Indian Journal of Nuclear Medicine

INTERESTING IMAGE
Year
: 2021  |  Volume : 36  |  Issue : 2  |  Page : 210--211

Solitary subcutaneous tissue metastasis as recurrence in a case of primary angiosarcoma of breast: Findings on 18F-fluorodeoxyglucose positron emission tomography-computed tomography


Sarthak Tripathy1, Sameer Rastogi2, Sneha Prakash1, Sreedharan Thankarajan Arun Raj1, Sambit Sagar1, Shamim Ahmed Shamim1,  
1 Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
2 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Shamim Ahmed Shamim
Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi - 110 029
India

Abstract

Primary angiosarcomas of the breast are rare tumors, with a fatal outcome. We present a rare case of an operated primary angiosarcoma of the right breast in a 20-year-old female who showed disease recurrence in the right posterior arm subcutaneous tissue on 18F-fluorodeoxyglucose positron emission tomography-computed tomography after 1 year of surgery without any other visceral metastasis.



How to cite this article:
Tripathy S, Rastogi S, Prakash S, Arun Raj ST, Sagar S, Shamim SA. Solitary subcutaneous tissue metastasis as recurrence in a case of primary angiosarcoma of breast: Findings on 18F-fluorodeoxyglucose positron emission tomography-computed tomography.Indian J Nucl Med 2021;36:210-211


How to cite this URL:
Tripathy S, Rastogi S, Prakash S, Arun Raj ST, Sagar S, Shamim SA. Solitary subcutaneous tissue metastasis as recurrence in a case of primary angiosarcoma of breast: Findings on 18F-fluorodeoxyglucose positron emission tomography-computed tomography. Indian J Nucl Med [serial online] 2021 [cited 2021 Sep 17 ];36:210-211
Available from: https://www.ijnm.in/text.asp?2021/36/2/210/318893


Full Text



A 20-year-old female underwent radical mastectomy with axillary lymph node dissection for a lump in the right breast. Histopathology of the surgical specimen revealed primary angiosarcoma of the breast. She developed a swelling in the right posterior arm after 1 year of surgery. Follow-up was done with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F FDG PET-CT) in view of high suspicion of metastasis and to locate any other distant site of metastasis. “PETCT scan findings revealed a mass lesion with variegated contour in the subcutaneous tissue of the right posterior arm, infiltrating the underlying triceps muscle and showing increased FDG uptake [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f, [Figure 1]g. No other FDG avid focal lesion was seen elsewhere in the body to suggest any distant visceral or skeletal metastasis. Biopsy from the mass revealed metastasis from the primary angiosarcoma of the breast, which showed perineural invasion and was positive for CD31 and CD34 on immunohistochemistry.{Figure 1}

Primary angiosarcoma of the breast is a rare, but aggressive malignancy of endovascular origin, comprising only 0.04% of all the malignancies involving breast, and affects the parenchyma of nonirradiated breast fields.[1],[2],[3] In contrast, secondary angiosarcoma arises in the dermal and subcutaneous layers of the skin of radiated fields after a period of 7–10 years after radiotherapy and may not necessarily involve the parenchyma.[4] Breast angiosarcoma showed a propensity for hematogenous metastasis, and the reported sites involved include lung, skin, liver, bone, central nervous system, spleen, ovary, and heart.[5],[6] It frequently affects young women aged 20–50 years without any previous history of a malignancy.[7] Breast angiosarcomas are highly FDG avid tumors, and standardized uptake volume (SUVmax) is an important prognostic parameter in 18F FDG PET-CT studies and higher SUVmax values correlates directly with a poorer prognosis. Furthermore, there is a significant difference in the values of SUVmax of primary and secondary angiosarcomas.[8] The authors through this case want to highlight the role of 18F FDG PET-CT in restaging of such rare tumors, while demonstrating a rare site of metastasis without any other distant visceral and skeletal metastasis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Lagrange JL, Ramaioli A, Chateau MC, Marchal C, Resbeut M, Richaud P, et al. Sarcoma after radiation therapy: Retrospective multiinstitutional study of 80 histologically confirmed cases. Radiation Therapist and Pathologist Groups of the Fédération Nationale des Centres de Lutte Contre le Cancer. Radiology 2000;216:197-205.
2Huang J, Mackillop WJ. Increased risk of soft tissue sarcoma after radiotherapy in women with breast carcinoma. Cancer 2001;92:172-80.
3Lim RF, Goei R. Best cases from the AFIP: Angiosarcoma of the breast. Radiographics 2007;27 Suppl 1:S125-30.
4Arora TK, Terracina KP, Soong J, Idowu MO, Takabe K. Primary and secondary angiosarcoma of the breast. Gland Surg 2014;3:28-34.
5Ohta M, Tokuda Y, Kuge S, Okumura A, Tanaka M, Kubota M, et al. A case of angiosarcoma of the breast. Jpn J Clin Oncol 1997;27:91-4.
6Marchant LK, Orel SG, Perez-Jaffe LA, Reynolds C, Schnall MD. Bilateral angiosarcoma of the breast on MR imaging. AJR Am J Roentgenol 1997;169:1009-10.
7Sher T, Hennessy BT, Valero V, Broglio K, Woodward WA, Trent J, et al. Primary angiosarcomas of the breast. Cancer 2007;110:173-8.
8Cassou-Mounat T, Champion L, Bozec L, Laurence V, Huchet V, Luporsi M, et al. Primary and secondary breast angiosarcoma: FDG PET/CT Series. Clin Nucl Med 2019;44:e33-5.