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Primary breast angiosarcoma is an uncommon, aggressive vascular tumour that poses diagnostic difficulties due to overlapping clinical, radiological and histological features. We describe a patient who presented with a painless breast lump where initial cytology suggested ductal carcinoma, and core needle biopsy showed fibroadenoma. Immunohistochemistry (IHC) confirmed angiosarcoma. She underwent a mastectomy with axillary dissection. Final histopathology showed a poorly differentiated angiosarcoma with negative margins and no nodal involvement. Adjuvant radiotherapy (intensity-modulated radiation therapy with active breathing control, 66 Gy in 33 fractions) was delivered, and adjuvant chemotherapy was not administered after tumour board discussion. At 2 years follow-up, she remains disease free. This case underlines the potential for diagnostic misclassification, the importance of IHC for accurate diagnosis and the value of multidisciplinary management in achieving favourable outcomes.