Giant Breast Angiosarcoma in a 20-Year-Old Young Adult Female: A Case Report and Review of Literature.

Introduction: Primary breast angiosarcoma (PAS) is an extremely rare vascular malignancy that typically presents as a breast mass or cutaneous changes. Given its highly aggressive nature, rapid progression, and early metastasis that result in a poor prognosis, coupled with a lack of standardized treatment guidelines, there is an urgent need to develop novel, effective therapeutic strategies. Case presentation: This report focused on a 20-year-old Uyghur woman presenting with a painless, rapidly enlarging mass in the left breast. Staging evaluation with breast MRI, whole-body contrast-enhanced CT, and bone scintigraphy revealed a large (10 × 7 cm) primary tumor and bilateral axillary lymphadenopathy suspicious for metastasis, with no evidence of distant disease (cT3N1M0, stage III). The high-grade angiosarcoma was confirmed through a core needle biopsy of the breast mass. With no remarkable medical or family history of breast cancer, the patient underwent complete surgical resection of the breast angiosarcoma, which provided a definitive pathological diagnosis. Given negative lymph node biopsy results, axillary lymph node dissection was not performed. Postoperatively, the patient received adjuvant chemotherapy with paclitaxel and bevacizumab. The regimen was well tolerated, and no disease recurrence was observed during follow-up. This case exemplified a practical management strategy for PAS, emphasizing the key role of clinical presentation and conventional imaging in guiding surgical decisions, particularly in resource-limited settings. Conclusions: As a rare, highly malignant tumor, PAS requires early diagnosis and multidisciplinary management, including thorough metastasis evaluation and personalized therapy, to optimize survival and quality of life.