Radiation-induced breast angiosarcoma associated with germline BRCA1 mutation: a case report

Resumo

Radiation-induced breast angiosarcoma (RIAS) is a rare, aggressive vascular neoplasm associated with prior radiotherapy, usually diagnosed at a late stage and with poor prognosis. This is the case of a 65-year-old female patient with a history of multiple cancers and a germline mutation in BRCA1, who developed RIAS. At age 57, she was diagnosed with triple-negative right breast carcinoma and underwent neoadjuvant chemotherapy, breast-conserving surgery, and adjuvant radiotherapy. With a positive BRCA1 panel, at age 61, the patient underwent a risk-reducing bilateral mastectomy. Approximately four months after surgery, rapidly progressing purplish lesions appeared on the right hemithorax, adjacent to the surgical scar. The biopsy, initially performed to investigate cancer recurrence, confirmed the diagnosis of breast angiosarcoma associated with previous radiotherapy (c-MYC positive). The staging computed tomography scan revealed extensive dermal infiltration, rendering surgical treatment unfeasible, thus leading to the recommendation for palliative management with radiotherapy and adjuvant chemotherapy with docetaxel and gemcitabine.