PMC10368090_01
Imaging and pathological findings. a Magnetic resonance imaging showing a 10-cm round and rim-enhancing mass with central necrosis in the right breast. b The surgical specimen appears reddish-brown with hemorrhagic changes. c Hematoxylin-eosin staining shows angiosarcomatous proliferation of endothelial cells (magnification, x20). d Immunohistochemical staining of the primary breast angiosarcoma (magnification, x20). CD31 and CD34 are expressed robustly in malignant cells. Factor VIII is expressed partially, and the expression of Ki-67 is 30% in the cellular areas.
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Breast ultrasonography revealed a hypoechoic and heterogeneous solid mass measuring approximately 10 cm, and contrast-enhanced magnetic resonance imaging revealed a centrally necrotic mass measuring 8.0 x 7.9 x 5.9 cm and showing rim enhancement in the right breast (Fig. 1a). On gross examination, the surgically removed tumor specimen appeared poorly circumscribed, reddish-brown, and soft to firm; measured 8.6 x 8.0 x 3.6 cm; and had hemorrhagic areas (Fig. 1b). The findings of histopathological examination led to a final diagnosis of high-grade angiosarcoma comprising capillary components with anastomosing dilated vascular channels lined with atypical endothelial cells (i.e., stage 3A) (Fig. 1c). Immunohistochemical analysis indicated robust expression of the endothelial markers CD31 and CD34, and partial expression of factor VIII in the tumor, and 30% of the cells expressed Ki-67 (Fig. 1d).
Imaging findings and FoundationOne  CDx results at the time of recurrence. a, b CT shows metastases in the lungs (a) and liver (b). c Magnetic resonance imaging shows brain metastases. d FoundationOne  CDx analysis shows a point mutation in PIK3CA, loss of TP53, and variants of unknown significance in eight other genes. e Timeline of the case.
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Planned CT performed 1 year after the surgery revealed metastatic lesions in the lungs, liver, and bones, and brain magnetic resonance imaging showed brain metastases, although the patient did not exhibit any symptoms (Fig. 2a-c). At the time, there were no active clinical trials targeting the specific tumor genetic profile of the patient (Fig. 2d). However, she eventually died 18 months after the surgery (Fig. 2e).