Bilateral metastatic breast angiosarcoma to the mandibular gingiva: case report A.K. Poulopoulos a , K. Antoniades b, *, A. Kiziridou c a Department of Oral Medicine and Pathology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece b Department of Oral and Maxillofacial Surgery, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece c Department of Pathology, Theagenion Anticancer Hospital, Thessaloniki, Greece Abstract Metastases to the jaws and oral soft tissues are rare. A case of breast angiosarcoma metastatic to the mandible and the gingiva, bilaterally in the premolar area is presented. The clinical, histological features and the management of the metastatic oral lesions are reported. Our case emphasises the possibility that in patients with history of breast angiosarcoma, oral in¯ammatory-like lesions may be an indication of a metastatic deposit. # 2001 Elsevier Science Ltd. All rights reserved. Keywords: Breast angiosarcoma; Metastasis; Mandibular gingiva 1. Introduction Angiosarcoma is a rare, highly malignant soft tissue sarcoma [1]. Primary angiosarcoma of the breast is a rare tumor, with approximately 170 cases reported in the literature [2]. Secondary angiosarcoma of the breast may appear as a late sequel of radiotherapy for breast cancer [3]. Breast angiosarcoma has the worst prognosis of all mammary malignancies. Treat- ment options are numerous and con¯icting [4]. Metastatic tumors to the oral cavity are uncommon. A review of the literature revealed only four reported cases of angiosarcoma metastatic to the oral cavity [5±8]. This paper presents a case of breast angiosarcoma metastatic to the mandible and the gingiva bilaterally in the premolars area. 2. Case report A 61 year-old woman was referred to the Department of Oral and Maxillofacial Surgery, for investigation and management of bilateral bleeding lumps on the man- dibular gingiva in the area of the premolars. The past medical history revealed a primary angio- sarcoma of the breast. The initial excisional biopsy performed 2 years ago, described the breast tumor as a mass of 6 cm diameter, characterised by inter- anastomosing channels around breast ducts, lined by endothelial cells with large nucleoli, and numerous mitoses. The choice of treatment was complete surgical excision of the breast; it included the mass in adequate margins and specimens of lymph nodes of the ®rst level. Histopathologic study of the tumor indicated angio- sarcoma of the breast of high grade malignancy. The removed lymph nodes were free of metastatic lesions. Full laboratory investigation including chest X-ray, liver enzymes, liver±spleen scan, mamograph of the right breast, bone scan, liver echo were negative. Six addi- tional sessions of chemotherapy were performed that included methotrexate, doxorubicin and ifosfamide. A local recurrence followed 9 months after the ®rst presentation and second excisional biopsy con®rmed the initial diagnosis. The patient was treated with radio- therapy (total tumor dose 5040cGys, four treatments over 1 week). Two months later, computerized tomo- graphy revealed osteolytic lesion on the right clavicle and a second session of chemotherapy was performed, with additional radiotherapy (total tumor dose 3500cGys, four treatments over 1 week). Oral examination revealed bilateral nodular bleed- ing boggy masses on the mandibular gingiva in the area of premolars, located on the buccal surface. No cervical lymphadenopathy was found. The patient reported that the masses were gradually growing in size, creating functional problems and haemorrhage had been caused by traumatic occlusion. In addition, the 1368-8375/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved. PII: S1368-8375(00)00078-6 Oral Oncology 37 (2001) 199±201 www.elsevier.com/locate/oraloncology * Corresponding author. Tel.: +30-31-999654; fax: +30-31- 999451.