Angiosarcoma of the breast: a 30 year perspective with an optimistic outlook

The aim of this study was to investigate the incidence and clinicopathological features of angiosarcoma of the breast by focusing on those cases passing through a busy general teaching hospital over a 30 year period. A search was carried out of all cases in the files of the Department of Pathology of the Royal London Hospital from 1970 to 2000. Four cases were identified as primary angiosarcomas involving the breast. The medical and surgical histories, macroscopic and microscopic features and clinical outcome with long-term follow-up are described in each case. Similarities were identified, such as initial presentation with a ‘bruise’ and a latent period before the diagnosis was established. Half of our cases followed irradiation for breast cancer. In all cases the prognosis after surgery was excellent. The rarity of primary mammary angiosarcoma was confirmed. In younger patients the lesion was not associated with previous radiotherapy, but the older patients presented after radiotherapy for adenocarcinoma of the breast. Although very uncommon, these tumours must be considered in the differential diagnosis, especially with the increasing use of fine-needle-aspiration and core biopsy for preoperative diagnosis. The prognosis after complete surgical excision may be better than generally believed.