Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

A Papule Arising in Irradiated Breast Tissue—Diagnosis

A Papule Arising in Irradiated Breast Tissue—Diagnosis Diagnosis: Atypical vascular lesion (AVL). Microscopic findings Histopathologic examination of the papule revealed a relatively well-circumscribed vascular proliferation consisting of dilated and angulated vascular channels lined by a single layer of widely spaced inconspicuous endothelial cells with only mild cytologic atypia. Focal branching of the vascular channels and projections of endothelium-covered stroma into the vascular lumina were seen. There was a mild associated chronic inflammatory infiltrate. The lesion was limited to the superficial to midreticular dermis and did not infiltrate the deep dermis or subcutaneous tissue. Discussion The histologic description of the lesion in the present case—a superficially dermal-based, relatively well-circumscribed vascular proliferation composed of dilated vascular channels that were lined by inconspicuous endothelial cells without significant cytological atypia—was consistent with an AVL. This entity has been described in women who were previously treated with radiation therapy for breast carcinoma.1-4 It typically presents as a discrete 3- to 4-mm pink papule on the surface of irradiated tissue. The lesions most commonly occur as a single papule, but they also may rarely present as multiple papules. The lesion is referred to as atypical because the endothelial cells lining the vessels, although monomorphous and single layered, may have mild cytologic atypia. Also, the AVL is often not well circumscribed, and the anastamosing and dissecting pattern of vascular proliferation may suggest a well-differentiated angiosarcoma, which is clinically much more aggressive. Although angiosarcoma and AVL may be confused with one another, AVL has a more innocuous clinical course and unique histologic features, including the lack of involvement of the subcutaneous tissues, lack of substantial cytologic atypia, and monomorphous single-layered or sometimes bilayered endothelial cells that line the vascular channels, which have hyperchromatic nuclei but lack prominent nucleoli and mitotic figures. The histopathologic findings of AVL are suggestive of a lymphatic origin.1 The vascular and lymphatic changes of AVL are suspected to be a manifestation of radiation damage to cutaneous tissue. While benign clinically, these lesions are of great importance as they can be clinically and histologically mistaken for angiosarcoma, a malignant neoplasm that has a consistently aggressive course and poor long-term outcome and is also seen in patients who have undergone radiation therapy. Treatment consists of simple excision. Long-term follow-up of similar patients who have been described in the literature has shown that AVLs are not associated with recurrence, aggressive local growth, or metastasis. Finally, there is no evidence to suggest that AVL represents a precursor to angiosarcoma. References 1. Diaz-Cascajo CBorghi SWeyers WRetzlaff HRequena LMetze D Benign lymphangiomatous papules of the skin following radiotherapy: a report of five new cases and a review of the literature. Histopathology 1999;35319- 327PubMedGoogle ScholarCrossref 2. Gottfarstein-Maruani AEsteve E Benign vascular proliferations in previously irradiated skin. Am J Surg Pathol 2002;261372- 1373PubMedGoogle ScholarCrossref 3. Requena LKutzner HMentzel TDuran RRodriguez-Peralto JL Benign vascular proliferations in irradiated skin. Am J Surg Pathol 2002;26328- 337PubMedGoogle ScholarCrossref 4. Fineberg SRosen PP Cutaneous angiosarcoma and atypical vascular lesions of the skin and breast after radiation therapy for breast carcinoma. Am J Clin Pathol 1994;102757- 763PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

A Papule Arising in Irradiated Breast Tissue—Diagnosis

Archives of Dermatology , Volume 142 (1) – Jan 1, 2006

A Papule Arising in Irradiated Breast Tissue—Diagnosis

Abstract

Diagnosis: Atypical vascular lesion (AVL). Microscopic findings Histopathologic examination of the papule revealed a relatively well-circumscribed vascular proliferation consisting of dilated and angulated vascular channels lined by a single layer of widely spaced inconspicuous endothelial cells with only mild cytologic atypia. Focal branching of the vascular channels and projections of endothelium-covered stroma into the vascular lumina were seen. There was a mild associated chronic...
Loading next page...
 
/lp/american-medical-association/a-papule-arising-in-irradiated-breast-tissue-diagnosis-SXZm67I9kO
Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.142.1.101-f
Publisher site
See Article on Publisher Site

Abstract

Diagnosis: Atypical vascular lesion (AVL). Microscopic findings Histopathologic examination of the papule revealed a relatively well-circumscribed vascular proliferation consisting of dilated and angulated vascular channels lined by a single layer of widely spaced inconspicuous endothelial cells with only mild cytologic atypia. Focal branching of the vascular channels and projections of endothelium-covered stroma into the vascular lumina were seen. There was a mild associated chronic inflammatory infiltrate. The lesion was limited to the superficial to midreticular dermis and did not infiltrate the deep dermis or subcutaneous tissue. Discussion The histologic description of the lesion in the present case—a superficially dermal-based, relatively well-circumscribed vascular proliferation composed of dilated vascular channels that were lined by inconspicuous endothelial cells without significant cytological atypia—was consistent with an AVL. This entity has been described in women who were previously treated with radiation therapy for breast carcinoma.1-4 It typically presents as a discrete 3- to 4-mm pink papule on the surface of irradiated tissue. The lesions most commonly occur as a single papule, but they also may rarely present as multiple papules. The lesion is referred to as atypical because the endothelial cells lining the vessels, although monomorphous and single layered, may have mild cytologic atypia. Also, the AVL is often not well circumscribed, and the anastamosing and dissecting pattern of vascular proliferation may suggest a well-differentiated angiosarcoma, which is clinically much more aggressive. Although angiosarcoma and AVL may be confused with one another, AVL has a more innocuous clinical course and unique histologic features, including the lack of involvement of the subcutaneous tissues, lack of substantial cytologic atypia, and monomorphous single-layered or sometimes bilayered endothelial cells that line the vascular channels, which have hyperchromatic nuclei but lack prominent nucleoli and mitotic figures. The histopathologic findings of AVL are suggestive of a lymphatic origin.1 The vascular and lymphatic changes of AVL are suspected to be a manifestation of radiation damage to cutaneous tissue. While benign clinically, these lesions are of great importance as they can be clinically and histologically mistaken for angiosarcoma, a malignant neoplasm that has a consistently aggressive course and poor long-term outcome and is also seen in patients who have undergone radiation therapy. Treatment consists of simple excision. Long-term follow-up of similar patients who have been described in the literature has shown that AVLs are not associated with recurrence, aggressive local growth, or metastasis. Finally, there is no evidence to suggest that AVL represents a precursor to angiosarcoma. References 1. Diaz-Cascajo CBorghi SWeyers WRetzlaff HRequena LMetze D Benign lymphangiomatous papules of the skin following radiotherapy: a report of five new cases and a review of the literature. Histopathology 1999;35319- 327PubMedGoogle ScholarCrossref 2. Gottfarstein-Maruani AEsteve E Benign vascular proliferations in previously irradiated skin. Am J Surg Pathol 2002;261372- 1373PubMedGoogle ScholarCrossref 3. Requena LKutzner HMentzel TDuran RRodriguez-Peralto JL Benign vascular proliferations in irradiated skin. Am J Surg Pathol 2002;26328- 337PubMedGoogle ScholarCrossref 4. Fineberg SRosen PP Cutaneous angiosarcoma and atypical vascular lesions of the skin and breast after radiation therapy for breast carcinoma. Am J Clin Pathol 1994;102757- 763PubMedGoogle Scholar

Journal

Archives of DermatologyAmerican Medical Association

Published: Jan 1, 2006

Keywords: breast tissue,papule

References