A 50-year-old patient with no relevant personal history who had long noticed an indurated nodule in the lower inner quadrant of the left breast.
Mammography showed an irregular lesion with impetus limits requiring FNAC, which showed a fusocellular lesion with atypia on the fundus.
With all this it was decided to intervene the patient.
An irregular fragment of fibropathological tissue measuring 5 x 3.9 x 2 cm of maximum dimension was received for pathological study.
Serial sections showed a slightly stellate and whitish irregular area of 2 cm in maximum diameter centered by a cystic cavity with an afractuous contours and a muzzy and friable content around 0.9 cm.
Histologically, the diagnosis of angiosarcoma of the breast was made by distinguishing three relatively well-differentiated patterns:
(a) low grade: anastomosed vascular channels the endothelium of which shows a single cellular row with little or no atypia, including mammary stroma and adipose tissue.
(b) intermediate grade: small papillae appear in the vascular lumens together with areas of endothelial proliferation.
There are foci with cellular atypia, mitosis and fusiform cellular elements, although these are not striking.
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(c) high grade: striking intravascular papillary proliferations of endothelial cells, fusocellular areas and extensive areas of solid growth in which necrotic foci and evident vascular lakes are distinguished.
Atypia and mitotic figures are prominent.
The presence of high-grade areas with histological features conditioned the overall high-grade assignment to the lesion because they are the same determining the aggressiveness and therefore the prognosis of the neoplasia.
The lesion contacted the surgical margins of resection. Mastectomy was performed (treatment of choice for breast angiosarcoma). Several areas of necrosis corresponded to a lesion whitish and a 4 cm tumor with similar residual cavity characteristics, respectively.
No lymphadenopathy was observed.
The patient received several cycles of postoperative radiotherapy and was followed-up by the emergency department during this period of eighteen months. She was admitted to the emergency department due to liver coma and died four days later.
Imaging studies revealed multiple liver metastases.
