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
| 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.
