Breast - nonmalignant
Benign tumors / changes
Atypical or benign vascular lesion, post radiation

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 23 November 2016, last major update November 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Post radiation atypical vascular lesions
Cite this page: Atypical or benign vascular lesion, post radiation. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastatypicalvascular.html. Accessed December 9th, 2016.
Definition / General
  • Vascular proliferations that develop after external radiotherapy for breast carcinoma, within field of radiation (Am J Clin Path 1994;102:757)
Essential Features
  • Benign atypical vascular proliferations developing after external radiation for breast carcinoma
  • Typically involves skin overlying breast
  • Two types: 1) Lymphatic type; 2) Vascular type
  • Differentiate from angiosarcoma by well circumscribed nature, lack of multi layering, mitosis and hemorrhage and absence of extension into subcutaneous tissue
  • Vascular type is higher risk for subsequent development of angiosarcoma
  • Complete excision and follow up for recurrence is standard treatment
Terminology
  • “Atypical vascular lesion” term coined by Fineberg and Rosen in 1994 (Am J Clin Path 1994;102:757)
  • Note: atypical vascular pattern refers to a dermoscopic pattern that helps differentiate benign cutaneous lesions from melanoma
Epidemiology
  • Mean age 61 years
  • Develops 1 - 12 years (mean 6 years) after therapy in radiation field
Sites
  • Breast exposed to previous radiation, usually in the skin area
Etiology
Clinical Features
Prognostic Factors
Case Reports
Treatment
  • Complete excision and careful follow up for recurrence
Clinical Images

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Left breast is erythematous with sclerotic tissue changes

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Figs 1 and 4: Papules and nodules in and around the mastectomy scar

Gross Description
  • One or more circumscribed papules, bluish purple nodules, small vesicles or erythematous plaques, usually in irradiated field, median 0.5 cm
  • Frequently multiple synchronous lesions with discoloration
Micro Description
  • Relatively well circumscribed, anastomosing growth pattern of irregular slit-like vascular spaces dissecting dermal collagen but not extending into subcutis
  • Lined by single layer of endothelial cells without atypia
  • Often micropapillary tufts
  • Resembles benign lymphangioendothelioma or patch stage Kaposi sarcoma (Am J Surg Pathol 2002;26:328)

    Lymphatic type:
  • Predominantly thin walled, variably anastomosing lymphatics primarily in superficial dermis

    Features of angiosarcoma which are lacking in AVLs:
  • Multi layering of endothelial cells, prominent nucleoli, mitoses, hemorrhage, destruction of adnexa and extension into subcutaneous tissues
Micro Images

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Figures 9 - 11

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H&E, CD31 and FLI1

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Lesions confined to papillary and reticular dermis

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Dermis showed perivascular lymphocytic infiltrate and collagenization

Positive Stains
Negative Stains
Molecular / Cytogenetics Description
Differential Diagnosis
  • Angiosarcoma, well differentiated:
    • Atypical endothelial cells, infiltrative margins, usually high grade, larger (median 7.5 cm vs. 0.5 cm for atypical vascular lesions), positive nuclear staining for c-MYC
    • Atypical vascular lesions are well circumscribed, not infiltrative, no multi layering, no mitosis, no hemorrhage
    • However, angiosarcoma may be part of morphologic continuum with atypical vascular lesions (J Am Acad Dermatol 2007;57:126), and may need additional biopsies to distinguish these entities
  • Hobnail hemangioma: smaller, more superficial and more localized
  • Lymphangioendothelioma: has intravascular papillary stromal projections that resemble papillary endothelial hyperplasia