Hildebrandt G, Mittag M, Gütz U, Kunze M L, Haustein U F
Departments of Radiotherapy and Radiooncology, University of Leipzig, Stephanstrasse 11, 04103 Leipzig, Germany.
Eur J Dermatol. 2001 Nov-Dec;11(6):580-3.
Cutaneous angiosarcoma is a rare malignancy that sometimes occurs as a late sequela of breast conservation therapy. We report on a 79-year-old female who developed well-differentiated angiosarcoma in a lymphedematous left breast 5.5 years after surgery and radiotherapy for early invasive ductal breast cancer. The initial appearance was very similar to late radiation dermatitis, and histologically interpreted as scar tissue with atypical vascular lesion. The lesion progressed further, and was clinically suspicious for angiosarcoma. Thus, a second biopsy was taken which confirmed the diagnosis. A complete mastectomy removed all the tumor with clear margins. However, within a period of 16 months she presented four local recurrences which were treated by wide local excision. At present, the patient is free of locally recurrent tumour for 7 months. The few cases of breast angiosarcoma after breast conservation therapy reported so far demonstrate that these lesions are difficult to diagnose due to their rarity and their highly variable and benign appearance, which sometimes may mimic radiation-induced cutaneous changes. Since chronic lymphedema possibly contributes to the development of angiosarcoma, long-term clinical surveillance of these patients is recommended. Biopsies should be taken if new skin lesions occur.
皮肤血管肉瘤是一种罕见的恶性肿瘤，有时作为保乳治疗的晚期后遗症出现。我们报告一例79岁女性，在早期浸润性导管乳腺癌手术及放疗5.5年后，左乳淋巴水肿处发生了高分化血管肉瘤。最初表现与晚期放射性皮炎非常相似，组织学上被解释为伴有非典型血管病变的瘢痕组织。病变进一步发展，临床上怀疑为血管肉瘤。因此，进行了第二次活检，确诊为血管肉瘤。完整的乳房切除术切除了所有肿瘤，切缘清晰。然而，在16个月内她出现了4次局部复发，均通过广泛局部切除进行治疗。目前，患者已无局部复发病灶7个月。迄今为止报道的少数保乳治疗后发生乳房血管肉瘤的病例表明，由于这些病变罕见且外观高度可变且呈良性，有时可能模仿辐射引起的皮肤变化，因此难以诊断。由于慢性淋巴水肿可能促成血管肉瘤的发生，建议对这些患者进行长期临床监测。如果出现新的皮肤病变，应进行活检。
