Radiation-induced secondary breast angiosarcoma: a case report and literature review

Secondary angiosarcoma of the breast is an aggressive tumour that often arises in patients who have undergone radiation therapy, particularly in patients with long-standing lymphoedema. The median latency to onset following radiotherapy typically ranges from 5 to 10 years. The incidence of this condition is expected to increase with the increasing trend in breast-conserving surgery and radiotherapy. However, due to its rarity, the literature on treatment and prognosis remains limited, highlighting the need for further research into molecular characteristics and therapeutic options. We are presenting a case of a 68-year-old female with a history of bilateral breast cancer on routine surveillance identified progressive skin changes in the right breast, which included a crimson-red appearance with elevated nodules and plaques. On clinical examination, these dermal changes covered approximately three-quarters of the breast, extending toward the angle of Louis, without any underlying palpable mass. A punch biopsy was performed, which confirmed the diagnosis of secondary angiosarcoma. A Positron Emission Tomography (PET) scan revealed non-metastatic disease. The patient was counselled for bilateral mastectomy, but she opted for the affected side only. An affected-side mastectomy was performed, and the patient made a full recovery. However, three months after the mastectomy, the patient developed nodular lesions, and a biopsy confirmed recurrent angiosarcoma. After a multidisciplinary team decision, the patient was started on taxane therapy weekly. Co-secondary angiosarcoma of the breast is a rare but clinically significant complication, especially following radiation therapy. Early detection is crucial for effective treatment and improved prognosis. This case emphasises the need for personalised treatment plans and highlights the increasing incidence of this condition as breast-conserving therapies become more common. Molecular studies on tissue samples are needed to develop targeted therapies and improve survival outcomes, particularly in regions with limited diagnostic resources.