Experience in the treatment of radioinduced angiosarcoma of the breast in a patient with primary multiple lesions of the breast and bladder. Case report

Among the multiple primary malignant tumors, breast cancer is the most common and in most cases it is combined with the second mammary gland, uterine body, stomach, colon, skin and ovary. Breast angiosarcoma is a very rare disease with unfavorable prognosis. Radiation therapy to the area of the breast is considered to be the main risk factor for the radiation-induced angiosarcoma. Diagnosis is based on the clinical aspect, the results of morphological and immunohistochemical findings. There are no uniform standards for the treatment of this pathology; a surgical method, systemic therapy, and radiation therapy are used. The article presents a clinical case of a female patient born in 1952, who was diagnosed with synchronous multiple primary cancer in 2014: stage 2A left breast cancer (cT2N0M0); bladder cancer stage I (cT1cN0M0). After the complex treatment, the patient received adjuvant endocrine therapy with Tamoxifen. In December 2018, single bluish formations appeared in the area of the postoperative scar, followed by a rapid growth of formations on the skin within a month, with a tendency to merge and necrosis. The patient was sent for biopsy of the formations with suspected recurrence of the disease. Immunomorphological patterns correspond to the angiosarcoma in the skin of the mammary gland. A simple mastectomy was performed. After 3 months, growth of angiomyosarcoma in the soft tissues of the anterior chest wall continued. Excision of the tumor in the soft tissues of the chest was performed and the patient underwent postoperative course of radiation therapy with a single focal dose (SFD) 2.5 Gy, total boost isodose of 50 Gy. At follow-up examinations held from January to December 2021, there is no evidence for continued growth and recurrence of the disease. The presented clinical observation demonstrates the experience of diagnostics and treatment of radiation-induced angiosarcoma in the patient with multiple primary synchronous lesions of the breast and bladder.