Breast

• Atypical vascular proliferations on irradiated skin, often small and multiple

• Superficial dermal based growth of narrow vascular spaces
• Develops after external radiation for breast carcinoma
• Typically involves the skin overlying breast
• 2 subtypes: lymphatic type and vascular type
• Differentiated from angiosarcoma by lack of multilayering, mitosis, marked cytologic atypia, blood lakes and absence of extension into subcutaneous tissue

• Atypical vascular lesion term coined by Fineberg and Rosen in 1994 (Am J Clin Pathol 1994;102:757)
• Acceptable terminology: atypical vascular proliferation

• ICD-O: 9126/0 - atypical vascular lesion
• ICD-11: XH8KN7 - atypical vascular lesion

• Wide age range has been reported but is most common in late sixth to early seventh decade (Breast Cancer Res Treat 2014;146:347, Am J Surg Pathol 2005;29:983)
• Develops 3 to 6 years after radiation treatment (Semin Diagn Pathol 2017;34:410)

• Skin of breast or anterior chest wall exposed to previous radiation

• Directly associated with radiation treatment
• Median total administered dose: 50 Gy (Am J Surg Pathol 2005;29:983)

• Multiple, small papules or vesicles and erythematous plaques (Am J Surg Pathol 2002;26:328)

• Mostly follows a benign course (Am J Surg Pathol 2005;29:983)
• Local recurrences and development of further similar lesions may occur in the radiation field
• Progression to angiosarcoma is rare but reported (Am J Surg Pathol 2005;29:983)

• 41 and 61 year old women with small vascular lesions of the breast diagnosed by MRI guided vacuum assisted biopsy (Radiol Case Rep 2022;17:2492)
• 43 year old woman presented with 29 atypical vascular lesions following breast conserving surgery and radiation (Cutis 2019;103:E22)
• 49 year old woman presented with postradiation atypical vascular proliferation mimicking angiosarcoma 8 months following breast conserving therapy for breast carcinoma (J Clin Aesthet Dermatol 2011;4:47)

• Complete excision with uninvolved surgical margins and follow up (Am J Surg Pathol 2005;29:983)

Contributed by Anna Purdy, M.S.N.


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• ≥ 1 circumscribed papules, bluish purple nodules, small vesicles or erythematous plaques, median of 0.5 cm
• Tends to be well demarcated, symmetric and wedge shaped (Semin Diagn Pathol 2017;34:410)

Contributed by Indu Agarwal, M.D., Sharlene See, M.D. and Julie M. Jorns, M.D.

• CD31, D2-40 (lymphatic type) (Breast Cancer Res Treat 2014;146:347)
• Variable CD34

• c-MYC

• Unknown

• Left breast skin, punch biopsy:
  • Atypical vascular lesion (see comment)
  • Comment: The lesion is comprised of a vascular proliferation dissecting the collagen in the superficial dermis. There is no significant nuclear pleomorphism or mitotic activity. An immunostain performed for c-MYC is negative in the lesion. Morphologic and immunohistochemical findings support the diagnosis.

A brownish papular lesion of skin on the breast is excised. Histopathologic examination shows that it is comprised of a wedge shaped, relatively well circumscribed vascular proliferation, dissecting the collagen in the superficial dermis. No significant nuclear pleomorphism or mitotic activity is noted. What is the most important information you need to make the diagnosis?

1. Family history of cancer
2. History of cancers of other sites
3. History of chemotherapy
4. History of radiation to the site

D. History of radiation to the site. Atypical vascular lesions only occur in previously irradiated areas of the breast. The histologic description matches that of an atypical vascular lesion but to make a confident diagnosis, prior history of irradiation and histologic examination of the entire lesion is essential.

Comment Here

Reference: Atypical vascular proliferation