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Abstract
We present image findings, especially rare MRI of a primary breast angiosarcoma with its histopathology, and also analyze the relevant medical literature reports in terms of the MRI findings. As our patient had unique features of a primary breast angiosarcoma, this case could be very helpful for future diagnosis of this rare breast malignancy by MRI.
References
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Fig. 1.
Mammography (a) shows extremely dense breast. Sonography (b) shows irregular indistinct heterogeneous echoic mass of the upper inner quadrant of the left breast. The increased vascularity in the hypoechoic portion of the scanned area is demonstrated by color Doppler scanning (c).
Fig. 2.
MRI shows an irregularly shaped, 4.9 × 4.5 cm sized, low signal mass on T1WI (a) and several, dot-like, high signals (arrows), suggesting internal hemorrhagic foci within a mass. The mass shows high signal intensity on T2WI (b). The central portion of the mass shows early dynamic-phase enhancement (c) and a washout pattern on the delayed phase (d). The periphery of the mass shows persistent trapping of contrast medium in the irregular enhancing portion and surrounding edema. Large, draining vessels (arrowheads) around the mass are well seen on MIP imaging (e). PET-CT (f) shows the inhomogeneous FDG uptake (SUV = 2.2–2.9) of the mass.
Fig. 3.
A photomicrograph shows the combination of the numerous, inter-anastomosing vascular spaces and more solid, spindle-cell areas effacing the normal lobular architecture (Hematoxylin & Eosin staining, × 200) (a). On immunohistochemical staining, tumor cells are diffusely and strongly positive for CD34 (b) and focally positive for factor VIII (c). The estimated Ki-67 index in the cellular areas is approximately 40% (× 400) (d).
Table 1.
MRI Findings of Primary Breast Angiosarcoma in Articles: the Original MRI Descriptions of Each Article were Used
| Articles | No. of preop. MRI | No. of MRI presented with images | MRI sequences | |||
|---|---|---|---|---|---|---|
| T1 | T2 | Dynamic contrast enhancement | Others sequences/ findings | |||
| Liberman et al. Radiology 1992 (9) | 1 | 1 | Low to intermediate SI (Chest MRI) | SI increased than T1 (Chest MRI) | N/A | Heavily T2 – Tubular areas of the mass, very high SI; vascular channels containing slow flowing blood |
| Marchant et al. AJR Am J Roentgenol 1997 (10) | 2 | 2 | N/A | N/A | N/A | 3D gadolinium enhanced fast spoiled gradient echo Right breast – Enhancing mass with irregular borders. Large draining vessel. Cystic cavity within the mass containing blood. Left breast – Mildly irregular contour enhancing mass. |
| Glazebrook et al. AJR Am J Roentgenol 2005 (14) | 1 | 1 | Increased SI of the area of blood lakes (no image) | N/A | N/A | 3D fast spoiled gradient echo – Multiple nodular areas of rapid and intense contrast enhancement within the mass. Large draining vein |
| Yang et al.* Radiology 2007 (1) | 6 | 2 | Large, lobulated mass Heterogeneously hypointense Irregularly high SI; hemorrhagic nature Markedly heterogeneous architecture | Heterogeneously hyperintense Cystic cavities representing a venous lake | Intense and heterogeneous enhancement with rapid initial enhancement followed by washout kinetic features | Partially irregular and diffuse infiltration Skin thickening Extension to the pectoralis fascia without invasion |
| Kim et al. J Korean Surg Soc 2012 (11) | 1 | 1 | N/A | N/A | Early rapid enhancement with plateau | |
| Dashevsky et al.* Radiol Case Rep 2013 (2) | 1 | 1 | Smooth, lobulated, hypointense mass | Hyperintense | A rapid rise to the peak with washout | STIR – Increased circumferential signal surrounds the mass: edema |
| O'Neill et al. J Med Imaging Radiat Oncol 2014 (15) | 1 | 1 | Low SI (no image) | High SI (no image | e) Irregular, heterogeneous enhancement and plateau kinetics (no Extension to the pectoralis fascia without invasionmage) | MIP – An area of high signal within low signal parenchyma |
| Lin et al.* Medicine 2016 (3) | 1 | 1 | Center – hyperintensity; central intratumoral hematoma Periphery – hypointensity; tumor location | Remarkable inhomogeneous enhancement at the periphery (early) Persist pattern of enhancement (delay) Non-enhancement at the center | Large amount of bridging anastomotic vascular spaces at the tumor periphery; trapping of contrast medium | |
| Iacoponi et al. Int J Surg Case Rep 2016 (16) | 1 | 1 | N/A | N/A | Type 3 pattern | DWI – Solid and hypervascularized components with significant enhancement High ADC Areas with intratumoral bleeding |
| Wang et al.* Breast J 2017 (4) | 13 | 1 | (10/13) Poorly defined lesions with low SI | High SI | Rapid enhancement (early) | A persistent and prolonged enhancement (late) |
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