J Pathol Transl Med.  2022 Nov;56(6):342-353. 10.4132/jptm.2022.08.31.

A clinicopathologic and immunohistochemical study of primary and secondary breast angiosarcoma

• Abada E
• Jang H
• Kim S
• Ali-Fehmi R
• Bandyopadhyay S

• KMID: 2535854
• DOI: http://doi.org/10.4132/jptm.2022.08.31

Abstract

Background
We aimed to study the clinicopathologic and immunohistochemical (IHC) (CD117, c-Myc, and p53) characteristics, and overall survival of primary and secondary breast angiosarcoma (BAS).
Methods
This was a retrospective study of BAS cases diagnosed between 1997 and 2020 at our institution. Hematoxylin and eosin-stained slides were reviewed for tumor morphology, margin status, and lymph node metastasis. CD117, p53, D2-40, CD31, and c-Myc IHC stains were performed on 11 viable tissue blocks. Additional clinical information was obtained from the electronic medical records.
Results
Seventeen patients with BAS were identified. Of these, five (29%) were primary and 12 (71%) were secondary BAS, respectively. The median age at diagnosis for primary BAS was 36 years. The median age at diagnosis for secondary BAS was 67 years. The median time to secondary BAS development following radiotherapy was 6.5 years (range, 2 to 12 years). There was no significant difference between primary and secondary BAS in several histopathologic parameters examined, including histologic grade, necrosis, mitotic count, lymph node metastasis, and positive tumor margins. There was also no difference in CD117, p53, D2-40, CD31, and c-Myc expression by IHC between primary and secondary BAS. During a median followup of 21 months, primary BAS had two (40%) reported deaths and secondary BAS had three (25%) reported deaths. However, this difference in survival between both groups was not statistically significant (hazard ratio, 0.51; 95% confidence interval, 0.09 to 3.28; p = .450).
Conclusions
BAS is a rare and aggressive disease. No histologic, IHC (CD117, c-Myc, and p53), or survival differences were identified between primary and secondary BAS in this study.

Keyword

Breast angiosarcoma; Primary breast angiosarcoma; Secondary breast angiosarcoma; Immunohistochemistry; Overall survival

Figure

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  Fig. 1. Low-grade breast angiosarcoma (BAS). (A) Primary BAS with dilated and anastomosing vascular channels lined by flat endothelial cells infiltrating into the breast parenchyma. A focus of atypical ductal hyperplasia is also seen. (B) Higher magnification of previous image. (C) Secondary BAS with dilated and anastomosing vascular channels lined by flat endothelial cells. (D) Higher magnification of previous image.

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  Fig. 2. Intermediate-grade primary breast angiosarcoma. (A) Anastomosing vascular channels lined by endothelial cells displaying mild to moderate cytologic atypia, with increased cellularity and tufting. (B) Higher magnification of previous image.

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  Fig. 3. High grade breast angiosarcoma (BAS). (A) Primary BAS showing vascular channels lined by malignant spindled to ovoid cells with prominent cytologic atypia, increased cellularity and solid areas. (B) Higher magnification of previous image. A mitotic figure is also seen. (C) Secondary BAS showing vascular channels with mostly solid spindled to ovoid malignant cells with prominent cytologic atypia and increased cellularity. (D) Higher magnification of previous image.

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  Fig. 4. CD117. (A) Primary breast angiosarcoma (BAS) showing CD117 cytoplasmic immunoreactivity on immunohistochemistry (IHC). (B) Secondary BAS showing CD117 cytoplasmic immunoreactivity on IHC.

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  Fig. 5. Secondary breast angiosarcoma showing p53 nuclear immunoreactivity on immunohistochemistry.

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  Fig. 6. c-Myc immunohistochemistry (IHC). (A) Primary breast angiosarcoma (BAS) showing c-Myc nuclear immunoreactivity on IHC. (B) Secondary BAS showing c-Myc nuclear immunoreactivity on IHC.

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  Fig. 7. (A) Primary breast angiosarcoma (BAS) showing CD31 membranous immunoreactivity on immunohistochemistry (IHC). (B) Secondary breast angiosarcoma showing CD31 membranous immunoreactivity on IHC. (C) Primary BAS showing D2-40 membranous immunoreactivity on IHC. (D) Secondary BAS showing D2-40 membranous immunoreactivity on IHC.

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  Fig. 8. Kaplan-Meier curves of overall survival (OS) by type of breast angiosarcoma (BAS). CI, confidence interval; NR, not reached; HR, hazard ratio.

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  Fig. 9. Kaplan-Meier curves of overall survival (OS) by race. CI, confidence interval; NR, not reached; HR, hazard ratio.

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  Fig. 10. Kaplan-Meier curves of overall survival (OS) by mitotic count. CI, confidence interval; NR, not reached; HPF, high-power field; HR, hazard ratio.

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  Fig. 11. Kaplan-Meier curves of overall survival (OS) by positive margins. CI, confidence interval; NR, not reached; HR, hazard ratio.

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  Fig. 12. Kaplan-Meier curves of overall survival (OS) by tumor necrosis. CI, confidence interval; NR, not reached; HR, hazard ratio.

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  Fig. 13. Kaplan-Meier curves of overall survival (OS) by tumor grade. CI, confidence interval; NR, not reached; HR, hazard ratio.

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  Fig. 14. Kaplan-Meier curves of overall survival (OS) by CD117. CI, confidence interval; NR, not reached; HR, hazard ratio.

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  Fig. 15. Kaplan-Meier curves of overall survival (OS) by c-Myc. CI, confidence interval; NR, not reached; HR, hazard ratio.

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