Peritoneal Post-Radiation Angiosarcoma in a Patient With a History of Radiation for Cervical Cancer

BACKGROUND Post-radiation angiosarcoma (PRA) is a rare, invasive mesenchymal tumor associated with prior cancer radiotherapy. The diagnostic criteria for PRA include a history of radiation exposure, the development of a new malignant tumor with a long latency period within the irradiated field, and a histological type different from that of the primary malignancy if radiation was administered for the original cancer. Although PRA can arise in any part of the body, it most commonly occurs in the skin. Only a few cases of vascular sarcoma secondary to radiotherapy for cervical cancer have been reported, and reports of peritoneal angiosarcoma following pelvic irradiation for cervical cancer are exceedingly rare. CASE REPORT A 69-year-old woman presented with abdominal discomfort 22 years after receiving radiation therapy for cervical cancer. Imaging and laboratory evaluations failed to reveal a definitive cause, leading to suspicion of recurrence or metastasis of cervical cancer. The patient underwent surgical exploration; postoperative histopathology with immunohistochemistry confirmed the diagnosis of angiosarcoma. She subsequently received 4 cycles of chemotherapy with paclitaxel, carboplatin, and bevacizumab. However, 4 months after surgery, computed tomography revealed new lesions in the abdominal cavity and intestinal wall. The patient ultimately died of disease progression. CONCLUSIONS This case illustrates a rare instance of peritoneal angiosarcoma occurring after radiotherapy for cervical cancer. Clinicians should maintain a high index of suspicion for secondary malignancies in long-term cancer survivors presenting with new-onset peritoneal symptoms. Secondary peritoneal angiosarcoma should be considered in patients with prior radiation exposure and peritoneal involvement.