</td><td align="left">Alive</td></tr><tr><td align="left">Tsumagari K</td><td align="left">2000</td><td align="left">19</td><td align="left">9</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">Bone, Liver, Lung, Brain, Surgical site, Nasal cavity</td><td align="left">27</td><td align="left">Dead</td></tr><tr><td align="left">Kitamura</td><td align="left">2001</td><td align="left">46</td><td align="left">Hand fist size</td><td align="left">Mastectomy</td><td align="left">Skin, Liver, Lung</td><td align="left">24</td><td align="left">Dead</td></tr><tr><td align="left">Fujisawa</td><td align="left">2003</td><td align="left">65</td><td align="left">5</td><td align="left">Mastectomy</td><td align="left">Lung, Skin</td><td align="left">16</td><td align="left">Alive</td></tr><tr><td align="left">Nishiyama</td><td align="left">2003</td><td align="left">18</td><td align="left">14</td><td align="left">Mastectomy</td><td align="left">Surgical site, Lung, Liver</td><td align="left">9</td><td align="left">Dead</td></tr><tr><td align="left">Nakayama</td><td align="left">2004</td><td align="left">40</td><td align="left">3</td><td align="left">Mastectomy</td><td align="left">Contralateral breast</td><td align="left">51</td><td align="left">Alive</td></tr><tr><td align="left">Nakata</td><td align="left">2004</td><td align="left">51</td><td align="left">8</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">16</td><td align="left">Alive</td></tr><tr><td align="left">Yoneyama</td><td align="left">2005</td><td align="left">32</td><td align="left">5.5</td><td align="left">Mastectomy + Axillary dissection</td><td align="left">None</td><td align="left">72</td><td align="left">Alive</td></tr><tr><td align="left">Sadashima</td><td align="left">2007</td><td align="left">60</td><td align="left">2</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">12</td><td align="left">Alive</td></tr><tr><td align="left">Ueda S</td><td align="left">2008</td><td align="left">28</td><td align="left">7</td><td align="left">Mastectomy</td><td align="left">Bone</td><td align="left">6</td><td align="left">Alive</td></tr><tr><td align="left">Yoshida C</td><td align="left">2008</td><td align="left">38</td><td align="left">9</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">2</td><td align="left">Alive</td></tr><tr><td align="left">Ueda S</td><td align="left">2008</td><td align="left">44</td><td align="left">4</td><td align="left">Mastectomy</td><td align="left">Bilateral breast, Bilateral ovary, Bone, Lung, Liver</td><td align="left">41</td><td align="left">Dead</td></tr><tr><td align="left">Sakamoto M</td><td align="left">2009</td><td align="left">32</td><td align="left">8</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">4</td><td align="left">Alive</td></tr><tr><td align="left">Takenaka M</td><td align="left">2009</td><td align="left">87</td><td align="left">11</td><td align="left">Mastectomy</td><td align="left">Lung</td><td align="left">2</td><td align="left">Dead</td></tr><tr><td align="left">Miyasaka M</td><td align="left">2010</td><td align="left">59</td><td align="left">12</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">17</td><td align="left">Alive</td></tr><tr><td align="left">Komatsu M</td><td align="left">2010</td><td align="left">54</td><td align="left">5.5</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">2</td><td align="left">Alive</td></tr><tr><td align="left">Oda T</td><td align="left">2011</td><td align="left">27</td><td align="left">5</td><td align="left">Mastectomy + Tissue expander</td><td align="left">Ovary, Bone, Liver, Pelvis</td><td align="left">3</td><td align="left">Alive</td></tr><tr><td align="left">Satou F</td><td align="left">2011</td><td align="left">61</td><td align="left">10</td><td align="left">Partial mastectomy + sentinel lymph node biopsy</td><td align="left">Ovary, Bone, Liver, Pelvis</td><td align="left">14</td><td align="left">Alive</td></tr><tr><td align="left">Hosono Y</td><td align="left">2011</td><td align="left">47</td><td align="left">3.2</td><td align="left">Mastectomy + Sentinel lymph node biopsy</td><td align="left">Lung, Liver</td><td align="left">29</td><td align="left">Dead</td></tr><tr><td align="left">Hoskimoto N</td><td align="left">2012</td><td align="left">27</td><td align="left">7</td><td align="left">Mastectomy</td><td align="left">Skin</td><td align="left">40</td><td align="left">Alive</td></tr><tr><td align="left">Okaminami Y</td><td align="left">2013</td><td align="left">33</td><td align="left">5</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">42</td><td align="left">Alive</td></tr><tr><td align="left">Mizumoto S</td><td align="left">2014</td><td align="left">78</td><td align="left">16</td><td align="left">Mastectomy + lymph node sampling</td><td align="left">Rt knee, pleura</td><td align="left">13</td><td align="left">Dead</td></tr><tr><td align="left">Our case</td><td align="left">2015</td><td align="left">73</td><td align="left">3.5</td><td align="left">Mastectomy</td><td align="left">None</td><td align="left">60</td><td align="left">Alive</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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