Clues to imaging diagnosis of primary angiosarcoma of the breast

Background: Primary angiosarcoma. of the breast is rare and there are no defined diagnostic criteria for breast imaging. Objective: To describe breast imaging of two cases of histologically proven angiosarcoma and identify clues to imaging diagnosis. Methods: Clinical study of two female patients with breast lumps at King Chulalongkorn. Memorial Hospital. The modalities of breast imaging included mammography, ultrasongraphy and magnetic resonance imaging (MRI). Results: Both female patients were young adults, aged 26 and 22 seen in 2002 and 2004. They manifested huge breast lumps. The first patient had bilateral simultaneous involvement. The left breast was very large and not compressible on mammography. It showed a rapid growth and bleeding ulceration. The second patient suffered from unilateral left breast enlargement with tenderness. Both masses were hyperdense on mammogram and hypoechogenicity with hypervascularity on color Doppler ultrasound. The MRI findings supported vascular masses with internal hemorrhage. An early subacute phase of hemorrhage was displayed by the second patient. Both were operated but succumbed to lung metastatses. Conclusion: The imaging diagnostic clues consisted of huge masses without pathologic lymph node on the mammograms, hypervascularized masses in color Doppler ultrasound, hemorrhagic areas and strong enhancement demonstrable by MRI. Another clue is presence on imaging of lung metastasis at the time of initial diagnosis.