Rare case of radiotherapy-induced angiosarcoma (RIAS) after conservative and radical treatment of breast cancer: About two cases and review of the literature.

INTRODUCTION AND IMPORTANCE: Angiosarcoma of the breast is a rare malignant tumour of endothelial origin. It is characterised by a high degree of malignancy and a polymorphous clinical and radiological presentation, a source of diagnostic error and delay. It has a very poor prognosis. Mammary angiosarcoma is a rare but formidable complication of radiotherapy. The specificity of this observation is that we are presenting two clinical cases of different surgical management of breast cancer who suffered the same complication from radiotherapy. CASE PRESENTATION: We report two cases of Radiotherapy-induced angiosarcoma (RIAS) in two patients with a history of breast cancer one treated by conservative surgery and radiotherapy and the other by radical surgery and radiotherapy both patients were operated. CLINICAL DISCUSSION: Radiotherapy-induced angiosarcoma (RIAS) is a rare complication of radiotherapy. The increasing use of conservative treatment of breast cancer, which combines surgery with radiotherapy and chemotherapy, can rarely be complicated by breast sarcoma. CONCLUSION: The natural history of radiation-induced angiosarcoma is more or less rapid, with death occurring in the setting of metastatic spread after a median survival of 24 months. The quality of the surgical procedure is a prognostic factor.

Occult primary breast cancer: Two cases report and literature review.

INTRODUCTION AND IMPORTANCE: Occult breast cancer (OBC) is defined as a clinically recognizable metastatic carcinoma arising from an undetectable primary breast tumor. PRESENTATION OF CASE: We report in this work 2 cases of occult breast cancer treated at the Mohammed VI center of onco-gynecology of the CHU of Casablanca. CLINICAL DISCUSSION: Significant advances in breast imaging have occurred since its description, decreasing its incidence. However current management is based upon old studies, with variable clinical, radiological and pathological definitions of OBC. CONCLUSION: The introduction of better diagnostic techniques and more detailed pathology continue to impact the true incidence of OBC. SUMMARY: Carcinoma of unknown primary is an intriguing clinical phenomenon that is defined as biopsy-proven metastasis of a malignant tumor in the absence of an identifiable primary site after a complete clinical workup. Carcinoma of unknown primary accounts for approximately 3 to 5% of all cancer diagnoses, and consists of a heterogeneous group of tumors that have acquired the ability to metastasize before the development of a clinically evident primary lesion. Clinical and radiological examinations represent the first steps in the diagnostic algorithm for Carcinoma of unknown primary syndrome. However, histological and immunohistochemical analyses, together with evaluation by a multidisciplinary team and adequate therapy are essential for the diagnosis and treatment of Carcinoma of unknown primary syndrome of OBC. We report in this work 2 cases of occult breast cancer treated at the Mohammed VI center of onco-gynecology of the CHU of Casablanca; A multidisciplinary approach including surgery, radiotherapy, hormonal and biological therapy was implemented. Currently, 10 month after the first presentation, the two patient received ipsilateral breast radiotherapy and sequential adjuvant chemotherapy followed by hormone therapy. Evolution was marked by good control.

Primary neuroendocrine carcinoma of the breast in association with squamous cell carcinoma of the breast: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Squamous cell carcinoma associated with primary neuroendocrine carcinoma (NEC) of the breast, also known as composite tumor, is an extremely rare malignancy with a very poor prognosis. PRESENTATION OF CASE: We report the case of a patient treated in our department for primary neuroendocrine carcinoma of the breast associated with squamous cell carcinoma by radical surgery. CLINICAL DISCUSSION: Diagnosis is based on histology and, above all, immunohistochemistry. Management depends on the primary or secondary origin of the neuroendocrine component, which constitutes the prognostic element. CONCLUSION: Squamous cell carcinoma associated with neuroendocrine carcinoma of the breast is an aggressive tumor. Due to its rarity, it is difficult to diagnose and to determine the most appropriate therapeutic protocol.

Leiomyosarcoma of the male breast: Case report.

INTRODUCTION: Primary sarcoma in man is very rare and knowledge about this tumor is limited with very few cases published in the literature. CASE REPORT: A 65-year-old man operated on 20 years ago for a left breast tumor with a skin graft at the tumor site (no documentation or pathology report). He consulted for a mass in the left breast, bleeding on contact, associated with nodules in the right breast that looked suspicious. On breast ultrasound, a tissue formation in the lower medial quadrant of the left breast with irregular contours, measuring 42 × 53mm with the presence of several suspicious tissue formations in the right breast, the largest measuring 2 × 2cm.Surgical removal of the left mass with a right mastectomy with pathology report of breast leiomyosarcoma with healthy surgical borders followed by radiotherapy for local control. DISCUSSION: Leiomyosarcoma is an extremely rare tumor in the breast and usually originates from the blood vessels, myoepithelium, or nipple musculature, as in our case. Breast sarcomas represent less than 1% of all malignant neoplasms of the breast. Their incidence in women is much higher than in men. CONCLUSION: Primary breast sarcomas are rare tumors that originate from the mesenchymal tissue of the breast and represent less than 1% of all malignant neoplasms of the breast. Their diagnosis is confirmed by biopsy with immunohistochemical and only surgery can guarantee cure. Radiotherapy is recommended for local control after surgery.