Primary and secondary angiosarcoma: a case report

Abstract

Introduction: Angiosarcoma is a rare malignant vascular neoplasm belonging to the sarcoma group. It is a highly infiltrative tumor with a high local recurrence rate and hematogenous metastasis. Objective: To report a case in order to
analyze the treatment of a rare malignant vascular neoplasm. Methods: This is a case report based on a retrospective
analysis of the medical records of a patient treated at the mastolgy outpatient clinic of Hospital Barão de Lucena in Recife,
Pernambuco. Results: The patient is F.S.A, a 43-year-old female, from Ribeirão, Pernambuco, menarche at 11 years old, G1P1,
with no family history of breast cancer. She was referred to the mastology outpatient clinic at Hospital Barão de Lucena
due to a tumor in the left breast in 2020. Ultrasound revealed simple cysts in both breasts and a lipoma in the left breast
at 11 o’clock, measuring 2.4x1.0x2.2 cm, classified as Breast Imaging Reporting and Data System (BI-RADS) 4. Core biopsy
revealed a vascular and spindle cell lesion with mild nuclear atypia and compromised margins. Immunohistochemistry
was conducted, revealing CD34 and CD31 antibodies and 10% Ki-67 expression. A radical left mastectomy with reconstruction using a lipo-grafted latissimus dorsi flap was performed. After surgery, the patient underwent chemotherapy
and radiotherapy as adjuvant therapy. The patient returned on January 29, 2024 for a follow-up visit, reporting a skin discoloration between the skin and the latissimus dorsi muscle flap in the sternal region. A histopathological examination
was requested, which confirmed a well-differentiated angiosarcoma. A left segmental mastectomy was performed with
immediate reconstruction using an inferior pedicle flap. Conclusion: Although radiotherapy is a secondary risk factor
for angiosarcoma, it remains an important form of adjuvant treatment. Surgery is the best option in this case.