Primary Angiosarcoma of breast- A case report with review of literature

Angiosarcoma is rare, accounting for less than 1% of all malignant mammary lesions. The prognosis is usually poor due to high rates of local recurrence and early development of metastases. We report a 40 year old woman with a highly vascular mass on radiology, she presented with bony metastases at presentation. Core biopsy of the breast mass performed twice showed only haemorrhage and necrosis. Due to biopsy she developed ulceration and presented with nipple discharge. Frozen section done from the base of the ulcer was haemorrhagic and inflammatory. Cytology of nipple discharge too showed inflammation & haemorrhage. Finally mastectomy was done and histopathology showed angiosarcoma of intermediate grade. Immunohistochemically the tumor showed positivity for CD31, multifocal substantial positivity for CD34,FLi-1 diffusely positive and negative for cytokeratin. Ki 67 proliferation index – upto 60-70% in foci, IHC confirmed Angiosarcoma intermediate to high grade. Angiosarcoma is a rare tumor which is difficult to diagnose on core biopsy of breast. A highly vascular breast mass should always be considered malignant until proven otherwise. Surgical treatment seems to be the best course of action.