several randomized trials have demonstrated that breast - conserving surgery followed by radiation therapy , which is called breast - conserving therapy ( bct ) , is as effective as mastectomy and should be a standard treatment for early - stage breast cancer .
recently , there has been an increase in reports of angiosarcoma ( as ) after bct [ 2 , 3 , 4 ] .
lymphedema - associated cutaneous as , so - called stewart - treves syndrome , was first described in 1948 by stewart and treves .
herein , we report a case of as which developed after bct and a case of stewart - treves syndrome with a focus on lymphedema .
in 1997 , a 62-year - old woman underwent bct with 50 gy radiation for left - sided breast cancer , categorized as stage ia .
she was started on weekly intravenous paclitaxel at a dose of 100 mg / m . in may 2009 , she presented with an erythematous purplish palpable mass on the right breast ( fig .
a punch biopsy revealed the invasion of spindle - shaped cells with vascular differentiation into the subcutaneous tissue ( fig .
each time , further wide excisions were performed . due to these local recurrences , at 85 cycles after the administration of weekly paclitaxel therapy , the patient was switched to monthly docetaxel at a dose of 70 mg / m . since then
a 64-year - old woman was diagnosed with right - sided breast cancer that was categorized as stage ia .
she received no adjuvant radiotherapy because she had already been treated with chemotherapy using a combination of paclitaxel and carboplatin for ovarian cancer . in november 2011
, the patient was admitted to our hospital for evaluation of purplish ecchymosed cutaneous lesions without a palpable mass on the right breast in the setting of chronic lymphedema ( fig .
a punch biopsy revealed pleomorphic spindle - shaped cells with little vascular differentiation infiltrated into the dermis ( fig .
the patient was started on monthly docetaxel at a dose of 75 mg / m .
in 1997 , a 62-year - old woman underwent bct with 50 gy radiation for left - sided breast cancer , categorized as stage ia .
she was started on weekly intravenous paclitaxel at a dose of 100 mg / m . in may 2009 , she presented with an erythematous purplish palpable mass on the right breast ( fig .
a punch biopsy revealed the invasion of spindle - shaped cells with vascular differentiation into the subcutaneous tissue ( fig .
each time , further wide excisions were performed . due to these local recurrences , at 85 cycles after the administration of weekly paclitaxel therapy , the patient was switched to monthly docetaxel at a dose of 70 mg / m . since then
a 64-year - old woman was diagnosed with right - sided breast cancer that was categorized as stage ia .
she received no adjuvant radiotherapy because she had already been treated with chemotherapy using a combination of paclitaxel and carboplatin for ovarian cancer . in november 2011
, the patient was admitted to our hospital for evaluation of purplish ecchymosed cutaneous lesions without a palpable mass on the right breast in the setting of chronic lymphedema ( fig .
a punch biopsy revealed pleomorphic spindle - shaped cells with little vascular differentiation infiltrated into the dermis ( fig .
the patient was started on monthly docetaxel at a dose of 75 mg / m .
many studies have demonstrated that radiation may be a major risk factor in the development of as [ 2 , 3 , 4 ] . on the other hand ,
case 2 suggests that chronic lymphedema is the primary risk factor for as , which was first described in 1948 by stewart and treves .
radiation therapy secondarily tends to induce the development of as , since radiation therapy induces fibrosis and proliferation of lymphatic vessels via cytokines such as vascular endothelial growth factor , which is followed by subclinical chronic edema .
it is suggested that axillary lymph node dissection predisposes patients to the development of as , since it is closely associated with lymphedema .
the increased use of bct is likely to lead to an increase in the number of patients with as .
the prognosis of as after bct is poor , with a low 5-year overall survival ( 55% ) and a low disease - free survival at 5 years ( 35% ) .
therefore , breast surgeons and radiologists should be aware of skin changes in order to improve the early detection of as during the follow - up of patients who have undergone bct , and especially those treated with axillary lymph node dissection .
 several randomized trials have shown that breast - conserving therapy ( bct ) is as effective as mastectomy and should be a standard treatment for early - stage breast cancer . 
 recently , there has been an increase in reports of angiosarcoma ( as ) after bct . 
 herein , we report a case of as which developed after bct and a case of stewart - treves syndrome with a focus on lymphedema . 
 chronic lymphedema is the primary risk factor for as , which was first described in 1948 by stewart and treves [ cancer 1948;1:6481 ] . 
 radiation therapy secondarily tends to induce the development of as , since radiation therapy induces fibrosis and proliferation of lymphatic vessels via cytokines such as vascular endothelial growth factor , which is followed by subclinical chronic edema . 
 it is suggested that axillary lymph node dissection predisposes patients to the development of as , since it is closely associated with lymphedema . 
 breast surgeons and radiologists should be aware of skin changes in order to improve the early detection of as during the follow - up of patients who have undergone bct , and especially those treated with axillary lymph node dissection . 
Introduction
Case Report
Case 1
Case 2
Discussion