Indian Journal of Pathology and Microbiology
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Year : 2012  |  Volume : 55  |  Issue : 2  |  Page : 264-265
Angiosarcoma in recurrent malignant phyllodes tumor of breast


1 Department of Pathology, CSM Medical University, (erstwhile KGMC), Shahmina Road, Lucknow, Uttar Pradesh, India
2 Department of Surgery, CSM Medical University, (erstwhile KGMC), Shahmina Road, Lucknow, Uttar Pradesh, India

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Date of Web Publication3-Jul-2012
 

How to cite this article:
Kumar M, Goel MM, Sagar M, Tiwari S. Angiosarcoma in recurrent malignant phyllodes tumor of breast. Indian J Pathol Microbiol 2012;55:264-5

How to cite this URL:
Kumar M, Goel MM, Sagar M, Tiwari S. Angiosarcoma in recurrent malignant phyllodes tumor of breast. Indian J Pathol Microbiol [serial online] 2012 [cited 2014 Apr 21];55:264-5. Available from: http://www.ijpmonline.org/text.asp?2012/55/2/264/97905


Sir,

Angiosarcoma in recurrent malignant phyllodes tumor of breast is extremely rare. They are less than 1% of all breast tumors. [1] We present a case of 22-year-old lady with a history of rapidly enlarging breast lump of 5 months duration. She was operated for the same one year back diagnosed as phyllodes tumor. Contralateral breast was normal and no axillary lymphadenophathy was identified. Patient had not received radiotherapy in the past. There was no family history of breast carcinoma. Hematological and biochemical profile were unremarkable. Computed tomography (CT) scan of right breast revealed a well defined heterogeneous soft tissue mass. Mastectomy specimen showed a well circumscribed, soft to firm tumor measuring 8 x 8 cm in size with greyish white and hemorrhagic areas [Figure 1]a. The nipple and areola were unremarkable. Multiple areas were sectioned and stained with hematoxylin and eosin. Sections showed malignant phyllodes tumor with sarcomatous components in the same field [Figure 1]b. The ductal epithelial component and atypical stromal cell proliferation admixed with the extensive areas of the anastomosing vascular channels. Stromal cells were plump to spindle in shape showing increased nuclear-cytoplasmic ratio, hyperchromatic to vesicular nuclei with inconspicuous to prominent nucleoli and mild cytoplasm [Figure 1]c. Mitotic figures, foci of necrosis, and hemorrhage were present in between the anastomosing vascular channels [Figure 1]d. Immunuhistochemistry for CD34 [Figure 1]e and CD31 was strongly positive in tumor areas [Figure 1]f. Diagnosis of angiosarcoma in recurrent malignant phyllodes tumor was made. Phyllodes tumors are characterized by increased stromal cellularity and characteristic broad "leaf-like" papillae inserted into cleft-like spaces. Phyllodes tumors of breast show variable clinicopathological behaviour ranging from a benign to malignant. Grading of benign, borderline and malignant tumor is based on the stromal cellularity, stromal cytologic atypia, mitotic activity and circumscribed vs invasive margin. The majority of these lesions behave in a completely benign in that they do not have metastatic potential and local recurrence per se is not an indicator of malignancy. Histologic grade of angiosarcoma is of prognostically importance, but a recent study has shown that there is no correlation between histologic grade and patients outcome. [2] Malignancy developed in the mesenchymal component of phyllodes, whereas the ductal component are usually benign. Angiosarcomas may also develop as stromal components of phyllodes tumor. The sarcomatous stromal component may contain Liposarcoma. Leiomyosarcoma, Chondrosarcoma, Osteosarcoma, and Angiosarcoma are rarely encountered in malignant phyllodes tumor. [3] In our case, less than 50% of angiosarcomatous foci was present. In the absence of epithelial component, the neoplasms were classified as primary stromal sarcomas. The finding of a malignant heterologus element places the tumor into malignant category. Only few cases of angiosarcoma arising in recurrent phyllodes tumor has been published. [4] In comparison, primary angiosarcomas are relatively rarer, they typically occur in younger women, arise from breast parenchyma; and Secondary angiosarcomas usually occurs in elderly women, arise from skin and show a pattern of infiltration into breast parenchyma. Both primary and secondary breast angiosarcoma carry a prognosis worse than mammary carcinoma. [5] The surgery with adequate margin is primary treatment. The role of adjuvant therapy has not yet been well established. It is important to be aware of the unusual occurrence and to differentiate from soft tissue sarcoma. To the best of our knowledge, we are reporting very rare case angiosarcoma in recurrent malignant phyllodes tumor.
Figure 1: (a) Resected tumor showing greyish white and hemorrhagic areas. (b) Leaf like projections, characteristic of phyllodes tumor (hematoxilin and eosin stain, ×200). (c) Marked nuclear atypia in stromal tissue (hematoxilin and eosin stain, ×400). (d) focal stromal area showing anastomosing vascular channels & marked nuclear. Atypia (hematoxilin and eosin stain, x400). (e) Angiosarcomatous foci positive for CD34 (IHC, x400). (f) Angiosarcomatous foci positive for CD31 (IHC, ×400)

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   References Top

1.Carter BA, Page DL. Phyllodes tumor of the breast: local recurrence versus metastatic capacity. Human Pathol 2004;35:1051-2.  Back to cited text no. 1
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2.Nascimento AF, Raut CP, Fletcher CD. Primary angiosarcoma of the breast: clinicopathologic analysis of 49 cases, suggesting that grade is not prognostic. Am J Surg Pathol 2008;32:1896-904.  Back to cited text no. 2
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3.Rosen PP. Fibroepithelial neoplasm. In: Rosen PP, editors. Rosen's Breast Pathology. 3 rd ed. Philadelphia: Lippincott Williams &Wilkins; 2009. p. 187-229.  Back to cited text no. 3
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4.Mamoon N, Mushtaq S, Hassan U, Rashid R, Khadim MT, Sarfraz T, et al. Angiosarcoma arising in recurrent phyllodes tumour. Histopathology 2009;54:913-6.  Back to cited text no. 4
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5.Biswas T, Tang P, Muhs A, Ling M. Angiosarcoma of the breast: A rare clinicopathological entity. Am J Clin Oncol 2009;32:582-6.  Back to cited text no. 5
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Correspondence Address:
Madhu Kumar
Department of Pathology, CSM Medical University, (erstwhile KGMC),Shahmina Road, Lucknow, Uttar Pradesh- 226 003
India
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DOI: 10.4103/0377-4929.97905

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