Papers accepted for publication
1. Radiation-associated angiosarcoma of the breast with MYC amplification: excisional biopsy-mastectomy correlation in multifocal disease
Zulal Secil Ipin Cekic, Yeliz Arman Karakaya, Ferda Bir, Sevda Yilmaz, Seymanur Ala Enli, Papatya Bahar Baltalarli, Aziz Gultekin
Background: Radiation-associated angiosarcoma of the breast (RAASB) is a rare, aggressive late complication of radiotherapy. Case presentation: We report a 73-year-old woman who presented with multiple violaceous cutaneous lesions of the right breast 5 years, 11 months, and 2 days after completion of adjuvant radiotherapy for invasive breast carcinoma of no special type. Because lesion onset could not be retrospectively recalled, latency was calculated from radiotherapy completion to clinical evaluation and excisional biopsy on 7 April 2026. Excision of a single 2.0 cm cutaneous lesion established the diagnosis of angiosarcoma. Subsequent total mastectomy demonstrated broader multifocal dermal and subcutaneous involvement and greater histopathological (HP) heterogeneity, including focal solid high-grade growth and tumor necrosis involving 10-15% of the sampled tumor area. Tumor cells expressed vimentin, cluster of differentiation (CD)31, CD34, ETS-related gene (ERG), Friend leukemia integration 1 transcription factor (FLI-1), factor VIII, and D2-40, with strong nuclear c-MYC immunoexpression in >80% of cells. MYC fluorescence in situ hybridization performed on the mastectomy specimen confirmed high-level amplification, with a MYC/green chromosome 8 centromeric control (SE 8) ratio of 5.06 across 50 tumor nuclei. Surgical margins were tumor-free. At the latest documented follow-up on 21 August 2026, the patient was receiving her ninth cycle of Paclitaxel. Without subsequent imaging, objective disease status remained undetermined. Discussions: Comparison of the excisional biopsy and mastectomy specimens showed that a diagnostically adequate biopsy of a single lesion may underrepresent the multifocal extent and HP heterogeneity of RAASB. Conclusions: MYC analysis provides complementary diagnostic evidence and should be interpreted within the integrated clinicopathological context.
Corresponding author: Zulal Secil Ipin Cekic, Research Assistant, MD; e-mail: zsecil98@gmail.com
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2. The skeleton in Pieter Pourbus Last Judgment (1551): a visual echo of Vesalius?
Michele Augusto Riva
The publication in 1543 of De humani corporis fabrica libri septem by Andreas Vesalius (1514-1564) profoundly influenced the visual representation of human anatomy. This paper examines a skeletal figure in the 1551 Last Judgment by Pieter Pourbus (ca. 1523-1584), painted for the courtroom of the Brugse Vrije in Bruges, in relation to a posterior skeletal figure in Book I of the Fabrica. A comparative historical and anatomical analysis was combined with a targeted review of the literature on Vesalian illustration, the circulation of anatomical images, and the documented influence of Michelangelo on Pourbus. The two figures share a posterior presentation and particular emphasis on the vertebral column, ribs and scapular region, but differ substantially in posture, limb position, pelvic alignment and function. Pourbus skeleton is crouched within a resurrection scene, whereas the Vesalian figure is an upright didactic demonstration. Michelangelo s Last Judgment, known to Pourbus through prints, is a documented source for several figures in the painting and provides an essential parallel iconographic context. At the same time, Vesalian images circulated rapidly after 1543 through copying and adaptation. No documentary evidence has been identified showing that Pourbus owned or consulted the Fabrica. The resemblance should therefore not be interpreted as evidence of direct borrowing. Rather, the comparison provides a possible visual echo of the anatomical culture that developed after 1543 and illustrates how anatomical representation and Renaissance visual culture could intersect in the years following the publication of the Fabrica.
Corresponding author: Michele Augusto Riva, Full Professor, MD, PhD; e-mail: michele.riva@unimib.it
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1. Radiation-associated angiosarcoma of the breast with MYC amplification: excisional biopsy-mastectomy correlation in multifocal disease
Zulal Secil Ipin Cekic, Yeliz Arman Karakaya, Ferda Bir, Sevda Yilmaz, Seymanur Ala Enli, Papatya Bahar Baltalarli, Aziz Gultekin
Background: Radiation-associated angiosarcoma of the breast (RAASB) is a rare, aggressive late complication of radiotherapy. Case presentation: We report a 73-year-old woman who presented with multiple violaceous cutaneous lesions of the right breast 5 years, 11 months, and 2 days after completion of adjuvant radiotherapy for invasive breast carcinoma of no special type. Because lesion onset could not be retrospectively recalled, latency was calculated from radiotherapy completion to clinical evaluation and excisional biopsy on 7 April 2026. Excision of a single 2.0 cm cutaneous lesion established the diagnosis of angiosarcoma. Subsequent total mastectomy demonstrated broader multifocal dermal and subcutaneous involvement and greater histopathological (HP) heterogeneity, including focal solid high-grade growth and tumor necrosis involving 10-15% of the sampled tumor area. Tumor cells expressed vimentin, cluster of differentiation (CD)31, CD34, ETS-related gene (ERG), Friend leukemia integration 1 transcription factor (FLI-1), factor VIII, and D2-40, with strong nuclear c-MYC immunoexpression in >80% of cells. MYC fluorescence in situ hybridization performed on the mastectomy specimen confirmed high-level amplification, with a MYC/green chromosome 8 centromeric control (SE 8) ratio of 5.06 across 50 tumor nuclei. Surgical margins were tumor-free. At the latest documented follow-up on 21 August 2026, the patient was receiving her ninth cycle of Paclitaxel. Without subsequent imaging, objective disease status remained undetermined. Discussions: Comparison of the excisional biopsy and mastectomy specimens showed that a diagnostically adequate biopsy of a single lesion may underrepresent the multifocal extent and HP heterogeneity of RAASB. Conclusions: MYC analysis provides complementary diagnostic evidence and should be interpreted within the integrated clinicopathological context.
Corresponding author: Zulal Secil Ipin Cekic, Research Assistant, MD; e-mail: zsecil98@gmail.com
Abstract - Download PDF PDF2. The skeleton in Pieter Pourbus Last Judgment (1551): a visual echo of Vesalius?
Michele Augusto Riva
The publication in 1543 of De humani corporis fabrica libri septem by Andreas Vesalius (1514-1564) profoundly influenced the visual representation of human anatomy. This paper examines a skeletal figure in the 1551 Last Judgment by Pieter Pourbus (ca. 1523-1584), painted for the courtroom of the Brugse Vrije in Bruges, in relation to a posterior skeletal figure in Book I of the Fabrica. A comparative historical and anatomical analysis was combined with a targeted review of the literature on Vesalian illustration, the circulation of anatomical images, and the documented influence of Michelangelo on Pourbus. The two figures share a posterior presentation and particular emphasis on the vertebral column, ribs and scapular region, but differ substantially in posture, limb position, pelvic alignment and function. Pourbus skeleton is crouched within a resurrection scene, whereas the Vesalian figure is an upright didactic demonstration. Michelangelo s Last Judgment, known to Pourbus through prints, is a documented source for several figures in the painting and provides an essential parallel iconographic context. At the same time, Vesalian images circulated rapidly after 1543 through copying and adaptation. No documentary evidence has been identified showing that Pourbus owned or consulted the Fabrica. The resemblance should therefore not be interpreted as evidence of direct borrowing. Rather, the comparison provides a possible visual echo of the anatomical culture that developed after 1543 and illustrates how anatomical representation and Renaissance visual culture could intersect in the years following the publication of the Fabrica.
Corresponding author: Michele Augusto Riva, Full Professor, MD, PhD; e-mail: michele.riva@unimib.it
Abstract - Download PDF PDF