Fineberg S, Rosen P P
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Am J Clin Pathol. 1994 Dec;102(6):757-63. doi: 10.1093/ajcp/102.6.757.
Despite the widespread use of radiation therapy to treat breast carcinoma, angiosarcomas arising in the field of radiation therapy are rare. The authors studied three patients with cutaneous angiosarcoma and four patients with atypical vascular lesions (AVL). All had breast conserving surgery, axillary lymph node dissection, and radiation therapy for breast carcinoma. Six patients received conventional high energy postoperative doses of external beam radiation therapy to the breast. Details of radiation therapy were not available for one angiosarcoma patient. Angiosarcoma was diagnosed 3.5 years, 3.7 years, and 5.25 years after radiotherapy. The three angiosarcomas were multifocal or diffuse and high grade, with solid cellular foci located mainly in the dermis. In three patients AVL presented as discrete skin nodules (2 unifocal and 1 multifocal) and in one patient as a breast mass. The four AVL consisted of focal proliferation of dilated vascular spaces lined predominantly by a single layer of plump and sometimes hyperchromatic endothelial cells. After two angiosarcoma patients underwent mastectomy, one died 10 months after diagnosis with recurrent local angiosarcoma and the other is alive without angiosarcoma 2 months after diagnosis. One angiosarcoma patient died of unrelated causes 2 weeks after diagnosis. One AVL patient developed a second cutaneous AVL in the axillary region 17 months after excision of an AVL from the same area. None of the AVL patients has developed angiosarcoma or recurrent mammary carcinoma. They remain well 10 months, 18 months, 7 years and 7 months, and 10 years, respectively, after initial local excision. The authors conclude that cutaneous angiosarcoma and unusual benign cutaneous vascular lesions can develop within the field of radiation therapy for breast cancer. Unlike other radiation therapy-induced sarcomas, cutaneous angiosarcoma often occurs within a short time interval after radiotherapy. It is important to distinguish AVL from angiosarcoma. Longer follow-up will be necessary to fully characterize the prognostic importance of atypical vascular lesions, but currently there is no evidence that they represent a precursor to radiation-induced angiosarcoma.
尽管放射治疗在乳腺癌治疗中广泛应用，但放疗区域发生的血管肉瘤却很罕见。作者研究了3例皮肤血管肉瘤患者和4例非典型血管病变（AVL）患者。所有患者均接受了保乳手术、腋窝淋巴结清扫术及乳腺癌放射治疗。6例患者接受了常规的术后高能外照射放疗。有1例血管肉瘤患者的放疗细节不详。血管肉瘤在放疗后3.5年、3.7年和5.25年被诊断出来。这3例血管肉瘤为多灶性或弥漫性且分级高，实性细胞灶主要位于真皮层。3例AVL表现为散在的皮肤结节（2例单灶性和1例多灶性），1例表现为乳腺肿块。这4例AVL由扩张的血管腔隙局灶性增生构成，主要由单层丰满且有时核深染的内皮细胞衬里。2例血管肉瘤患者行乳房切除术后，1例在诊断为局部血管肉瘤复发后10个月死亡，另1例在诊断后2个月存活且无血管肉瘤。1例血管肉瘤患者在诊断后2周死于无关原因。1例AVL患者在同一区域切除AVL后17个月，腋窝区域出现了第二个皮肤AVL。所有AVL患者均未发生血管肉瘤或复发性乳腺癌。在最初局部切除后，他们分别在10个月、18个月、7年7个月和10年保持良好状态。作者得出结论，皮肤血管肉瘤和不寻常的良性皮肤血管病变可在乳腺癌放疗区域内发生。与其他放疗诱发的肉瘤不同，皮肤血管肉瘤常发生在放疗后的短时间内。将AVL与血管肉瘤区分开来很重要。需要更长时间的随访来全面确定非典型血管病变的预后重要性，但目前没有证据表明它们是放疗诱发血管肉瘤的前驱病变。
