Magnetic resonance imaging findings of radiation-induced breast angiosarcoma: A case report

Abstract

BACKGROUND

Breast conservation surgery (BCS) with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer, significantly reducing the risk of tumor recurrence. However, this treatment is associated with adverse effects, including the rare but aggressive radiation-induced angiosarcoma (RIAS). Despite its rarity and nonspecific initial presentation, RIAS presents a challenging diagnosis, emphasizing the importance of imaging techniques for early detection and accurate diagnosis.

CASE SUMMARY

We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer. Initial mammography and ultrasound were inconclusive, showing post-treatment changes but failing to identify the underlying angiosarcoma. Contrast-enhanced breast magnetic resonance imaging (MRI) revealed diffuse skin thickening and nodularity with distinctive enhancement kinetics, leading to the diagnosis of RIAS. This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS, facilitating timely and appropriate surgical intervention.

CONCLUSION

Breast MRI is crucial for detecting RIAS, especially when mammography and ultrasound are inconclusive.

Keywords: Radiation-induced angiosarcoma; Radiotherapy; Breast conserving surgery; Breast cancer; Magnetic resonance imaging; Case report

Core Tip: Radiation-induced angiosarcoma (RIAS) of the breast is extremely rare and aggressive complication of the radiotherapy. The diagnosis is difficult clinically, radiologically and even pathologically. Mammography and ultrasound findings of RIAS are nonspecific and may be occult on the initial conventional breast imaging. Breast magnetic resonance imaging can provide better morphologic characterization and extent of disease, which is critical in surgical planning and preventing delays in diagnosis.