A Case Report of Primary Breast Angiosarcoma
Respected JRCR editors, I hereby apply for invitation to submit the case to the Journal of Radiology Case Reports. History: A 31-year-old unmarried female presented with gradual increase in right breast size over a period of one year. On clinical examination, no discrete palpable mass was seen. Imaging: Ultrasonography of the breast was performed first which showed multiple hypoechoic non-vascular tubular lesions (Figures 1,2) and oedema (Figure 3) predominantly in upper quadrant of the right breast. Digital mammography (Figures 4,5) with 3D tomosynthesis depicted only trabecular thickening. Contrast enhanced MRI (Figure 6) was performed to map extent of the disease which showed extensive non-mass enhancement in entire right breast predominantly in the upper quadrant. The disease was labelled as BIRADS IV and subjected to trucut biopsy from multiple sites. Pathology: Histopathological analysis showed features of capillary cavernous haemangioma. Considering large size & indistinct margins of lesion, the tissue block was sent for second opinion. It was interpreted as well differentiated angiosarcoma (Figures 7,8). On immunohistochemistry, cells were positive for CD31 and CD34. Surgery: The patient underwent right radical mastectomy. Final histopathology showed intermediate grade(II) angiosarcoma. Tumour was composed of predominantly low-grade capillary component with anastomosing neoplastic vascular channels irregularly infiltrating fat and lobules. Ki 67 was 40% in cellular areas. Take Home Message: Radiological as well as pathological misdiagnosis of breast angiosarcoma is common. It is important to maintain a high index of suspicion for this rare and highly aggressive breast malignancy in young patients presenting with non-specific imaging features to aid in its early diagnosis.