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Late Presentation of High Grade Angiosarcoma after Implant-Based Reconstruction for Breast Cancer
Lauren Chmielewski, MD, University Hospitals Case Medical Center Department of Plastic and Reconstructive Surgery, PGY-5
Ayesha Punjabi, MD, University Hospitals Case Medical Center Department of Plastic and Reconstructive Surgery, PGY-1
Hooman Soltanian, MD, University Hospitals Case Medical Center Department of Plastic and Reconstructive Surgery
David Rowe, MD, University Hospitals Case Medical Center Department of Plastic and Reconstructive Surgery
University Hospitals Case Medical Center Department of Plastic and Reconstructive Surgery
2016-01-26
Presenter: Lauren Chmielewski
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Hooman Soltanian
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Angiosarcoma of the breast is a rare entity that portends a poor prognosis. Primary angiosarcoma is a disease of the breast parenchyma of young women. Secondary angiosarcoma affects the chest wall of older women who have undergone radiation therapy for breast cancer with a median interval of about 5-10 years after radiation exposure.
Angiosarcoma commonly presents with skin lesions: painless patches, papules, or red-purple nodules with irregular surfaces. These skin lesions are frequently surrounded by satellite lesions with variable presence of surrounding skin changes (discoloration, erythema, edema) . Lymphedema is another risk factor for the development of ipsilateral upper extremity lymphangiosarcoma in the post mastectomy patient (Stewart-Treves syndrome).
The issue of angiosarcoma in the reconstructed breast has scantly been addressed in the literature. To our knowledge, there are only two existing case reports addressing angiosarcoma arising in the reconstructed breast. Additionally, these reports address angiosarcoma presenting in breasts reconstructed with autologous tissue. , We report a case of chest wall angiosarcoma in a patient who had undergone mastectomy with implant reconstruction nearly three decades prior to presentation. The patient was not exposed to radiation therapy and had no other risk factors. She was diagnosed from pathologic specimens taken during implant removal and capsulectomy. Ultimately, the patient underwent successful resection and reconstruction of her chest wall. We believe this case is a powerful learning experience and should be shared for the benefit of anyone practicing reconstructive breast surgery.
