Case 242: Radiation-induced Angiosarcoma

Area of Science:

• Oncology
• Radiation Oncology
• Dermatology

Background:

• A 59-year-old woman with a history of invasive lobular carcinoma, estrogen and progesterone receptor-positive, underwent partial mastectomy and axillary node dissection.
• She received accelerated partial breast radiation (APBR) in 2005 for a low-grade, small tumor with clear margins and no lymph node involvement.
• Her medical history included hypercholesterolemia and depression, with a family history of breast cancer.

Observation:

• Nine years post-APBR, the patient presented with progressive, painful, pruritic breast fullness, skin dimpling, and discoloration.
• Clinical examination revealed a periareolar ulcerating skin plaque, nipple retraction, and retroareolar aching.
• Imaging studies, including mammography, ultrasonography, and MRI, were performed to evaluate the changes.

Findings:

• Mammography in September 2013 showed stable benign postoperative findings (BI-RADS category 2).
• Physical examination identified a 1-cm periareolar ulcerating plaque and a palpable lumpectomy bed seroma.
• No axillary adenopathy or angiolymphatic invasion was noted, consistent with prior findings.

Implications:

• This case underscores the potential for rare, late-onset complications following accelerated partial breast radiation.
• Long-term surveillance is crucial for patients treated with APBR to detect delayed adverse effects.
• Further research may be needed to understand the pathogenesis and optimal management of such late radiation-induced skin changes.