Loyola researchers conclude more study needed to find special markers that can reliably predict which lesions will progress to deadly angiosarcomas
MAYWOOD, Ill. -- Physicians have long noticed that breast cancer patients who have had surgery or radiation therapy have an heightened risk of developing angiosarcoma, a rare type of cancer that originates in the lining of the blood vessels.
Now, researchers at Loyola University Health System in Maywood, Ill., have focused in on a finding that could be a possible precursor to angiosarcoma. With further research this finding could lead to more definitive markers that could predict those who are most likely to develop the disease. Angiosarcoma is a malignant, rapidly growing, highly invasive type of cancer that has a high mortality rate.
In a case study published in the August issue of the Journal of the American Academy of Dermatology, researchers at Loyola identified what at first appeared to be only a tiny bruise on the right breast of a 63-year-old woman. Four years prior the woman had had a lumpectomy in the breast and radiation therapy for cancer. She had also had chemotherapy and hormone therapy.
"Normally, when you see a benign-appearing vascular lesion, you probably would pass it up," said Dr. Joshua Mandrell, a dermatologist who co-authored the report. "But given her history, we biopsied it and it did show that it was an atypical vascular lesion."
Atypical vascular lesions are abnormal vascular growths that are thought to form in response to trauma, such as that caused by surgery and radiation therapy, according to the study. The lesions are so rare that few medical professionals are aware of their existence. There are also no well defined prognosis factors or treatment guidelines for them.
"Atypical vascular lesions are not completely benign blood vessel growths and are not angiosarcoma. They are right in the middle. They are atypical enough that we suggest in our study that they warrant treatment," Mandrell said. "The thought is that they could potentially become angiosarcomas."
As a precaution, the patient’s lesion and a significant amount of tissue surrounding it was surgically removed.
"We wanted to make sure that nothing was left that could progress to an angiosarcoma," Mandrell said.
The study concludes that the focus of future research should be on finding markers to detect which type of atypical vascular lesions are more likely to lead to an angiosarcoma.
"This is probably where most of the research should be done," Mandrell said. "Anybody who has had radiation has changes in their skin. It was probably radiation in combination with the surgery for the cancer that led to the development of this entity. The main question is, ‘Are there special markers or other histological features underneath the microscope that would suggest that an atypical vascular lesion is worse and more likely to develop into an angiosarcoma and another one is not?’ That’s still not well defined."
The study also concludes that the medical community needs to heighten its surveillance of the skin of patients who have a history of surgery and radiation therapy for breast cancer.
"Even benign-appearing lesions can be serious given that medical history," Mandrell said. "Dermatologists and primary care physicians should be looking at the skin for any changes in this patient population."
The Journal of the American Academy of Dermatology is the official publication of the American Academy of Dermatology, an organization dedicated to the clinical and continuing education needs of the entire dermatologic community. It is internationally known as the leading journal in the field. The journal’s original, peer-reviewed articles cover clinical and investigative studies, treatments, new diagnostic techniques, and other topics relating to the prevention, diagnosis and treatment of skin disorders.
Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 569-licensed-bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children’s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 264-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.