Sporadic Cutaneous Angiosarcomas: A Proposal for Risk Stratification Based on 69 Cases.
Am J Surg Pathol. 2008 Jan
Deyrup AT, McKenney JK, Tighiouart M, Folpe AL, Weiss SW.
*Department of Pathology ‡Department of Biostatistics, Winship Cancer Institute, Emory University, Atlanta GA †Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR §Department of Pathology, The Mayo Clinic, Rochester, MN.
Angiosarcomas have traditionally been considered high-grade lesions for which histologic features and grading have played no role in prognostication and, consequently, they have been excluded from the American Joint Committee on Cancer staging system. We have, therefore, analyzed 69 cutaneous angiosarcomas seen in consultation and not associated with lymphedema or prior radiation therapy to determine if a combination of histologic and clinical parameters could be used to differentiate indolent from aggressive tumors.
The clinical features analyzed included patient age, location, size, depth, and focality of the lesion; the histologic features studied included pattern of growth (vasoformative vs. solid), nuclear grade (high vs. low), necrosis (present/absent), cell type (epithelioid or spindled), extent of inflammatory infiltrate (minimal vs. marked), and mitotic rate. Lesions occurred on the head/neck (49), extremities (15), and trunk (5) of adults (21 to 94 y) and predominated in males (41 males; 28 females). Tumors ranged in size from 0.3 to 15 cm (average 3.1 cm) and involved the papillary (n=9), reticular (n=16), or deep dermis/ subcutis (n=30). They could be predominantly vasoformative to solid (greater than 50% solid, n=41). Most lesions were of high (n=65) as opposed to low (n=4) nuclear grade, were mitotically active (0 to 99/10 high power fields), and occasionally displayed necrosis (n=14) and epithelioid features (n=21). Inflammatory infiltrates were minimal in most cases. Follow-up information was obtained for all patients. Recurrences developed in 18 patients (26%) and metastasis in 15 (22%) to the following sites: lung (6), lymph node (7), liver (2), bone (2), and parotid gland (1). Forty-seven patients died (30 of disease) and 22 were alive at last known follow-up (range, 16 to 158 mo; mean, 65; median, 36).
Five-year disease-specific survival was 48%. By univariate analysis only older age, anatomic site, necrosis, and epithelioid features correlated with increased mortality. Tumors were stratified into low (n=41) or high risk groups based on necrosis and/or epithelioid features. By multivariable analysis, high-risk group (hazard ratio 4.07, P=0.0004) and age >70 (hazard ratio 2.79, P=0.012) were associated with increased mortality, and tumor depth (P=0.048) correlated with the risk of local recurrence. The high-risk group had a significantly worse prognosis than the low-risk group with 3-year survival of 24% and 77%, respectively. No patients with high-risk features survived 5 years.
In conclusion, we report that a combination of clinical and histologic features allows stratification of angiosarcoma patients into 2 risk groups that are strongly associated with marked differences in clinical course. These features seem to diminish in importance with increased tumor size and are probably most useful in tumors less than 5 cm in maximum dimension.
Lippincott Williams & Wilkins, Inc.
http://www.ajsp.com/pt/re/ajsp/abstract ... 29!8091!-1
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Angiosarcoma arising in an unirradiated breast with subsequent pituitary metastasis
Clin Breast Cancer. 2007 Oct
Rozen WM, Mann GB.
Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia. firstname.lastname@example.org
Breast-conserving surgery, Mastectomy, Radiation therapy
Angiosarcoma of the breast is a rare condition with known risk factors. The Stewart-Treves syndrome describes angiosarcoma of the arm or breast in the setting of adjuvant radiation therapy (RT) after breast conservation surgery. Angiosarcoma of the breast, in the absence of RT, is rarer still. We present a unique case of angiosarcoma of the breast, diagnosed 6 years after conservative surgery for carcinoma of the breast when no adjuvant RT was given. Chronic postoperative lymphoedema in the breast delayed the investigation of skin changes, with an eventual diagnosis of angiosarcoma. An isolated pituitary metastasis 9 months from the diagnosis, the first such reported case, adds to the complexity of the case. The diagnosis and management of angiosarcoma of the breast is discussed. Angiosarcoma is a rare occurrence after breast conservative surgery. Postoperative lymphoedema can impede early diagnosis. The disease can display unique metastatic potential.
http://www.cigjournals.com/CIG/c.abs/cl ... icle206768
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Cutaneous angiosarcoma following conservative surgery and radiotherapy for breast carcinoma. A case report
Cesk Patol. 2007 Apr
Kajo K, Lúcan J, Macháleková K, Beratsová Z.
Ustav patologickej anatómie, Jesseniovej lekárskej fakulty, Martinskej fakultnej nemocnice, Martin. email@example.com
Breast angiosarcomas (AS) are very rare neoplasms, which can be divided into primary (or sporadic), and secondary AS, the latter arising either on the base of lymphoedema after mastectomy (so called AS with Stewart-Treves syndrome- ASSTS), or skin AS after breast conservation surgery with subsequent radiotherapy for breast cancer (KPRAS). The authors present a case of a 55-year-old female patient with a 17mm tumour in nipple region, developing 8 years after primary diagnosis of tubulolobular carcinoma of the breast which was treated by breast conservation surgery and radiotherapy. A probatory bioptic examination of the lesion proved well-differentiated KPRAS. The patient underwent mastectomy. The authors analyse the basic clinical and morphological features of KPRAS, which distinguish it from other forms of AS, e.g. occurrence in older age, shorter period of latency after radiation therapy when compared to ASSTS, absence of lymphoedema, and rare involvement of the breast tissue. Prognosis of this entity is very poor; today the most reliable prognostic marker is histological grading. However, it will be needed to assess in the future new indicators of prognosis of patients with this rare disease.
http://www.ncbi.nlm.nih.gov/pubmed/1762 ... d_RVDocSum
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Cutaneous angiosarcoma arising after radiotherapy treatment of a breast carcinoma. Description of a case and review of the literature
Pathologica. 2003 Aug
Di Tommaso L, Fabbri A.
Dipartimento di Oncologia, Sezione di Anatomia Patologica Marcello Malpighi, Ospedale Bellaria, Università di Bologna, via Altura 3, 40139 Bologna. firstname.lastname@example.org
Cutaneous angiosarcomas occurring as a complication of radiation therapy for breast cancer are rare. To the best of our knowledge 37 cases have been reported in English literature during the last two decades. We describe a case of angiosarcoma arising in the skin of a breast previously irradiated for breast carcinoma. The patient, a 74-year-old woman, had been treated with conservative surgery and radiotherapy for a pT1N0 infiltrating ductal carcinoma of the left breast in 1993. Nine years later a skin lesion, which was interpreted as a recurrence, arose in the same site. A biopsy obtained from the lesion, and initially considered to be negative for cancer, showed istological features consistent with those of the atypical vascular lesion. Seven months later the same lesion transformed in a 5 x 3 reddish mass which at histological examination was diagnosed as an high grad post-irradiation angiosarcoma of the skin of the breast. Data on previously reported post iradiation angiosarcoma of the breast are reviewed; further consideration on differential diagnosis between those lesions and atypical vascular lesions are presented.
http://www.ncbi.nlm.nih.gov/pubmed/1457 ... PlusDrugs2
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Arm and Leg Swelling After Cancer
http://www.lymphedemapeople.com/wiki/do ... ter_cancer
Secondary Lymphedema in the cancer patient
http://www.lymphedemapeople.com/phpBB2/ ... php?t=1159
Angiosarcoma and Long Term Lymphedema
http://www.lymphedemapeople.com/phpBB2/ ... .php?t=564
Does Lymphedema Treatment Spread Cancer?
http://www.lymphedemapeople.com/wiki/do ... ead_cancer
Lymphedema After Cancer - How Serious Is It?
http://www.lymphedemapeople.com/wiki/do ... ious_is_it
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