Surgical Pathology Criteria

Angiosarcoma of the Breast

Differential Diagnosis

Angiosarcoma of the Breast Perilobular Hemangioma
Almost always a hemorrhagic mass >2 cm Microscopic, incidental lesion
Diffuse, infiltrating Localized
Complex anastomoses No complex anastomoses
Intermediate and high grade tumors are cytologically atypical No significant cytologic atypia
Frequent papillae or tufting No papillae or tufting
Complete excision and examination are required to insure accurate diagnosis of an apparently benign vascular lesion in the breast

 

Angiosarcoma of the Breast Hemangioma of the Breast
Diffuse Circumscribed
Infiltrates and destroys lobules Adjacent to or surrounds lobules
Rarely <2 cm Rarely >2 cm
No fibrous septa Fibrous septa forming lobules of angioma
No feeder vessels May have feeder vessels
Complex anastomoses Few anastomoses, not complex
Intermediate and high grade tumors are cytologically atypical Focal atypia at most
Frequent papillae or tufting No papillae or tufting
May have hemorrhage and necrosis No hemorrhage or necrosis
No muscular walls Venous hemangioma may have muscular walls
Complete excision and examination are required to insure accurate diagnosis of an apparently benign vascular lesion in the breast

 

Angiosarcoma of the Breast Angiomatosis of the Breast
Variable patterns: channels, papillae, spindle cells Uniform pattern of vessels
Usually a t least focal cytologic atypia Cytologically bland
Invades lobules Does not invade lobules
Frequent papillae and tufting No papillae or tufting
  • Complete excision and examination are required to insure accurate diagnosis of an apparently benign vascular lesion in the breast
  • Angiomatosis is an extremely rare lesion; it is a diagnosis that requires consultation
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    Low Grade Angiosarcoma Pseudoangiomatous Stromal Hyperplasia
    Endothelial lined spaces No endothelial lining of spaces
    Red blood cells in some spaces No red blood cells in spaces
    Infiltrates fat No infiltration of fat
    Infiltrates lobules Merges with lobular stroma
    Lining is CD31+ Lining is CD31 negative
    Both contain anastomosing spaces containing CD34+ cells

     

    High Grade Angiosarcoma Undifferentiated or Poorly Differentiated Malignant Neoplasm
    May have peripheral vascular differentiation Lacks any vascular differentiation
    CD34 or CD31 positive Positive for other specific lineage markers

     

    Angiosarcoma Atypical Vascular Lesion
    Usually no history of radiation Almost all have received radiation
    Most within the breast but may be in the skin in irradiated patients Usually in the skin of the breast
    Most often a hemorrhagic mass > 2 cm Small non-hemorrhagic lesion
    Note: Atypical vascular lesions may evolve into angiosarcoma. The morphologic features that separate the two are poorly defined.

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