Introduction: Post-radiation angiosarcoma of the breast is a rare but aggressive vascular malignancy that can develop as a late complication of radiotherapy for breast cancer. It is associated with a risk of local recurrence and a poor prognosis. Case presentation: Herein, we describe a case of an 80-year-old postmenopausal woman with a prior history of stage IIIC left breast invasive ductal carcinoma, treated with lumpectomy, axillary dissection, radiotherapy, and endocrine therapy. Several years after treatment, she presented with a painless, superficial brown skin lesion over the irradiated breast. Histopathological examination and immunohistochemical analysis confirmed high-grade angiosarcoma with epithelioid features. Staging investigations showed no distant metastatic disease, and the patient underwent a left simple mastectomy. During follow-up, she developed recurrent disease, presenting as cutaneous and chest wall lesions, both confirmed histologically as recurrent angiosarcoma. The patient subsequently underwent wide local excision with rotational flap reconstruction for local recurrence. The patient is currently under regular follow-up with no further recurrence or active complaints. Discussion: Radiogenic breast angiosarcoma is an uncommon cancer, and while various studies have documented its clinical features and treatment, few have specifically addressed recurrent instances. Our case demonstrates the clinical course of recurrent post-radiation angiosarcoma and the difficulty in achieving local disease control following several surgical treatments. Conclusions: This report highlights the prognosis, treatment, and clinical presentation of recurrent breast radiogenic angiosarcoma. Clinicians should maintain a high index of suspicion in previously irradiated patients presenting with new or progressive skin changes.

Background and Clinical Significance: Gallstone ileus (GI) is a rare but serious complication of gallstone disease. This condition is characterized by migration of gallstones through a cholecystoenteric fistula, resulting in mechanical bowel obstruction. GI primarily affects older patients with multiple comorbidities. Case Presentation: Herein, we describe a case of 68-year-old Saudi woman with a history of end-stage renal disease, pulmonary hypertension, diabetes mellitus, bronchial asthma, and atrial fibrillation. She presented with acute calculous cholecystitis. Due to her condition, she was managed conservatively initially. The patient was recommended laparoscopic cholecystectomy but she declined due to fear of anesthesia-related complications. She re-presented after two months with abdominal pain, vomiting, distension, and constipation. Computed tomography (CT) scan showed a 3.2 cm ectopic gallstone impacted in the distal ileum with proximal bowel dilatation and segmental ischemia, confirming GI. Laparotomy showed bowel ischemia and localized perforation. The patient was managed with enterolithotomy, resection of 25 cm of distal ileum, and primary anastomosis. Post-surgery, the patient had favorable recovery. Conclusions: This case highlights need for early diagnosis and appropriate management of GI in patients with multiple comorbidities.