The role of c-MYC expression in the diagnostic and clinical confirmation of radiation-induced angiosarcoma

Luka  Jovanović; Predrag Filipović; Jelena Dedović Stojaković; Zorka Milovanović; Milica Labudović Borović; Jasminka Tanasijević; Predrag Patrašinović; Tamara Marinković; Vesna Plešinac Karapandžić

doi:10.2298/VSP201207028J

Luka Jovanović Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia;
Predrag Filipović Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Jelena Dedović Stojaković Institute for Oncology and Radiology of Serbia, *Department of Radiation Oncology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia;
Zorka Milovanović Institute for Oncology and Radiology of Serbia, Department of Pathology, Belgrade, Serbia
Milica Labudović Borović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Jasminka Tanasijević General Hospital Studenica, Kraljevo, Serbia
Predrag Patrašinović Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, University of Belgrade, Faculty of Medicine, Belgrade, Serbia;
Tamara Marinković Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, University of Belgrade, Faculty of Medicine, Belgrade, Serbia;
Vesna Plešinac Karapandžić Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, University of Belgrade, Faculty of Medicine, Belgrade, Serbia;

DOI: https://doi.org/10.2298/VSP201207028J

Keywords: adenocarcinoma;, genetics;, immunohistochemistry;, neoplasms, radiation-induced;, radiotherapy, adjuvant;, risk assessment;, sarcoma; survival.

Abstract

Introduction. Angiosarcomas (ASs) arising from vascular tissue, account for 3.3% of all sarcomas and have a poor prognosis. Radiation-induced AS is a rare late complication of radiotherapy (RT) treatment and is characterized by a gene expression profile such as amplification of the MYC oncogene, by which we can distinguish primary from secondary induced tumor. Case report. For a 77-year-old female patient with early-stage endometrial adenocarcinoma, a radical hysterectomy with bilateral salpingo-oophorectomy was initially done. According to pathological risk factors, the postoperative external beam conformal RT (CRT) of the pelvis was administered with concomitant brachytherapy. Six years after the treatment, on the anterior abdominal wall, in the region of the postoperative irradiation field and surgical scar, an infiltrative AS of the skin and subcutaneous adipose tissue was histologically confirmed. The patient received six cycles of mono-adriamycin chemotherapy with verified partial regression. Additional immunohistochemical analysis (IHC) of c-MYC, Ki67, and CD34 expression showed a high proliferative index (Ki67 around 60%) and c-MYC positivity indicating the molecular pattern of radiation-induced AS. Furthermore, the high proliferative index could explain the positive response to chemotherapy. Conclusion. The novel postoperative RT techniques provide better survival and local control in risk-endometrial cancer groups with a decrease in irradiation complications. These patients with longer survival are at a higher risk of developing radiation-induced tumors as late side-effects of RT. When assessing the probability of radiation-induced AS, IHC analysis of c-MYC expression could distinguish secondary from other AS if Cahan’s criteria are fulfilled.

Author Biography

Luka Jovanović, Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia;

Research assistant at Institute for oncology and radiology of Serbia and The Medical Faculty University of Belgrade, Institute for Microbiology and Immunology;

Clinitian at Research assistant at Institute for oncology and radiology of Serbia

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