Primary breast angiosarcoma with false negative result of core needle biopsy

A 45-year-old woman was referred to the Breast Care Unit due to a palpable lump in her right breast, that had been present for 5 months.In the medical history, there was hyperthyroidism and a history of hysterectomy with bilateral salpingo-oophorectomy due to cervical cancer.There was no family history of cancer.On physical examination, a movable lump was palpable in the lower inner quadrant of the right breast, slightly tethering the skin without signs of infiltration.Lymph nodes were not enlarged.An ultrasound (US) examination showed a poorly defined area of heterogeneous echogenicity, within which areas of glandular and fibrous tissue echogenicity were visible, measuring 48 × 27 × 50 mm, which shows vascularity on color Doppler US and was assessed as BI-RADS 4.Contrast-enhanced spectral mammography (CESM) was performed and the low-energy images showed heterogeneously dense breast tissue with a partially obscured mass in the lower inner quadrant of the right breast which had irregular shape, indistinct margins and heterogeneous enhancement on the recombined images, measuring 52 x 40 mm and was assessed as BI-RADS 4 (Fig. 1A-D).Magnetic resonance imaging (MRI) scan showed soft-tissue tumor with high signal intensity in T2-weighted images, vivid contrast enhancement and restricted diffusion (Fig. 2A-D).A core needle biopsy was performed and histopathological examination was consistent with benign vascular tumor (CD34+, SMA+, CD31+, D2-40-, CK-) hemangioma or angiomatosis.Wide local excision of the tumor was performed.Postoperative histopathological examination revealed a tumor consistent with angiosarcoma with varying degrees of histological malignancy (Fig. 3A-D).Computed tomography scan showed no evidence of metastatic disease, so the patient was qualified for simple right-sided mastectomy without lymphadenectomy and for adjuvant radiotherapy.In the follow-up examinations no signs of local recurrence were observed but there were metastases to the liver and bones.The patient underwent palliative chemotherapy according to the AI regimen (Doxorubicin + Ifosfamide) and a single palliative radiotherapy session to the Th8 vertebra.The patient passed away approximately 3 years after the onset of initial symptoms.