Bilateral Angiosarcoma of the Breast: Case Report and Review of the Literature

INTRODUCTION: The Angiosarcoma of the breast is a malignant mesenchymal neoplasia that has its origin at endothelial cells of blood vessels of the breast. It is a rare pathology, which represents 0. 04% of the primary tumors of the breast and about 8% of the sarcomas presented at the mammary gland. It occurs mainly in women under 40 years old. The incidence of synchronic contralateral breast Angiosarcoma is about 20%. The dissemination of the tumor is mainly hematogenic. It is usually presented as tumor, with a diameter of about 5 centimeters with soft consistence and badly bounded borders. The diagnosis is histopathological. The prognosis is unfavorable due to the high aggressiveness of the tumor, with recurrence taxes around 50% and a survival index of about 41% in 3 years. The usually recommended treatment is the surgical approach through mastectomy. CASE REPORT: SNPM, female, 44 years old. She was sent to Hospital Federal da Lagoa for having a touchable nodule in the left breast two months before the first interview. The physical examination showed medium-volume breasts, with a palpable tumor at the union of internal quadrants of the left breast with four centimeters in diameter, badly defined bounds, mobile, with a slightly hard consistence and negative papillary discharge bilaterally. Mammography presented with no suspicious lesions. Ultrasonography of the breasts showed at the union of the internal quadrants of the left breast a hypoechogenic, heterogeneous and irregular nodule with. This nodule measured 3. 2 x 1. 3 x 2. 8 centimeters category BI-RADS 4. We made then a core biopsy of this nodule, with a hystopathological report compatible with breast Angiosarcoma of a low degree. An MRI was performed after this diagnosis. The MRI revealed an irregular and heterogeneous nodule, with intense precocious impregnation by the contrast medium and signals of limited distribution at the union of medium quadrants of the left breast. The nodule measured 4. 7 x 3. 8 x 3.5 centimeters corresponding to what was found at the USG performed previously. The MRI showed also a small irregular nodule with intense heterogeneous impregnation of the contrast medium and ascending curve placed in the third medium of the union of the superior quadrants of the right breast classified as BI-RADS 4. At this point, we performed core biopsy of the nodule of the right breast, which made the same diagnosis of the left breast lump. Skin bilateral sparing mastectomy with expander placement bilaterally was performed as the surgical treatment. Histopathological examination of the surgical right breast revealed a low-grade breast angiosarcoma with free surgical margins. The result of the left breast surgical specimen was breast angiosarcoma of intermediate histological grade with foci of high grade, focal necrosis, angiolymphatic invasion was not observed, surgical margins were also free. CONCLUSION: This is a rare and very agressive disease. In the case reported, the patient is at the age when the most cases of this kind of sarcoma appear. The patient had a bilateral tumor. Although the prognosis is dark and there is a high recurrence of the disease, we have decided for the bilateral adenectomy that spare the skin and areolopapilar complexes with expander placement bilaterally, respecting the desire of a young and depressive patient.