10.5826/dpc.1203a111
text/xml
2160-9381
1918
en
Cássio Rafael Moreira
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
dermoscopy
Dermoscopy performs an important role to diagnose radiation-induced angiosarcoma on the breast
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-07-28
2021-07-27
2022-07-28
2022-09-15
e2022111
Dermatol Pract Concept
Cássio Rafael Moreira
2022/07/28
10.5826/dpc.1203a111
e2022111
Department of dermatology, Municipal Health Authority of Apucarana, Paraná, Brazil
2160-9381
dermoscopy
en
e2022111
Dermoscopy performs an important role to diagnose radiation-induced angiosarcoma on the breast
https://dpcj.org/index.php/dpc/article/download/1918/1677
                     Dermatology Practical & Conceptual


           Dermoscopy Performs an Important Role
        to Diagnose Radiation-induced Angiosarcoma
                       on the Breast
         Gabriel Tagata Seleri1, Marina Riedi Guilherme1, Ana Lúcia de Oliveira Prestes1,
                                     Cássio Rafael Moreira1


1 Department of dermatology, Municipal Health Authority of Apucarana, Paraná, Brazil



Keywords: angiosarcoma, radiotherapy, oncology, dermoscopy
Citation: Seleri GT, Guilherme MR, Prestes ALDO, Moreira CR. Dermoscopy performs an important role to diagnose radiation-induced
angiosarcoma on the breast. Dermatol Pract Concept. 2022;12(3):e2022111. DOI: https://doi.org/10.5826/dpc.1203a111
Accepted: November 8, 2021; Published: July 2022
Copyright: ©2022 Seleri et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License
(BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/ which permits unrestricted noncommercial use, distribution, and
reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Cássio Rafael Moreira, Miguel Simião, 69, Apucarana, Paraná, Brazil E-mail: cassiorafamoreira@gmail.com




Introduction                                                             Case Presentation
Radiation-induced angiosarcoma (RIAS) is a rare subtype of               A 68-year-old Caucasian woman presented with a 3 cm,
angiosarcoma that originates from endothelial cells exposed              asymptomatic violaceus plaque on the areola of her right
to radiation. The breast is the most common location of                  breast (Figure 1A), 8 years after radiotherapy for the treat-
this condition, and the incidence of RIAS on women treated               ment of an invasive ductal carcinoma on the same location.
with breast-conserving surgery and radiotherapy vary from                Dermoscopy showed a central hemorrhagic crust, sur-
0.14% to 0.5%, depending upon the study. Prognosis is                    rounded by a purple background, with blue-red globules and
poor, recurrences are common, distant metastasis may occur,              shiny-white structures (Figure 1B). Histopathological exam-
5-year survival rates are between 28%-54% [1].                           ination with the presence of spindle cells proliferation, form-
    On early stages it usually presents itself as painless blue-         ing bundles and compact nodules in the dermis, alongside
red patches on a previously irradiated skin area, that pro-              positive immunohistochemistry for Ki-67 and CD34 mark-
gresses to red or violaceus plaques and eventually irregular             ers, confirmed well-differentiated angiosarcoma (Figure 2).
borders with a nodular appearance. Differential diagnosis
includes hematomas, hemangiomas, cellulitis, radiodermitis
                                                                         Conclusions
or atypical vessel lesions. Biopsy is the most accurate method
for the diagnosis.                                                       Diagnostic of incipient radiation-induced angiosarcoma
    This is a case report of RIAS on the breast, with relevant           is difficult due to the ample differential diagnosis and
clinical and dermoscopic features.                                       non-specific characteristics of this neoplasm. Although none




Research Letter | Dermatol Pract Concept. 2022;12(3):e2022111                                                                           1
Figure 1. (A) Clinical photo showing a violaceous plaque, with irregular borders on the areola. (B) Dermoscopy (DermLite DL4, x10) with
purple background, red globules, hemorrhagic crust and shiny white structures.




Figure 2. (A) Histopathological features showing proliferation of spindle cells, arranged in a lobular pattern on the dermis and extravasated
red blood cells (H&E, x10). (B) Spindle cells pleomorphism and cellular atypia (H&E, x40). Immunohistochemical staining with positive
CD34 marker (C) and Ki-67 marker (D) on the tumor cells, confirming its endothelial origin and high proliferation activity, respectively.




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are pathognomonic of RIAS, dermoscopic patterns are im-           References
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                                                                     sarcoma (RIA). J Am Acad Dermatol. 2015;73(2):e51-e55. DOI:
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Research Letter | Dermatol Pract Concept. 2022;12(3):e2022111                                                                      3
