title: Surgical Dead End in a Renal Transplant Recipient Associated With a Rare Thrombohemorrhagic Syndrome.
abstract: BACKGROUND
  Primary breast angiosarcoma is an extremely rare malignancy. Association of this type of tumor with Kasabach-Merritt syndrome has only been reported in 3 cases in the past. To our knowledge, this is the first reported case of a solid-organ recipient.
  
  
  METHODS
  A 53-year-old woman who underwent a deceased-donor renal transplantation 5 years previously presented with a 12-month history of a giant ulcerated lesion on her left breast. Biopsy of the overlying skin suggested primary angiosarcoma. Concurrently, the patient's bleeding from the site of the biopsy and hematology investigations indicated the presence of Kasabach-Merritt syndrome.
  
  
  RESULTS
  The case was discussed in a multidisciplinary setting. The decision was to use anthracycline-based chemotherapy as up-front treatment to assess tumor response and gain a local benefit for a subsequent resection. After the completion of 1 cycle of chemotherapy, the patient died of cardiovascular insufficiency. Primary angiosarcoma of the breast occurs in the third to fourth decade and has been reported only in women.
  
  
  CONCLUSIONS
  A high clinical suspicion and referral to a specialized center are necessary. Total mastectomy appears to be the only treatment conferring benefit; chemotherapy and radiation therapy are of little value.
authors.affiliation: Transplantation Unit, Athens University School of Medicine, Laiko General Hospital, Athens, Greece. Electronic address: mike_vailas@yahoo.com.
authors.forename: M G
authors.initials: MG
authors.lastname: Vailas
authors.affiliation: Transplantation Unit, Athens University School of Medicine, Laiko General Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Vernadakis
authors.affiliation: Transplantation Unit, Athens University School of Medicine, Laiko General Hospital, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Moris
authors.affiliation: Transplantation Unit, Athens University School of Medicine, Laiko General Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Zavos
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006394:Hemangiosarcoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D059885:Kasabach-Merritt Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents