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Suzuki, Yoko Department of Breast and Endocrine surgery in Okayama University Japan Hospital ORCID
Taniguchi, Kohei Department of Pathological diagnosis, Okayama University Japan Hospital
Hatono, Minami Department of Breast and Endocrine surgery in Okayama University Japan Hospital
Kajiwara, Yukiko Department of Breast and Endocrine surgery in Okayama University Japan Hospital
Abe, Yuko Department of Breast and Endocrine surgery in Okayama University Japan Hospital
Kawada, Kengo Department of Breast and Endocrine surgery in Okayama University Japan Hospital
Tsukioki, Takahiro Department of Breast and Endocrine surgery in Okayama University Japan Hospital
Kochi, Mariko Department of Breast and Endocrine surgery in Okayama University Japan Hospital
Nishiyama, Keiko Department of Breast and Endocrine surgery in Okayama University Japan Hospital
Iwamoto, Takayuki Department of Breast and Endocrine surgery in Okayama University Japan Hospital Kaken ID researchmap
Ikeda, Hirokuni Department of Breast and Endocrine surgery in Okayama University Japan Hospital
Shien, Tadahiko Department of Breast and Endocrine surgery in Okayama University Japan Hospital ORCID Kaken ID publons researchmap
Taira, Naruto Department of Breast and Endocrine surgery in Okayama University Japan Hospital Kaken ID publons
Tabata, Masahiro Department of Hematology, Oncology, Respiratory, and Allergy Medicine, Okayama University Japan Hospital
Yanai, Hiroyuki Department of Pathological diagnosis, Okayama University Japan Hospital
Doihara, Hiroyoshi Department of Breast and Endocrine surgery in Okayama University Japan Hospital
Abstract
Background Angiosarcoma of the breast is very rare and can be divided into primary and secondary angiosarcoma. Radiation-induced angiosarcoma (RIAS) is classified as secondary angiosarcoma. Diagnosis of RIAS is difficult due to its rarity, and the interpretation of pathological imaging is complicated. In the National Comprehensive Care Network (NCCN) guidelines, the first choice of treatment is surgery with negative margins. Adjuvant radiotherapy (RT) for close soft tissue margins should be considered. Preoperative or adjuvant chemotherapy of nonmetastatic disease is not recommended for angiosarcoma. We report a case of RIAS, which was impossible to diagnose with core needle biopsy (CNB) but was diagnosed by excisional biopsy. The patient was then administered adjuvant chemotherapy using conjugated paclitaxel (PTX).
Case presentation A 62-year-old woman noticed a tumor in her right breast. She had a history of right breast cancer and had undergone breast-conserving surgery, RT, and tamoxifen therapy 8 years previously. CNB, which was performed twice, was inconclusive. The tumor was surgically excised and pathological analysis yielded a diagnosis of angiosarcoma. She then underwent a right mastectomy. One month after she underwent right mastectomy, a nodule reappeared on the skin of her right breast, and excisional biopsy revealed recurrence of angiosarcoma. A few weeks later another nodule reappeared near the post-operative scar and excisional biopsy revealed recurrence of angiosarcoma. We assumed that surgical therapy was insufficient because the patient experienced relapse of angiosarcoma after complete mastectomy. After the second recurrence, we treated her with systemic chemotherapy using PTX. There was no evidence of recurrence 8 months after chemotherapy.
Conclusion Although angiosarcoma is difficult to diagnose, many patients have a poor prognosis. Therefore, prompt treatment intervention is desired. Moreover, there is little evidence regarding adjuvant therapy of angiosarcoma since it is a rare disease. We consider that adjuvant therapy helped to effectively prevent recurrence in the patient after complete excision.
Keywords
Radiation-induced angiosarcoma
Radiotherapy
Breast-conserving surgery
Breast cancer
Paclitaxel therapy
Adjuvant therapy of angiosarcoma
Published Date
2020-01-16
Publication Title
Surgical Case Reports
Volume
volume6
Issue
issue1
Publisher
SpringerOpen
Start Page
25
ISSN
2198-7793
Content Type
Journal Article
language
英語
OAI-PMH Set
岡山大学
Copyright Holders
© The Author(s). 2020
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DOI
Web of Science KeyUT
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isVersionOf https://doi.org/10.1186/s40792-020-0790-7
License
http://creativecommons.org/licenses/by/4.0/