PMC9982166_01
Case report timeline. MRI, magnetic resonance imaging; DSA, digital subtraction angiography; IHC, immunohistochemistry.
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F1
In February 2021, a 17-year-old female patient presented with a lump on the right breast about 1.5 x 1.5 cm in size in the lower inner quadrant (Figure 1).
MRI images of a 17-year-old female patient with right primary breast angiosarcoma. (A) MRI images show a mixed signal intensity area predominantly composed of isointense mass on T1. (B) Mixed signal intensity area predominantly of high signal intensity on T2. (C, E, F) Enhancement sequences image showed irregular heterogeneous high signal intensity. (D) On fat-suppressed T2-weighted images, the lesion shows bright (high) signal intensity. (G) High signal intensity on DWI and (H) low signal intensity on ADC images demonstrate restricted diffusion.
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F2
Subsequent contrast-enhanced MRI depicted the heterogenous enhancement with peripheral enhancement (Figure 2).
Biopsy of right breast lesion microphotography. The tumor is composed of atypical endothelial cells with different degrees of differentiation, forming irregular vascular cavities that coincide with each other, forming papillary and diffuse infiltration (x200, (A) punch biopsy and (C) excisional biopsy). Tumor cells exhibit fusiform or irregular shapes with little cytoplasm and hyperchromatic nuclei (x400, (B) punch biopsy and (D) excisional biopsy). Special stain CD31 positive (E). Special stain CD34 positive (F) (hematein-eosin staining).
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F3
Further immunohistochemistry demonstrated positive staining for vascular endothelial markers CD34, CD31, FLI-1, and erythroblast transformation-specific (ETS)-related gene (ERG) oncoprotein but not for cytokeratin (Figures 3A, B, E, F). Tumor cells exhibit fusiform or irregular shapes with little cytoplasm and hyperchromatic nuclei (Figures 3C, D).
Digital subtraction angiography (DSA) image of tumor vascularization before embolization (A). DSA after embolization (B).
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F4
A decision to undertake angiography (DSA) and tumor vascular embolization was taken to reduce the risk of bleeding and allow safe surgical resection (Figure 4).
The patient was operated on successfully with less amount of blood loss (A). In the mastectomy specimen section of the right breast, the tumor was ill-defined, with a focal area of necrosis and hemorrhage (B).
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F5
Postoperative pathological examination revealed angiosarcoma with tissue necrosis, hemorrhage and 19.5 x 15.3 x 6.6 cm in size (Figure 5).