Recurrent radiogenic angiosarcoma of the breast: a rare case report

Post-radiation angiosarcoma of the breast is a rare but aggressive vascular malignancy that can develop as a late complication of radiotherapy for breast cancer. It is associated with a risk of local recurrence and a poor prognosis.

Herein, we describe a case of an 80-year-old postmenopausal woman with a prior history of stage IIIC left breast invasive ductal carcinoma, treated with lumpectomy, axillary dissection, radiotherapy, and endocrine therapy. Several years after treatment, she presented with a painless, superficial brown skin lesion over the irradiated breast. Histopathological examination and immunohistochemical analysis confirmed high-grade angiosarcoma with epithelioid features. Staging investigations showed no distant metastatic disease, and the patient underwent a left simple mastectomy. During follow-up, she developed recurrent disease, presenting as cutaneous and chest wall lesions, both confirmed histologically as recurrent angiosarcoma. The patient subsequently underwent wide local excision with rotational flap reconstruction for local recurrence. The patient is currently under regular follow-up with no further recurrence or active complaints.

Radiogenic breast angiosarcoma is an uncommon cancer, and while various studies have documented its clinical features and treatment, few have specifically addressed recurrent instances. Our case demonstrates the clinical course of recurrent post-radiation angiosarcoma and the difficulty in achieving local disease control following several surgical treatments.

This report highlights the prognosis, treatment, and clinical presentation of recurrent breast radiogenic angiosarcoma. Clinicians should maintain a high index of suspicion in previously irradiated patients presenting with new or progressive skin changes.