A 74-year-old patient presents with a palpable lump in the left breast. She is status post left lumpectomy for infiltrating ductal carcinoma with sequential radiation 16 years ago. A new 2 cm mass is seen within the left breast on mammography as well as on ultrasound. The patient proceeds to have a biopsy of the area. The patient also has a breast magnetic resonance imaging (MRI) to evaluate extent of disease. 


When an angiosarcoma presents in the breast in a patient with prior breast cancer and treatment with surgery and radiation, it is thought that the angiosarcoma may be arising from the breast cancer treatment itself.


Angiosarcomas are a rare type of sarcoma that accounts for <1 percent of all sarcomas. Usually they are found in older patients occurring in the skin of the scalp. Approximately 25 percent of the time they are found in soft tissue of the body, however it is very rare to see them in the breast. They can present in either a primary malignancy or a secondary malignancy. When it is a primary carcinoma, it is typically found in younger patients and involves the breast parenchyma, such as milk ducts and glands that produce milk. When it presents as a secondary carcinoma, it is usually in older women who have a history of breast cancer with radiation to the breast and is cutaneous and multifocal. The occurrence rate of the secondary malignancy is between 0.04– 0.15 percent. 


Biswas T, Tang P, Muhs A, Ling M. Angiosarcoma of the breast: a rare clinicopathological entity.  

Mammography

Ultrasound

74-year-old presents with palpable lump in left breast, status post left lumpectomy for infiltrating ductal carcinoma with sequential radiation 16 years ago.

Image IQ: Palpable Lesion in a Prior Cancer Patient