1例误诊为非哺乳期乳腺炎的原发性乳腺血管肉瘤并文献复习_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

刘虹 ¹ , 陈娟 ² , 余慧珍 ³ , 王铁霖 ¹ , 王彬 ¹ , 王浩斌 ¹ ,  吴剑 ¹

1. ;
2. ;
3. ;

Corresponding author：

吴剑, Email: Wooj69@163.com

Keywords：

乳腺血管肉瘤; 非哺乳期乳腺炎; 误诊

DOI：

10.7507/1007-9424.202308075

Video：

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目的通过回顾分析1例被误诊为非哺乳期乳腺炎的原发性乳腺血管肉瘤患者资料，结合国内外文献，对乳腺血管肉瘤疾病特征及诊治要点进行总结，提供临床诊治参考，避免误诊。方法回顾性分析该例患者的临床表现、诊疗经过、辅助检查及病理特点；检索相关中英文文献资料，综合分析文献报道病例特点。结果该例患者初始表现为乳房胀痛，查体可见乳房肿胀，彩超及钼靶检查考虑乳腺炎性病变，前2次病理活检未提示恶性病变。肿瘤明显长大突出皮肤表面后行第3次活检确诊。总结文献报道病例资料，乳腺原发性血管肉瘤为罕见的乳腺恶性病变，手术为主要治疗方式，无标准化疗、放疗及靶向治疗方案。结论乳腺血管肉瘤恶性程度高，远期生存率低，模仿了乳腺多种良性疾病的生长模式。乳腺彩超及钼靶X线摄片无特征性改变，易延误诊治，病理活检为确诊依据。结合临床表现及辅助检查确诊后应尽早治疗，可改善预后。

Citation： 刘虹, 陈娟, 余慧珍, 王铁霖, 王彬, 王浩斌, 吴剑. 1例误诊为非哺乳期乳腺炎的原发性乳腺血管肉瘤并文献复习. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(12): 1488-1492. doi: 10.7507/1007-9424.202308075 Copy

1.	Varghese B, Deshpande P, Dixit S, et al. Primary angiosarcoma of the breast: a case report. J Radiol Case Rep, 2019, 13(2): 15-25.
2.	Friedrich AU, Reisenbichler ES, Heller DR, et al. Characteristics and long-term risk of breast angiosarcoma. Ann Surg Oncol, 2021, 28(9): 5112-5118.
3.	Meng T, Zhou Y, Ye MN, et al. Primary highly differentiated breast angiosarcoma in an adolescent girl. Eur Rev Med Pharmacol Sci, 2022, 26(4): 1299-1303.
4.	Russo D, Campanino MR, Cepurnaite R, et al. Primary high-grade angiosarcoma of the breast in a young woman with breast implants: A rare case and a review of literature. Int J Surg Pathol, 2020, 28(8): 906-912.
5.	Alshaar M, Alkhatib M, Sara S, et al. Primary breast angiosarcoma resembling a common benign tumor: A case report. Ann Med Surg (Lond), 2021, 65: 102281.
6.	梁烁, 王聪, 姚昶, 等. 浆细胞性乳腺炎合并浸润性导管癌误诊一例. 临床外科杂志, 2021, 29(7): 690-692.
7.	Wei N, Crowley TP, Ragbir M. Early breast angiosarcoma development after radiotherapy: a cautionary tale. Ann Plast Surg, 2019, 83(2): 152-153.
8.	Wu WH, Ji QL, Li ZZ, et al. Mammography and MRI manifestations of breast angiosarcoma. BMC Womens Health, 2019, 19(1): 73.
9.	Kacen MG, Sangle N, Kornecki A. Contrast-enhanced mammography in the diagnosis of breast angiosarcoma. Case Rep Radiol, 2021, 2021: 5542786.
10.	Mumin NA, Rahmat K, Hamid M, et al. Primary breast angiosarcoma: utilisation of pre-surgical magnetic resonance imaging (MRI) for accurate tumour characterization and planning—A case report and literature review. Curr Med Imaging, 2021, 17(4): 552-558.
11.	Glazebrook KN, Magut MJ, Reynolds C. Angiosarcoma of the breast. AJR Am J Roentgenol, 2008, 190(2): 533-538.
12.	Yang OO, Lan T, He JL, et al. Magnetic resonance imaging and contrast-enhanced ultrasound findings of a recurrent primary breast angiosarcoma: A case report. Medicine (Baltimore), 2021, 100(5): e24625.
13.	Wang XY, Jakowski J, Tawfik OW, et al. Angiosarcoma of the breast: a clinicopathologic analysis of cases from the last 10 years. Ann Diagn Pathol, 2009, 13(3): 147-150.
14.	Alves I, Marques JC. Radiation-induced angiosarcoma of the breast: a retrospective analysis of 15 years' experience at an oncology center. Radiol Bras, 2018, 51(5): 281-286.
15.	关会娟, 刘秋雨, 宋晓霞, 等. 乳腺血管肉瘤临床病理及分子生物学特征. 中华实用诊断与治疗杂志, 2020, 34(6): 570-572.
16.	Yan M, Gilmore H, Bomeisl P, et al. Clinicopathologic and immunohistochemical study of breast angiosarcoma. Ann Diagn Pathol, 2021, 54: 151795.
17.	刘红, 赵晶, 付丽. 乳腺原发性血管肉瘤的诊断治疗进展. 中国肿瘤临床, 2006, 33(15): 897-899.
18.	Taghipour Zahir S, Sefidrokh Sharahjin N, Rahmani K. Primary breast angiosarcoma: pathological and radiological diagnosis. Malays J Med Sci, 2014, 21(5): 66-70.
19.	Mergancová J, Lierová A, Coufal O, et al. Radiation-associated angiosarcoma of the breast: An international multicenter analysis. Surg Oncol, 2022, 41: 101726.
20.	Gutkin PM, Ganjoo KN, Lohman M, et al. Angiosarcoma of the breast: management and outcomes. Am J Clin Oncol, 2020, 43(11): 820-825.
21.	Zdravkovic D, Granic M, Crnokrak B. Proper treatment of breast angiosarcoma-mastectomy or breast conserving surgery? Breast Cancer Res Treat, 2020, 179(3): 765. doi: 10.1007/s10549-019-05509-0.
22.	Taffurelli M, Pellegrini A, Meattini I, et al. Secondary breast angiosarcoma: A multicentre retrospective survey by the national Italian association of Breast Surgeons (ANISC). Breast, 2019, 45: 56-60.
23.	Sasahara A, Tanabe M, Hayashi K, et al. A case of primary breast angiosarcoma with multiple discontinuous small lesions. Surg Case Rep, 2019, 5(1): 157. doi:10.1186/s40792- 019-0704-8.
24.	马榕, 张凯. 乳腺原发性血管肉瘤的临床病理特征及术式选择. 中国实用外科杂志, 2013, 33(3): 244-246.
25.	Herb J, Maduekwe UN, Goel N, et al. Does angiosarcoma of the breast need nodal staging? J Am Coll Surg, 2022, 234(5): 774-782.
26.	韩琼, 袁茂林, 吴斌. 基于SEER数据库的原发性乳腺血管肉瘤临床病理特征及预后因素分析. 中国普通外科杂志, 2019, 28(11): 1381-1387.
27.	Hatfield J, McClelland S 3rd, Luo J, et al. Management of localized breast angiosarcoma by north american radiation and medical oncologists. Clin Breast Cancer, 2018, 18(6): 498-503.
28.	Cannella L, Perri F, Clemente O, et al. The complex management of the breast angiosarcoma: a retrospective study. Oncology, 2023, 101(4): 234-239.
29.	Lewcun JA, Pameijer C, Kass R, et al. Doxorubicin, paclitaxel, and cisplatin based chemotherapy for the treatment of angiosarcoma: Two case reports. Int J Surg Case Rep, 2020, 68: 83-87.
30.	Bender L, Gantzer J, Somme F, et al. Complete response of a pleural, hepatic, and splenic metastatic primary breast angiosarcoma using gemcitabine monotherapy. JCO Oncol Pract, 2020, 16(4): 181-183.
31.	Kronenfeld JP, Crystal JS, Ryon EL, et al. Clinical outcomes for primary and radiation-associated angiosarcoma of the breast with multimodal treatment: long-term survival is achievable. Cancers (Basel), 2021, 13(15): 3814.
32.	Benevento R, Carafa F, Di Nardo D, et al. Angiosarcoma of the breast: a new therapeutic approach? Int J Surg Case Rep, 2015, 13: 30-32.
33.	Sturm EC, Marasco IS, Katz SC. Multidisciplinary management of angiosarcoma—a review. J Surg Res, 2021, 257: 213-220.
34.	Florou V, Rosenberg AE, Wieder E, et al. Angiosarcoma patients treated with immune checkpoint inhibitors: a case series of seven patients from a single institution. J Immunother Cancer, 2019, 7(1): 213.
35.	Qin X, Wu Y, Yu L, et al. Metastasis of primary breast angio-sarcoma to axillary and supraclavicular lymph nodes: a rare case diagnosed using imaging data. J Int Med Res, 2021, 49(3): 3000605211002337. doi: 10.1177/03000605211002337.
36.	Kim YJ, Ryu JM, Lee SK, et al. Primary angiosarcoma of the breast: A single-center retrospective study in Korea. Curr Oncol, 2022, 29(5): 3272-3281.
37.	Wang L, Lao IW, Yu L, et al. Primary breast angiosarcoma: A retrospective study of 36 cases from a single chinese medical institute with clinicopathologic and radiologic correlations. Breast J, 2017, 23(3): 282-291.
38.	Abdou Y, Elkhanany A, Attwood K, et al. Primary and secondary breast angiosarcoma: single center report and a meta-analysis. Breast Cancer Res Treat, 2019, 178(3): 523-533.
39.	Sato F, Yamamoto T. Breast angiosarcoma after primary breast cancer surgery: A systematic review. J Plast Reconstr Aesthet Surg, 2022, 75(9): 2882-2889.

1. Varghese B, Deshpande P, Dixit S, et al. Primary angiosarcoma of the breast: a case report. J Radiol Case Rep, 2019, 13(2): 15-25.
2. Friedrich AU, Reisenbichler ES, Heller DR, et al. Characteristics and long-term risk of breast angiosarcoma. Ann Surg Oncol, 2021, 28(9): 5112-5118.
3. Meng T, Zhou Y, Ye MN, et al. Primary highly differentiated breast angiosarcoma in an adolescent girl. Eur Rev Med Pharmacol Sci, 2022, 26(4): 1299-1303.
4. Russo D, Campanino MR, Cepurnaite R, et al. Primary high-grade angiosarcoma of the breast in a young woman with breast implants: A rare case and a review of literature. Int J Surg Pathol, 2020, 28(8): 906-912.
5. Alshaar M, Alkhatib M, Sara S, et al. Primary breast angiosarcoma resembling a common benign tumor: A case report. Ann Med Surg (Lond), 2021, 65: 102281.
6. 梁烁, 王聪, 姚昶, 等. 浆细胞性乳腺炎合并浸润性导管癌误诊一例. 临床外科杂志, 2021, 29(7): 690-692.
7. Wei N, Crowley TP, Ragbir M. Early breast angiosarcoma development after radiotherapy: a cautionary tale. Ann Plast Surg, 2019, 83(2): 152-153.
8. Wu WH, Ji QL, Li ZZ, et al. Mammography and MRI manifestations of breast angiosarcoma. BMC Womens Health, 2019, 19(1): 73.
9. Kacen MG, Sangle N, Kornecki A. Contrast-enhanced mammography in the diagnosis of breast angiosarcoma. Case Rep Radiol, 2021, 2021: 5542786.
10. Mumin NA, Rahmat K, Hamid M, et al. Primary breast angiosarcoma: utilisation of pre-surgical magnetic resonance imaging (MRI) for accurate tumour characterization and planning—A case report and literature review. Curr Med Imaging, 2021, 17(4): 552-558.
11. Glazebrook KN, Magut MJ, Reynolds C. Angiosarcoma of the breast. AJR Am J Roentgenol, 2008, 190(2): 533-538.
12. Yang OO, Lan T, He JL, et al. Magnetic resonance imaging and contrast-enhanced ultrasound findings of a recurrent primary breast angiosarcoma: A case report. Medicine (Baltimore), 2021, 100(5): e24625.
13. Wang XY, Jakowski J, Tawfik OW, et al. Angiosarcoma of the breast: a clinicopathologic analysis of cases from the last 10 years. Ann Diagn Pathol, 2009, 13(3): 147-150.
14. Alves I, Marques JC. Radiation-induced angiosarcoma of the breast: a retrospective analysis of 15 years' experience at an oncology center. Radiol Bras, 2018, 51(5): 281-286.
15. 关会娟, 刘秋雨, 宋晓霞, 等. 乳腺血管肉瘤临床病理及分子生物学特征. 中华实用诊断与治疗杂志, 2020, 34(6): 570-572.
16. Yan M, Gilmore H, Bomeisl P, et al. Clinicopathologic and immunohistochemical study of breast angiosarcoma. Ann Diagn Pathol, 2021, 54: 151795.
17. 刘红, 赵晶, 付丽. 乳腺原发性血管肉瘤的诊断治疗进展. 中国肿瘤临床, 2006, 33(15): 897-899.
18. Taghipour Zahir S, Sefidrokh Sharahjin N, Rahmani K. Primary breast angiosarcoma: pathological and radiological diagnosis. Malays J Med Sci, 2014, 21(5): 66-70.
19. Mergancová J, Lierová A, Coufal O, et al. Radiation-associated angiosarcoma of the breast: An international multicenter analysis. Surg Oncol, 2022, 41: 101726.
20. Gutkin PM, Ganjoo KN, Lohman M, et al. Angiosarcoma of the breast: management and outcomes. Am J Clin Oncol, 2020, 43(11): 820-825.
21. Zdravkovic D, Granic M, Crnokrak B. Proper treatment of breast angiosarcoma-mastectomy or breast conserving surgery? Breast Cancer Res Treat, 2020, 179(3): 765. doi: 10.1007/s10549-019-05509-0.
22. Taffurelli M, Pellegrini A, Meattini I, et al. Secondary breast angiosarcoma: A multicentre retrospective survey by the national Italian association of Breast Surgeons (ANISC). Breast, 2019, 45: 56-60.
23. Sasahara A, Tanabe M, Hayashi K, et al. A case of primary breast angiosarcoma with multiple discontinuous small lesions. Surg Case Rep, 2019, 5(1): 157. doi:10.1186/s40792- 019-0704-8.
24. 马榕, 张凯. 乳腺原发性血管肉瘤的临床病理特征及术式选择. 中国实用外科杂志, 2013, 33(3): 244-246.
25. Herb J, Maduekwe UN, Goel N, et al. Does angiosarcoma of the breast need nodal staging? J Am Coll Surg, 2022, 234(5): 774-782.
26. 韩琼, 袁茂林, 吴斌. 基于SEER数据库的原发性乳腺血管肉瘤临床病理特征及预后因素分析. 中国普通外科杂志, 2019, 28(11): 1381-1387.
27. Hatfield J, McClelland S 3rd, Luo J, et al. Management of localized breast angiosarcoma by north american radiation and medical oncologists. Clin Breast Cancer, 2018, 18(6): 498-503.
28. Cannella L, Perri F, Clemente O, et al. The complex management of the breast angiosarcoma: a retrospective study. Oncology, 2023, 101(4): 234-239.
29. Lewcun JA, Pameijer C, Kass R, et al. Doxorubicin, paclitaxel, and cisplatin based chemotherapy for the treatment of angiosarcoma: Two case reports. Int J Surg Case Rep, 2020, 68: 83-87.
30. Bender L, Gantzer J, Somme F, et al. Complete response of a pleural, hepatic, and splenic metastatic primary breast angiosarcoma using gemcitabine monotherapy. JCO Oncol Pract, 2020, 16(4): 181-183.
31. Kronenfeld JP, Crystal JS, Ryon EL, et al. Clinical outcomes for primary and radiation-associated angiosarcoma of the breast with multimodal treatment: long-term survival is achievable. Cancers (Basel), 2021, 13(15): 3814.
32. Benevento R, Carafa F, Di Nardo D, et al. Angiosarcoma of the breast: a new therapeutic approach? Int J Surg Case Rep, 2015, 13: 30-32.
33. Sturm EC, Marasco IS, Katz SC. Multidisciplinary management of angiosarcoma—a review. J Surg Res, 2021, 257: 213-220.
34. Florou V, Rosenberg AE, Wieder E, et al. Angiosarcoma patients treated with immune checkpoint inhibitors: a case series of seven patients from a single institution. J Immunother Cancer, 2019, 7(1): 213.
35. Qin X, Wu Y, Yu L, et al. Metastasis of primary breast angio-sarcoma to axillary and supraclavicular lymph nodes: a rare case diagnosed using imaging data. J Int Med Res, 2021, 49(3): 3000605211002337. doi: 10.1177/03000605211002337.
36. Kim YJ, Ryu JM, Lee SK, et al. Primary angiosarcoma of the breast: A single-center retrospective study in Korea. Curr Oncol, 2022, 29(5): 3272-3281.
37. Wang L, Lao IW, Yu L, et al. Primary breast angiosarcoma: A retrospective study of 36 cases from a single chinese medical institute with clinicopathologic and radiologic correlations. Breast J, 2017, 23(3): 282-291.
38. Abdou Y, Elkhanany A, Attwood K, et al. Primary and secondary breast angiosarcoma: single center report and a meta-analysis. Breast Cancer Res Treat, 2019, 178(3): 523-533.
39. Sato F, Yamamoto T. Breast angiosarcoma after primary breast cancer surgery: A systematic review. J Plast Reconstr Aesthet Surg, 2022, 75(9): 2882-2889.

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1例误诊为非哺乳期乳腺炎的原发性乳腺血管肉瘤并文献复习

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