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Post-radiotherapy vascular proliferations in mammary skin: A clinicopathologic study of 11 cases - 19/08/11

Doi : 10.1016/j.jaad.2006.10.025 
Ingerlisa W. Mattoch, MD a, , Jason B. Robbins, MD a, Richard L. Kempson, MD a, Sabine Kohler, MD a, b
a From the Departments of Pathology 
b Dermatology, Stanford University Medical Center 

Correspondence to: Ingerlisa W. Mattoch, MD, Department of Pathology, Stanford University Medical Center, 300 Pasteur Dr, Lane 235, Stanford, CA 94305.

Stanford, California

Abstract

Background

Post-radiotherapy atypical vascular lesions (AVL) in mammary skin show significant clinical and histopathologic overlap with well-differentiated angiosarcoma (AS) and pose a considerable diagnostic and managerial challenge when encountered.

Objective

We review Stanford’s experience with diagnosing AVL and formulate a clinicopathologic approach to these lesions.

Methods

We performed a clinicopathologic study on 11 cases that were initially diagnosed as AVL and examined whether there are specific clinical or histopathologic features that delineate AVLs from well-differentiated AS.

Results

Clinically, all patients were women with a mean age of 68.1 years, had a history of infiltrating breast carcinoma, and were treated by excision with postoperative radiation therapy. All lesions were located in mammary skin within the prior radiation field. The clinical presentation included erythema, telangiectasias, papules, plaques, and nodules. All patients were diagnosed with AVL on initial biopsy. Six patients showed no recurrence or progression of disease following incomplete excision with no further therapy (3/6) or re-excision with negative margins (3/6). The remaining 5 patients were shown to have AS in the re-excision specimen. The patients diagnosed with AS were older and had a shorter interval from radiation as compared to those who did not experience an adverse outcome. Histologically, all initial biopsy specimens were transected and were characterized by complex, anastomosing vascular proliferations with dilated spaces. Each case was morphologically evaluated according to the AVL criteria of Fineberg and Rosen. Three cases met all of the criteria for AVL, and these patients showed no progression of disease. The remaining cases met most but not all diagnostic criteria for AVL and showed some features of AS, but fell short of a definitive diagnosis of AS, including the 5 cases that were subsequently diagnosed as angiosarcoma.

Limitations

This retrospective study utilized a small number of cases from a single consultation service; therefore, some inherent selection bias may exist.

Conclusion

We could not identify unequivocal clinical or histologic criteria that allows for a sharp separation between AVL and AS. Dermatologists and pathologists need to be aware of the overlap between AVL and well-differentiated AS and all patients who receive a diagnosis of AVL should undergo complete excision with close clinical follow-up and biopsy of any new lesions.

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Abbreviations used : AS, AVL, BCTAR, BLAP, HHV


Plan


 Presented in part as a lecture at the 42nd Annual Meeting of the American Society of Dermatopathology, Seattle, WA, October 2005.
Funding sources: None.
Conflicts of interest: None declared.
Reprints not available from the authors.


© 2007  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 57 - N° 1

P. 126-133 - juillet 2007 Retour au numéro
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