By vgreene, 5 January, 2021

resp

(BMJ)—A woman in her late 50s presented w/ a 2-mo hx of progressive bruising on her L breast. Eight years prior, she had undergone L wide local excision for a grade II, triple-negative invasive ductal CA. She also received chemo and radiation tx. Exam: multiple purple, fragile lesions w/ bleeding, as well as thickened skin, extending toward the back. What’s the dx?
Chronic radiation tx changes
Angiosarcoma
Benign lymphangiomatous papule
Recurrent invasive ductal carcinoma
Domestic violence
You are correct. Radiotherapy-induced angiosarcoma is a known risk of radiation tx, w/ a reported incidence of 0.09% to 0.3%. The condition might present w/ palpable purple masses, a purplish skin rash, diffuse breast enlargement, and/or skin thickening. Sx can be mistaken for simple bruising or skin changes caused by radiation tx, which can delay dx. If radiotherapy-induced angiosarcoma is suspected, urgent referral to a breast clinic (w/in 2wk) is warranted. Bx, MRI, PET-CT, and ultrasound bx for any suspicious lymph nodes are required. Mainstay of tx is complete surgical excision (w/ clear margins), ideally w/in a month of dx.

This pt had an MRI to confirm the extent of the lesion, followed by resection. At 1-mo f/u, her skin graft and wounds had healed well, and no evidence of distant metastases was found on repeat PET-CT 2mo after surgery. She remains on active surveillance.

BMJ 2020;371:m4179