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Clinicopathological and immunohistochemical study of 30 cases of post-radiation atypical vascular lesion of the breast

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Abstract

Atypical vascular lesions (AVL) that occur in the field of prior radiation therapy for breast carcinoma are placed within the differential diagnosis with low grade angiosarcoma and other benign vascular lesions. Although considered a benign entity, the exact biological behavior of AVLs is not fully established because of the small number of cases reported in the literature. We aim to further characterize these lesions clinically and histopathologically, and to study their behavior. We report a series of 30 patients with AVL of the breast occurring after radiation exposure, diagnosed and treated at the European Institute of Oncology, Italy. Immunohistochemical study was performed in all cases, using CD31, D2-40, CD105, and Ki-67 antibodies. Twenty-seven patients were treated with standard doses of conventional adjuvant radiation therapy for the prior breast carcinoma. Three patients were treated with intraoperative radiotherapy with electrons. The post-radiation latency interval from breast carcinoma to AVL was 48.5 months (ranged from 1 to 146 months). Most of the lesions were classified as lymphatic type (78.6 %) based on D2-40 positivity. No extension into subcutaneous tissue or significant atypia was noted in all cases. Despite the fact that the AVL of our series have shown benign behavior in 93.3 %, one patient developed local recurrence of AVL, and two cases progressed to angiosarcoma at the previous AVL site. Further studies should be conducted to better understand the clinical behavior and to propose additional histopathologic diagnostic criteria to distinguish AVL from low grade angiosarcoma and those AVL with increased risk for malignant progression. Concerning current treatments of AVL, we recommend complete excision with free surgical margins and close follow up.

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Acknowledgments

This study was supported partially by grants from Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), European Institute of Oncology, and Fundação de Amparo a Pesquisa de São Paulo (FAPESP).

Conflict of interest

The authors declare that they have no conflict of interest. This research complies with the Brazilian and Italian current laws. The authors declare that they do not have financial relationship with the organizations that sponsored this research.

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Authors and Affiliations

  1. Department of Anatomic Pathology, Federal University of Minas Gerais, Av Prof. Alfredo Balena, 190, Belo Horizonte, MG, 30130-100, Brazil

    C. Fraga-Guedes & H. Gobbi

  2. Department of Pathology, European Institute of Oncology, Milan, Italy

    M. G. Mastropasqua & G. Viale

  3. Department of Anatomic Pathology, A.C. Camargo Cancer Center, São Paulo, Brazil

    R. M. Rocha

  4. Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    E. Botteri

  5. Department of Occupational Health, University of Milan, Milan, Italy

    E. Botteri

  6. Division of Breast Surgery, European Institute of Oncology, Milan, Italy

    A. Toesca

  7. University of Milan School of Medicine, Milan, Italy

    G. Viale

Authors
  1. C. Fraga-Guedes
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  2. H. Gobbi
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  3. M. G. Mastropasqua
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  4. R. M. Rocha
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  5. E. Botteri
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  6. A. Toesca
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  7. G. Viale
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Correspondence to H. Gobbi.

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Fraga-Guedes, C., Gobbi, H., Mastropasqua, M.G. et al. Clinicopathological and immunohistochemical study of 30 cases of post-radiation atypical vascular lesion of the breast. Breast Cancer Res Treat 146, 347–354 (2014). https://doi.org/10.1007/s10549-014-3020-9

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  • DOI: https://doi.org/10.1007/s10549-014-3020-9

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