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Arafat H, Abulaban-Awar O, Fatayer M, Abufara M. Successful management of primary sarcoma of the breast with complete pathological response: a case report. J Surg Case Rep 2023; 2023:rjad677. [PMID: 38111493 PMCID: PMC10726401 DOI: 10.1093/jscr/rjad677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/26/2023] [Indexed: 12/20/2023] Open
Abstract
Primary sarcomas of the breast are extremely rare and heterogenous malignancies; they should be differentiated from phyllodes tumors. They are characterized by their high rate of recurrence, rapid growth and aggressive coarse. We present a case of a 41-year-old Palestinian female who presented with a recurrent breast mass. Biopsy showed primary sarcoma and imaging confirmed metastasis to axillary lymph nodes. The patient received six cycles of ifosfamide-adriamycin protocol resulting in complete pathological response. She underwent left sided modified radical mastectomy followed by radiation and six more cycles of the same protocol as adjuvant. Primary breast sarcomas are rare neoplasms that require multidisciplinary discussion to guide treatment. The approach to these tumors is chemotherapy followed by surgical resection when operable, in addition to local control via radiotherapy and adjuvant chemotherapy.
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Affiliation(s)
- Hasan Arafat
- Department of Internal Medicine, Augusta Victoria Hospital, P.O. 19178, Rabia Al-Adawiyya Street, East Jerusalem, 91191, Palestine
| | - Ola Abulaban-Awar
- Cancer Care Center, Augusta Victoria Hospital, P.O. 19178, Rabia Al-Adawiyya Street, East Jerusalem, 91191, Palestine
| | - Mohammad Fatayer
- Department of Pathology, Augusta Victoria Hospital, P.O. 19178, Rabia Al-Adawiyya Street, East Jerusalem, 91191, Palestine
| | - Marwan Abufara
- Surgical Care Center, Augusta Victora Hospital, P.O. 19178, Rabia Al-Adawiyya Street, East Jerusalem, 91191, Palestine
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Esperança-Martins M, Melo-Alvim C, Dâmaso S, Lopes-Brás R, Peniche T, Nogueira-Costa G, Abreu C, Luna Pais H, de Sousa RT, Torres S, Gallego-Paez LM, Martins M, Ribeiro L, Costa L. Breast Sarcomas, Phyllodes Tumors, and Desmoid Tumors: Turning the Magnifying Glass on Rare and Aggressive Entities. Cancers (Basel) 2023; 15:3933. [PMID: 37568749 PMCID: PMC10416994 DOI: 10.3390/cancers15153933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Breast sarcomas (BSs), phyllodes tumors (PTs), and desmoid tumors (DTs) are rare entities that arise from connective tissue. BSs can be classified as either primary or secondary, whether they develop de novo or after radiation exposure or lymphedema. PIK3CA seems to play an important common role in different BS. Malignant PTs show similar behavior to BSs, while DTs are locally aggressive but rarely metastasize. BSs usually present as unilateral, painless, rapidly growing masses with rare nodal involvement. The diagnosis should be based on magnetic resonance imaging and a core needle biopsy. Staging should comprise a chest computed tomography (CT) scan (except for benign PT and DT), while abdominal and pelvic CT scans and bone scans should be added in certain subtypes. The mainstay of treatment for localized BS is surgery, with margin goals that vary according to subtype. Radiotherapy and chemotherapy can be used as neoadjuvant or adjuvant approaches, but their use in these settings is not standard. Advanced BS should be treated with systemic therapy, consistent with recommendations for advanced soft tissue sarcomas of other topographies. Given the rarity and heterogeneity of these entities, multidisciplinary and multi-institutional collaboration and treatment at reference centers are critical.
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Affiliation(s)
- Miguel Esperança-Martins
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Cecília Melo-Alvim
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Sara Dâmaso
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
| | - Raquel Lopes-Brás
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
| | - Tânia Peniche
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Gonçalo Nogueira-Costa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Catarina Abreu
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Helena Luna Pais
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Rita Teixeira de Sousa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Sofia Torres
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
| | - Lina Marcela Gallego-Paez
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Marta Martins
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Leonor Ribeiro
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Luís Costa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
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3
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Žatecký J, Coufal O, Fabian P, Holánek M, Sehnálková E, Burkoň P. Primary Breast Sarcoma: A Two-Centre Analysis and Review of Literature. Breast Care (Basel) 2023; 18:262-269. [PMID: 37900556 PMCID: PMC10601702 DOI: 10.1159/000530934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/28/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Primary breast sarcoma is a very rare malignant type of breast tumours with an incidence of 0.1% of all primary breast malignancies. Methods We present a retrospective analysis of the case series from two hospitals in the Czech Republic with a review of the diagnostic and treatment approach to primary breast sarcomas with an analysis of published prognostic factors. Results Eleven patients were included in the study, 9 women and 2 men. Statistical evaluation revealed that tumour size (p = 0.1964), grade (p = 0.1667), margin distance (p = 0.5403), mitotic activity (p = 0.8577), or age (p = 0.7822) were not prognostic factors in our cohort. Conclusion The analysis did not prove any of the factors, such as age, tumour size, grade, or mitotic activity, to be statistically significant prognostic factors. Based on the literature review, the most common published prognostic factors are tumour size, margin status, and grade, but the results are ambiguous.
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Affiliation(s)
- Jan Žatecký
- Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Surgery, Silesian Hospital in Opava, Opava, Czech Republic
- The Institute of Paramedical Health Studies, Faculty of Public Policies, Silesian University, Opava, Czech Republic
| | - Oldřich Coufal
- Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pavel Fabian
- Department of Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Miloš Holánek
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eva Sehnálková
- The Institute of Paramedical Health Studies, Faculty of Public Policies, Silesian University, Opava, Czech Republic
- Department of Pathology, Silesian Hospital in Opava, Opava, Czech Republic
| | - Petr Burkoň
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Radu I, Scripcariu V, Panuța A, Rusu A, Afrăsânie VA, Cojocaru E, Aniței MG, Alexa-Stratulat T, Terinte C, Șerban CF, Gafton B. Breast Sarcomas-How Different Are They from Breast Carcinomas? Clinical, Pathological, Imaging and Treatment Insights. Diagnostics (Basel) 2023; 13:diagnostics13081370. [PMID: 37189471 DOI: 10.3390/diagnostics13081370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Breast sarcoma (BS) is a very rare and poorly studied condition. This has led to a lack of studies with a high level of evidence and to low efficacy of current clinical management protocols. Here we present our experience in treating this disease in the form of a retrospective case series study including discussion of clinical, imaging, and pathological features and treatment. We also compare the main clinical and biological features of six cases of BS (phyllodes tumors were excluded) with a cohort of 184 patients with unilateral breast carcinoma (BC) from a previous study performed at our institution. Patients with BS were diagnosed at a younger age, presented no evidence of lymph node invasion or distant metastases, had no multiple or bilateral lesions, and underwent a shorter length of hospital stay versus the breast carcinoma group. Where recommended, adjuvant chemotherapy consisted of an anthracycline-containing regimen, and adjuvant external radiotherapy was delivered in doses of 50 Gy. The comparison data obtained from our BS cases and the ones with BC revealed differences in diagnosis and treatment. A correct pathological diagnosis of breast sarcoma is essential for the right therapeutic approach. We still have more to learn about this entity, but our case series could add value to existing knowledge in a meta-analysis study.
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Affiliation(s)
- Iulian Radu
- First Surgical Oncology Unit, Department of Surgery, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Viorel Scripcariu
- First Surgical Oncology Unit, Department of Surgery, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andrian Panuța
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinic of Plastic and Reconstructive Microsurgery, Emergency Clinical Hospital "Sf. Spiridon", 700111 Iasi, Romania
| | - Alexandra Rusu
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Vlad-Adrian Afrăsânie
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I-Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Maria Gabriela Aniței
- First Surgical Oncology Unit, Department of Surgery, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Teodora Alexa-Stratulat
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Terinte
- Department of Pathology, Regional Institute of Oncology, 700483 Iasi, Romania
| | | | - Bogdan Gafton
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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5
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Kumar M, Sagar M, Vimal JK, Kumar V. A malignant transformation of borderline phyllodes tumor to fibrosarcoma breast: A rare case report. J Cancer Res Ther 2023; 19:S892-S895. [PMID: 38384072 DOI: 10.4103/jcrt.jcrt_378_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/04/2022] [Indexed: 02/23/2024]
Abstract
ABSTRACT Phyllodes tumor of the breast with malignant transformation to fibrosarcoma of the breast is a rare entity. Breast fibrosarcoma is uncommon, accounting for less than 1% of all breast tumors. Prognosis of fibrosarcoma of the breast is poor. Due to its rarity, survival rates are not defined. A 23-year-old woman presented with a mass in the left breast, and another 48-year-old woman presented with right breast mass. Both patients underwent for surgery. The histological & immunohistochemical examination confirms the diagnosis of a malignant transformation from borderline phyllodes tumor to fibrosarcoma. We concluded that the phyllodes tumor is mostly benign but local recurrence is common. As the tumor progresses toward malignancy, due to the difficulty in the diagnosis of borderline phyllodes tumors, total mastectomy with axillary resection must be recommended.
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Affiliation(s)
- Madhu Kumar
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mala Sagar
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jitendra K Vimal
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
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6
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Ni Y, Tse GM. Spindle Cell Lesions of the Breast: A Diagnostic Algorithm. Arch Pathol Lab Med 2023; 147:30-37. [PMID: 35976671 DOI: 10.5858/arpa.2022-0048-ra] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 12/31/2022]
Abstract
CONTEXT.— Spindle cell lesions of the breast represent a broad spectrum of entities, ranging from nonneoplastic reactive conditions to high-grade malignant tumors. The wide range makes breast spindle cell lesions a diagnostic pitfall. OBJECTIVE.— To review the classification of spindle cell lesions of the breast, including clinical features, morphologic characteristics, and the role of immunohistochemistry as well as molecular tools in assisting the differential diagnosis. A diagnostic algorithm will be proposed. DATA SOURCES.— Literature and personal experience are the sources for this study. CONCLUSIONS.— Spindle cell lesions of the breast can be classified as biphasic or monophasic, with the former including both spindle cell and epithelial components, and the latter including only spindle cell elements. Each category is further subclassified as low or high grade. In the biphasic low-grade group, fibroadenoma and benign phyllodes tumor are the most common lesions. Other uncommon lesions include hamartoma, adenomyoepithelioma, and pseudoangiomatous stromal hyperplasia. In the biphasic high-grade group, borderline/malignant phyllodes tumor and biphasic metaplastic carcinoma are the main lesions to consider. In the monophasic low-grade group, reactive spindle cell nodule, nodular fasciitis, myofibroblastoma, fibromatosis, and fibromatosis-like metaplastic carcinoma have to be considered. In the monophasic high-grade group, the possible lesions are monophasic spindle cell metaplastic carcinoma, primary breast sarcoma, and metastases. Awareness of the clinical history and careful evaluation of any epithelial differentiation (with a large immunohistochemical panel) are crucial in the distinction.
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Affiliation(s)
- Yunbi Ni
- From the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Gary M Tse
- From the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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7
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Angiosarcoma of the breast in an elderly woman with a breast implant: A case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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8
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Kim YJ, Ryu JM, Lee SK, Chae BJ, Kim SW, Nam SJ, Yu JH, Lee JE. Primary Angiosarcoma of the Breast: A Single-Center Retrospective Study in Korea. Curr Oncol 2022; 29:3272-3281. [PMID: 35621657 PMCID: PMC9139487 DOI: 10.3390/curroncol29050267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Due to the rarity of primary angiosarcoma of the breast, optimal management is based on expert opinion. The aim of this study was to review all primary angiosarcomas of the breast obtained from a single center in terms of clinicopathologic characteristics, treatment, and survival outcomes. From 1997 to 2020, 15 patients with primary angiosarcoma of the breast underwent either mastectomy or wide excision. We analyzed the clinicopathologic data to assess disease-free survival and overall survival. Fifteen women with primary angiosarcoma of the breast were identified. The mean age at diagnosis was 33 years (range: 14–63 years). The overall mean tumor size was 7.7 cm (range 3.5–20 cm). Upon histological grading, there were three cases of low grade, five intermediate grade, six high grade, and one unidentified grade. The five-year disease-free survival rate was 24.4%, and the five-year survival rate was 37.2%. The survival rate of the low-grade patient group was statistically higher than that of the intermediate- or high-grade patient groups (p = 0.024). Primary angiosarcoma of the breast is a rare aggressive tumor characterized by high grade and poor outcome. Histologic grade appears to be a reliable predictor of survival. There are no standard treatment guidelines; thus, optimal R0 surgical resection remains the best approach. The roles of neoadjuvant, adjuvant chemotherapy, and radiotherapy remain unclear.
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Affiliation(s)
| | | | | | | | | | | | - Jong-Han Yu
- Correspondence: (J.-H.Y.); (J.-E.L.); Tel.: +82-2-3410-0260 (J.-H.Y.); +82-2-3410-3479 (J.-E.L.); Fax: +82-2-3410-6982 (J.-H.Y.); +82-2-3410-6982 (J.-E.L.)
| | - Jeong-Eon Lee
- Correspondence: (J.-H.Y.); (J.-E.L.); Tel.: +82-2-3410-0260 (J.-H.Y.); +82-2-3410-3479 (J.-E.L.); Fax: +82-2-3410-6982 (J.-H.Y.); +82-2-3410-6982 (J.-E.L.)
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9
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Wang J, Wang WL, Sun H, Huo L, Wu Y, Chen H, Gan Q, Meis JM, Maloney N, Lazar AJ, Yoon EC, Albarracin CT, Krishnamurthy S, Middleton LP, Resetkova E, Yu W, Tan D, Lu W, Solis Soto LM, Wang S, Wistuba II, Parwani AV, Prieto VG, Sahin AA, Li Z, Ding Q. Expression of TRPS1 in phyllodes tumor and sarcoma of the breast. Hum Pathol 2022; 121:73-80. [DOI: 10.1016/j.humpath.2022.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/31/2022]
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10
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Leiomyosarcoma Breast with Extensive Metastasis: a Case Report. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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A massive malignant phyllodes tumor – case study. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2021. [DOI: 10.2478/cipms-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The paper aims to introduce the case of an extensive breast malignancy – phyllodes tumor. This type of breast neoplasm is relatively rare. Indeed, it accounts for only 0.3-1% of all breast malignant tumours. In the paper, patient, disease, and treatment methods were described and evaluated. The efficacy of surgical treatment and adjuvant therapy (radiotherapy and chemotherapy) was assessed based on literature data. The authors concluded that late diagnosis of phyllodes tumor causes the necessity of mastectomy and radiotherapy and aggravates the prognosis.
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12
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Li GZ, Raut CP, Hunt KK, Feng M, Chugh R. Breast Sarcomas, Phyllodes Tumors, and Desmoid Tumors: Epidemiology, Diagnosis, Staging, and Histology-Specific Management Considerations. Am Soc Clin Oncol Educ Book 2021; 41:390-404. [PMID: 34010054 DOI: 10.1200/edbk_321341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast sarcomas arise from connective tissues of the breast and account for fewer than 1% of all breast malignancies. They can be subclassified as primary breast sarcomas, which arise de novo and are histologically diverse, and secondary breast sarcomas, which arise as a result of radiation or lymphedema and are most commonly angiosarcomas. Two other connective tissue neoplasms that occur within the breast include phyllodes tumors and desmoid tumors, which exhibit a spectrum of behaviors. Malignant phyllodes tumors are biologically similar to primary breast sarcomas, whereas desmoid tumors are technically benign but often locally aggressive. Patients with breast sarcomas often present with a rapidly growing mass or, in cases of radiation-associated angiosarcoma, violaceous cutaneous lesions. Core needle biopsy is generally required to confirm the diagnosis of sarcomas. Staging workup includes MRI and chest imaging, although these are not required in the case of benign phyllodes or desmoid tumors. In general, localized breast sarcomas should be resected, with the extent of resection tailored to histologic subtype. Radiation and chemotherapy can be used in the neoadjuvant or adjuvant setting, but data are limited, so treatment decisions should be made on an individualized basis. Systemic therapy options for metastatic disease and refractory breast desmoids mimic those used for the same histologies when present in other sites. Given the rarity and heterogeneity of breast sarcoma, as well as limited literature describing these entities, expert multidisciplinary evaluation is crucial for optimal decision making.
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Affiliation(s)
- George Z Li
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Rashmi Chugh
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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13
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Al-Wiswasy M, Al-Balas M, Al-Saffar R, Al-Balas H. Primary stromal sarcoma of breast: A case report and literature review. Breast Dis 2021; 40:199-205. [PMID: 33720870 DOI: 10.3233/bd-201012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Primary breast sarcoma (PBS) was first described in 1887 as a rare heterogeneous neoplasm arising from the mesenchymal tissue of the mammary gland accounting for less than 5% of all body soft-tissue sarcomas and less than 0.1% of all malignant tumors of the breast. CASE PRESENTATION A 31-year old lady presented with left breast mass which she felt four years before during which the mass increased in size from 1 to 6 cm in the largest diameter, diagnosed clinically as a benign fibroadenoma without any further cytological or histopathological confirmation. Histopathological examination of the excised breast mass reveals undifferentiated, primary stromal sarcoma of the breast (PSSB), which was followed by mastectomy three weeks later with reconstructive breast surgery with a total duration of follow-up of 3 years thereafter. This is the first case of PSSB reported in Jordan. DISCUSSION/CONCLUSION PSSB is the generic term given to malignant breast tumors thought to arise from the specialized mesenchymal stroma of the breast but lacking an epithelial component with a phylloides pattern. PSSB is difficult to diagnose preoperatively due to its rarity and inadequate imaging methods to establish an exact diagnosis. The histology of the patient mass may be the leading factor for the management of these tumors. Even in very young patients, a progressively growing breast mass should alert the clinician to investigate for malignancy and verify the results by biopsy. Surgery with adequate resection margins represents the only potentially curative modality with prognostic significance. Adjuvant chemotherapy and radiotherapy are not very beneficial. The prognosis is dismal for patients with lymph node involvement and the size of the tumor has a lesser bearing on the outcome.
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Affiliation(s)
- Mohammad Al-Wiswasy
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mahmoud Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Raith Al-Saffar
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hamzeh Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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14
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Choi A, Carpenter PM, Chopra S, Lara KM, Tseng WW, Patel DB, Hu J. Spindle cell carcinoma of the breast managed with neoadjuvant AIM: A case report. Rare Tumors 2020; 12:2036361320977021. [PMID: 33354306 PMCID: PMC7734559 DOI: 10.1177/2036361320977021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022] Open
Abstract
Spindle cell carcinoma (SpC), also known as metaplastic carcinoma—spindle cell type, is a subtype of metaplastic carcinoma. Metaplastic carcinomas of the breast are rare but are thought to be more aggressive than invasive ductal carcinomas. Due to their rarity, there are few randomized trials that can inform any standardized approaches to treatment. Treatment is instead extrapolated from other types of breast cancer or metaplastic carcinomas of different locations. Here we present the first known case report of a patient with spindle cell carcinoma of the breast successfully treated with a standard sarcoma neoadjuvant regimen of doxorubicin, ifosfamide, and mesna (AIM) that resulted in >99% necrosis of the tumor and negative margins at the time of resection.
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Affiliation(s)
- April Choi
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Medicine, LAC + USC Medical Center, Los Angeles, CA, USA
| | - Philip M Carpenter
- Department of Pathology, Keck School of Medicine at USC, Los Angeles, CA, USA
| | - Shefali Chopra
- Department of Pathology, Keck School of Medicine at USC, Los Angeles, CA, USA
| | - Kristi M Lara
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - William W Tseng
- Department of Surgery, Division of Breast, Endocrine and Soft Tissue Surgery, Keck School of Medicine at USC, Los Angeles, CA, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine at USC, Los Angeles, CA, USA
| | - James Hu
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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15
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Almas T, Hussain S, Ehtesham M, Ullah M, Khan MK. Residual Breast Sarcoma Left to Heal by Secondary Intention Following Wide Local Excision: An Unorthodox Approach to a Rare Malignancy. Cureus 2020; 12:e10433. [PMID: 33062546 PMCID: PMC7556687 DOI: 10.7759/cureus.10433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Breast sarcomas remain a rare malignancy and are noted to portend a particularly dismal prognosis. Due to their high rates of recurrence, a surgical excision with negative margins remains the preferred treatment modality. Nevertheless, their sparse prevalence often poses a diagnostic conundrum. In this report, we chronicle the case of a 46-year-old female with a recurrent breast sarcoma that was treated with wide local excision. Interestingly, no flap reconstruction, skin graft surgery, or primary wound closure was performed, and the resultant wound was left to heal by secondary intention. The patient continues to do well to date, with no postoperative complications.
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Affiliation(s)
- Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Salman Hussain
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Maryam Ehtesham
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Muneeb Ullah
- General Surgery, Maroof International Hospital, Islamabad, PAK
| | - Muhammad Kashif Khan
- Surgical Oncology, Federal Government Poly Clinic (Post Graduate Medical Institute), Islamabad, PAK.,Surgical Oncology, Maroof International Hospital, Islamabad, PAK
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16
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Kong J, Shahait AD, Kim S, Choi L. Radiation-induced undifferentiated pleomorphic sarcoma of the breast. BMJ Case Rep 2020; 13:13/2/e232616. [PMID: 32047082 DOI: 10.1136/bcr-2019-232616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Breast sarcoma is a rare form of malignancy that arises from connective tissue within the breast, comprising less than 5% of all sarcomas. They develop as primary tumours or as secondary following radiation therapy. Diagnosis can be challenging as breast sarcomas are often asymptomatic and resemble benign breast tissue changes. Radiation-induced breast sarcomas present in various forms with an average latency period of 10-20 years following initial radiation therapy. Angiosarcomas are the most common form, while other types such as undifferentiated pleomorphic sarcomas remain rare. Here, we report a case of radiation-induced undifferentiated pleomorphic breast sarcoma in a 75-year-old woman that developed nearly 20 years following breast conserving surgery and radiation for invasive ductal carcinoma. The patient initially noticed a mass in 2017 on self-examination. The mammogram, ultrasound and biopsy at the time showed a benign 2.2 cm nodular fasciitis without malignancy. The mass grew rapidly in the next 6 months to 5.6 cm and repeat biopsy diagnosed undifferentiated pleomorphic sarcoma. The mass abutted the pectoralis muscle but staging workup ruled out distant metastasis and the patient underwent wide local resection of the mass with clear margins. The patient subsequently underwent further postoperative radiation due to insufficient posterior margin width on wide local excision, as chest wall resection would have been required for a wider posterior margin. Prognosis for postradiation sarcomas is generally poor with 27%-36% 5-year survival, with surgical resection as the main line of treatment. The patient currently remains disease-free after 15 months of surveillance.
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Affiliation(s)
- Joshua Kong
- General Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Awni D Shahait
- General Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Steve Kim
- General Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lydia Choi
- General Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
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17
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De Sanctis R, Lorenzi E, Agostinetto E, D’Amico T, Simonelli M, Santoro A. Primary ovarian insufficiency associated with pazopanib therapy in a breast angiosarcoma patient: A CARE-compliant case report. Medicine (Baltimore) 2019; 98:e18089. [PMID: 31852067 PMCID: PMC6922591 DOI: 10.1097/md.0000000000018089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
RATIONAL The growing population of young cancer survivors and a trend toward postponing pregnancy until later years in life are leading to a deeper attention towards understanding treatment-induced sequelae, and, in particular, the effects of cancer and/or treatment on fertility. Nowadays, the infertility risks potentially associated with molecular targeted therapies are not established, and clinical reports are sparse. Moreover, the increasing use of molecular targeted drugs in the adjuvant setting and in diseases with better prognosis makes preservation of fertility a major topic in current research. PATIENT'S CONCERNS Here, we report the case of an 18-year-old woman, with a 3-cm superficial lump of the right breast, who had no remarkable family or medical history. Menarche had occurred at the age of 14 years, with normal regular periods. DIAGNOSIS High-grade angiosarcoma, with metastatic progression and multiple relapse, was diagnosed. INTERVENTIONS After diagnosis, right radical mastectomy was carried out with no evidence of residual disease. No adjuvant treatment was delivered. Lymph node metastasis were found later and chemotherapy with doxorubicin 25 mg/m/day and ifosfamide 1 g/m/day (both on days 1-3) every 21 days was administered. During treatment, the patient reported menstrual irregularities but no amenorrhea. Due to further local relapse a few years later, the patient was treated for progressive metastatic disease with gemcitabine 1000 mg/m on days 1 and 8 every 21 days for 6 cycles, and underwent surgery, followed by pegylated liposomal doxorubicin, 50 mg/m on day 1 every 28 days. After further disease progression 5 years after first diagnosis, pazopanib was administered at a dose of 800 mg daily for 10 months. OUTCOMES The patient experienced a transient ovarian insufficiency possibly due to pazopanib. Since amenorrhea developed within 2 months from the initiation of pazopanib treatment and menses returned regularly only after discontinuation of the treatment itself. LESSONS This is the first case report that strongly suggests a correlation between pazopanib exposure and development of ovarian insufficiency. Our case tantalizes to inspire additional preclinical and clinical research on the true incidence, possible dose dependence, and reversibility of pazopanib (and other TKIs) -induced ovarian failure.
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Affiliation(s)
- Rita De Sanctis
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center – IRCCS, Rozzano (MI)
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele – Milan
| | - Elena Lorenzi
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center – IRCCS, Rozzano (MI)
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele – Milan
| | - Elisa Agostinetto
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center – IRCCS, Rozzano (MI)
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele – Milan
| | - Tania D’Amico
- Department of Experimental Medicine, Endocrinology-Pituitary Disease, “Sapienza” University of Rome, Rome, Italy
| | - Matteo Simonelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center – IRCCS, Rozzano (MI)
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele – Milan
| | - Armando Santoro
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center – IRCCS, Rozzano (MI)
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele – Milan
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18
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Vergel JC, Osorio AM, Garcia Mora M, García Angulo Ó, Guzmán Abisaab L, Cervera-Bonilla S, Diaz Casas S. Breast Sarcomas: Experience of a Reference Center in Colombia. Cureus 2019; 11:e5078. [PMID: 31516788 PMCID: PMC6721959 DOI: 10.7759/cureus.5078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Breast sarcomas are tumors of a mesenchymal origin, with an incidence of less than 1% of the total breast tumors. The diagnosis of this disease is a challenge for pathologists, radiologists, and breast surgeons. Aim To describe the diagnostic, therapeutic, and outcomes approach of patients with breast sarcoma treated at the National Cancer Institute (NCI) in Bogota, Colombia. Materials and methods It is a descriptive and retrospective case series study of patients diagnosed with breast sarcoma treated at the NCI during the period between August 1, 2016 and March 30, 2019. Results We identified 14 patients diagnosed with breast sarcoma, 10 (71.4%) patients with primary breast sarcomas, and four (28.6%) with sarcomas associated with radiotherapy. The most frequent histological subtype in both, primary and secondary sarcomas, was angiosarcoma (n = 5, 35.7%). 100% (n = 14) of patients received surgical management as primary treatment. Eight (57.1%) patients presented recurrence (disease-free survival (DFS) follow-up of 5.95 months). A total of five deaths were recorded, representing 35.7% of patients (overall survival (OS) follow-up of 23.5 months). Conclusion Breast sarcomas are characterized by aggressive clinical behavior, which is why it is important to make a precise histological diagnosis and thus provide patients with radical surgical procedures that ensure local control of the disease and improve DFS.
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Affiliation(s)
- Juan C Vergel
- Breast and Soft Tissue Clinic, Instituto Nacional de Cancerologia, Bogotá D.C., COL
| | - Ana M Osorio
- Breast and Soft Tissue Clinic, Instituto Nacional de Cancerologia, Bogotá D.C., COL
| | - Mauricio Garcia Mora
- Breast and Soft Tissue Clinic, Instituto Nacional de Cancerologia, Bogotá D.C., COL
| | - Óscar García Angulo
- Breast and Soft Tissue Clinic, Instituto Nacional de Cancerologia, Bogotá D.C., COL
| | - Luis Guzmán Abisaab
- Breast and Soft Tissue Clinic, Instituto Nacional de Cancerologia, Bogotá D.C., COL
| | | | - Sandra Diaz Casas
- Breast and Soft Tissue Clinic, Instituto Nacional de Cancerologia, Bogotá D.C., COL
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19
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Genomic profile of breast sarcomas: a comparison with malignant phyllodes tumours. Breast Cancer Res Treat 2018; 174:365-373. [DOI: 10.1007/s10549-018-5067-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/20/2018] [Indexed: 01/04/2023]
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20
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Assi H, Salem R, Sukhon F, Abbas J, Boulos F, Saghir NE. Phyllodes tumors of the breast treated in a tertiary health care center: case series and literature review. J Int Med Res 2018; 48:300060518803530. [PMID: 30318976 PMCID: PMC7113489 DOI: 10.1177/0300060518803530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective This study was performed to determine the subtypes of phyllodes tumor (PT) in
patients at a single tertiary healthcare center in Lebanon and to describe
their characteristics along with a review of the literature. Methods This single-institution retrospective cohort study included all cases of PT
of the breast treated at the American University of Beirut Medical Center
from 1 January 2010 to 31 December 2014. The patients’ demographic data,
tumor characteristics, treatment data, and pathology reports were
analyzed. Results Thirty patients were enrolled. Their median age was 42 years. In total, 66.7%
had benign disease and 22.3% had malignant disease. Twenty-seven patients
underwent surgery, four received radiotherapy, and one received systemic
chemotherapy after PT progression. Twenty-seven patients had no recurrence
at the last follow-up, two had local recurrence, and one had metastatic
disease. All three patients with recurrence had an adequate negative
surgical margin at the first excision. Conclusion This is the first cohort of patients with PT described in Lebanon and one of
few in the Middle East. Our findings provide insight into the epidemiology,
treatment modalities, and prognosis of PT in this geographical region.
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Affiliation(s)
- Hazem Assi
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Salem
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fares Sukhon
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jaber Abbas
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Boulos
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nagi El Saghir
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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21
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Bayramoglu Z, Kebudi R, Yilmaz R, Buyukkapu Bay S, Kebudi A, Karanlik H, Iribas A, Darendeliler E, Onder S, Bilgic B, Adaletli I. Primary Rhabdomyosarcoma of the Breast: Imaging Findings and Literature Review. Breast Care (Basel) 2018; 13:293-297. [PMID: 30319332 DOI: 10.1159/000487750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Primary breast rhabdomyosarcoma (RMS) can occur in children. There is a lack of knowledge regarding radiologic findings and added diffusion-weighted magnetic resonance imaging (MRI) features of RMS in the literature. Case Report A 12-year-old girl was diagnosed with primary alveolar RMS of the breast. Gray scale ultrasound revealed posterior acoustic enhancement behind a well-circumscribed, multilobulated hypoechoic mass. Doppler ultrasound revealed increased peripheral and central vascularity. Hypointense septations on T2-weighted image exhibiting more enhancement than the stroma on late gadolinium-enhanced images were striking within a hyperintense mass. A hyperintense hemorrhagic focus on T1-weighted image was present in the absence of any necrosis. Avid enhancement on early postcontrast images proceeding from the periphery to the center was depicted. Conclusion A rapidly enlarging mass with an echogenic peripheral rim together with posterior acoustic enhancement on gray scale ultrasound, intense vascularity on Doppler ultrasound, axillary lymphadenopathy, and satellite nodules on MRI should raise suspicion. Enhancing central and peripheral septations are suggestive of RMS. Dynamic contrast-enhanced MRI in suspected cases can provide valuable data in the differential diagnosis.
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Affiliation(s)
- Zuhal Bayramoglu
- Pediatric Radiology Division, Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Rejin Kebudi
- Pediatric Hematology-Oncology Section, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.,Pediatric Hematology-Oncology Department, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Ravza Yilmaz
- Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sema Buyukkapu Bay
- Pediatric Hematology-Oncology Department, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Abut Kebudi
- Department of Surgery and Surgical Oncology, School of Medicine, Maltepe University, Istanbul, Turkey
| | - Hasan Karanlik
- Department of Surgery, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Ayca Iribas
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Emin Darendeliler
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Pathology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bilge Bilgic
- Pathology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ibrahim Adaletli
- Pediatric Radiology Division, Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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22
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Chellakhi M, Benchakroun N, Bouchbika Z, Jouhadi H, Tawfiq N, Sahraoui S, Benider A. [Radiotherapy of primary breast sarcomas: Retrospective study]. Cancer Radiother 2018; 22:211-215. [PMID: 29680464 DOI: 10.1016/j.canrad.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Primary breast sarcomas are heterogeneous tumours derived from non-epithelial mammary gland structures. Although they represent a rare entity, their incidence may increase in the coming years owing to conservative approach considered in the treatment of breast cancer. The aim of this work was to highlight the effect of postoperative irradiation in the treatment of these tumours. MATERIALS AND METHODS This is a retrospective study conducted at the Mohammed-VI centre for cancer treatment between 2004 and 2011. Survival rates were calculated by the Kaplan-Meier method. RESULTS Fifteen cases were collected. The median age was 41.9years. Phyllode sarcoma accounted for 66% of this series. Surgical treatment was performed in 93% of the patients with negative margins in 33.33% of the cases. Neoadjuvant chemotherapy was indicated in 46% of the patients with locally advanced tumours and 66% of the patients received postoperative radiotherapy for positive or close margins. Five years overall survival and relapse free survival was not significantly different with the use of adjuvant radiotherapy. CONCLUSION Due to the rarity of this entity and the absence of randomized trials, evidence based management is still lacking. However, a multidisciplinary approach is to be required including surgical excision followed by radiotherapy, depending on the tumour characteristics.
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Affiliation(s)
- M Chellakhi
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc.
| | - N Benchakroun
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - Z Bouchbika
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - H Jouhadi
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - N Tawfiq
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - S Sahraoui
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - A Benider
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
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23
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Zhou Z, Wang C, Sun X, Yang Z, Chen X, Shao Z, Yu X, Guo X. Prognostic factors in breast phyllodes tumors: a nomogram based on a retrospective cohort study of 404 patients. Cancer Med 2018; 7:1030-1042. [PMID: 29479819 PMCID: PMC5911599 DOI: 10.1002/cam4.1327] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/06/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to explore the independent prognostic factors related to postoperative recurrence-free survival (RFS) in patients with breast phyllodes tumors (PTBs). A retrospective analysis was conducted in Fudan University Shanghai Cancer Center. According to histological type, patients with benign PTBs were classified as a low-risk group, while borderline and malignant PTBs were classified as a high-risk group. The Cox regression model was adopted to identify factors affecting postoperative RFS in the two groups, and a nomogram was generated to predict recurrence-free survival at 1, 3, and 5 years. Among the 404 patients, 168 (41.6%) patients had benign PTB, 184 (45.5%) had borderline PTB, and 52 (12.9%) had malignant PTB. Fifty-five patients experienced postoperative local recurrence, including six benign cases, 26 borderline cases, and 22 malignant cases; the three histological types of PTB had local recurrence rates of 3.6%, 14.1%, and 42.3%, respectively. Stromal cell atypia was an independent prognostic factor for RFS in the low-risk group, while the surgical approach and tumor border were independent prognostic factors for RFS in the high-risk group, and patients receiving simple excision with an infiltrative tumor border had a higher recurrence rate. A nomogram developed based on clinicopathologic features and surgical approaches could predict recurrence-free survival at 1, 3, and 5 years. For high-risk patients, this predictive nomogram based on tumor border, tumor residue, mitotic activity, degree of stromal cell hyperplasia, and atypia can be applied for patient counseling and clinical management. The efficacy of adjuvant radiotherapy remains uncertain.
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Affiliation(s)
- Zhi‐Rui Zhou
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghai 200032China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai 200032China
| | - Chen‐Chen Wang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghai 200032China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai 200032China
| | - Xiang‐Jie Sun
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai 200032China
- Department of PathologyFudan University Shanghai Cancer CenterShanghai 200032China
| | - Zhao‐Zhi Yang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghai 200032China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai 200032China
| | - Xing‐Xing Chen
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghai 200032China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai 200032China
| | - Zhi‐Ming Shao
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai 200032China
- Department of Breast SurgeryFudan University Shanghai Cancer CenterShanghai 200032China
| | - Xiao‐Li Yu
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghai 200032China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai 200032China
| | - Xiao‐Mao Guo
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghai 200032China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai 200032China
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24
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Kunkiel M, Maczkiewicz M, Jagiełło-Gruszfeld A, Nowecki Z. Primary angiosarcoma of the breast-series of 11 consecutive cases-a single-centre experience. Curr Oncol 2018; 25:e50-e53. [PMID: 29507495 PMCID: PMC5832291 DOI: 10.3747/co.25.3816] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Angiosarcomas of the breast are rare parenchymal malignancies of the chest wall. Surgery is the main treatment modality with chemotherapy and radiotherapy used in case of recurrence. With generally unfavourable prognosis and lack of clear treatment guidelines due to its rarity and scarcity of available data, angiosarcoma of the breast is a challenging clinical situation for both oncologist and patient. We present here the results of a series of 11 consecutive primary angiosarcoma cases treated at our institute between 2000 and 2015.
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Affiliation(s)
- M. Kunkiel
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - M. Maczkiewicz
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - A. Jagiełło-Gruszfeld
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Z. Nowecki
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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25
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Ford S, Almond L, Gronchi A. An Update on Non-extremity Soft Tissue Sarcomas. Clin Oncol (R Coll Radiol) 2017; 29:516-527. [DOI: 10.1016/j.clon.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/08/2017] [Indexed: 12/18/2022]
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26
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Abstract
Benign and malignant peripheral nerve sheath tumors can involve the breast, presenting as masses in the dermis, deep breast parenchyma or axillary soft tissue. Although the histologic features are frequently characteristic, diagnosis can be challenging on core needle biopsy, and the differential diagnosis includes a variety of other benign and malignant spindle cell lesions of the breast. Here, we review the key clinical and pathological features of breast schwannoma, neurofibroma, granular cell tumor, and malignant peripheral nerve sheath tumor.
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Affiliation(s)
- Vivek Charu
- Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Ashley Cimino-Mathews
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA.
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27
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Multivariate Preoperative and Intraoperative Predictors of Postmastectomy Radiation Therapy in Patients for Whom Immediate Breast Reconstruction Is Planned. Plast Reconstr Surg 2017; 139:599e-605e. [DOI: 10.1097/prs.0000000000003052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Wienbeck S, Meyer HJ, Herzog A, Nemat S, Teifke A, Heindel W, Schäfer F, Kinner S, Müller-Schimpfle M, Surov A. Imaging findings of primary breast sarcoma: Results of a first multicenter study. Eur J Radiol 2016; 88:1-7. [PMID: 28189193 DOI: 10.1016/j.ejrad.2016.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate imaging findings in patients with primary breast sarcoma (PBS). MATERIALS AND METHODS A retrospective search in the databases of 10 radiological departments in Germany from 2000 to 2011 was performed. Only histologically proven cases of PBS were included into the study. Mammography was available in 31 patients (33 lesions), ultrasound images in 24 patients (24 lesions), and for 10 patients (14 lesions) magnetic resonance imaging (MRI) of the breast was performed. The breast findings were classified according to the American College of Radiology Breast Imaging Reporting and Data Systems (BI-RADS) 5th edition categories. Collected data were evaluated by means of descriptive statistics. RESULTS Forty-two female patients (mean age 62.0 years, range, 30-86 years) were included in the study. Clinically, all women had painless lumps. Irregular (53.3% [16/30]) or oval (30.0% [9/30]) mass with indistinct (73.3% [22/30]) or microlobulated (10% [3/30]) margins were common findings on mammograms. Ultrasound revealed typically an irregular (79.2% [19/24]), hypoechoic (62.5% [15/24]) mass, with indistinct margins (79.2% [19/24]), and posterior acoustic shadowing (79.2% [19/24]). MRI showed irregular masses (81.8% [9/11]) with irregular or spiculated margins, and a rapid initial signal increase with a delayed washout in kinetic analysis. CONCLUSION Overall, PBS has no pathognomonic imaging features and can mimic those of invasive mammary carcinoma. Breast sarcoma should be taken into the differential diagnosis of breast findings described above.
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Affiliation(s)
- Susanne Wienbeck
- University of Göttingen, Institute of Diagnostic and Interventional Radiology, Robert- Koch-Str. 40, 37075 Göttingen, Germany.
| | - Hans Jonas Meyer
- University Hospital Halle, Department of Radiology, Ernst-Grube-Str. 40, 06120 Halle, Germany
| | - Aimee Herzog
- University of Jena, Institute of Diagnostic and Interventional Radiology, Erlanger Allee 101, 07747 Jena, Germany
| | - Sogand Nemat
- University of Saarland, Clinic for Diagnostic and Interventional Radiology, Kirrberger Str. 100, 66424 Homburg, Germany
| | - Andrea Teifke
- University of Mainz, Department of Diagnostic and Interventional Radiology, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Walter Heindel
- University of Münster, Institute of Clinical Radiology, Albert-Schweitzer-Str. 33, 48149 Münster, Germany
| | - Fritz Schäfer
- University of Kiel, Institute of Radiology and Neuroradiology, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Sonja Kinner
- University of Essen, Institute of Diagnostic and Interventional Radiology and Neuroradiology, Hufelandstr. 55, 45147 Essen, Germany
| | - Markus Müller-Schimpfle
- Clinic Frankfurt Höchst, Department of Radiology, Gotenstr. 6, 65929 Frankfurt am Main, Germany
| | - Alexey Surov
- University Hospital Halle, Department of Radiology, Ernst-Grube-Str. 40, 06120 Halle, Germany; University of Leipzig, Department of Diagnostic and Interventional Radiology, Liebigstr. 20, 04103 Leipzig, Germany
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29
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Wang L, Lao IW, Yu L, Yang W, Wang J. Primary Breast Angiosarcoma: A Retrospective Study of 36 Cases from a Single Chinese Medical Institute with Clinicopathologic and Radiologic Correlations. Breast J 2016; 23:282-291. [PMID: 27933680 DOI: 10.1111/tbj.12731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this study was to present our experience with primary breast angiosarcoma (PBA) by describing a large series of cases with an emphasis on clinicopathologic and radiologic correlations. Thirty-six cases of PBA diagnosed at our institution between 2006 and 2014 were retrospectively evaluated. All but one case occurred in women with a median age of 35.5 years. The majority of patients presented with a deeply located painless mass, whereas a minority manifested as diffuse enlargement or swelling of the breast. Magnetic resonance imaging showed poorly demarcated lesions with low signal intensity on T1-weighted images, markedly high intensity on T2-weighted images, and prolongation of enhancement upon dynamic study. Histologically, 19 cases (52.8%) were low grade, 12 cases (33.3%) were intermediate grade, and 5 cases (13.9%) were high grade. Follow-up information was available for 27 patients and revealed local recurrence and/or metastasis in 16 patients (59.3%). Five patients (18.5%) died of the disease at a median interval of 20 months. Univariate analysis showed that tumor differentiation had effect on disease-free survival (DFS) (p = 0.005) but failed to predict overall survival (OS) (p = 0.645). The treatment modality was related to OS (p = 0.042) but not DFS (p = 0.131). The Cox proportional hazards regression model suggested that tumor differentiation was an independent predictor of DFS (p = 0.015). We hypothesize that tumor differentiation may be used as a prognostic factor for this rare malignancy. Clinicopathologic and radiologic correlation may help pathologists to arrive at the correct diagnosis of PBA.
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Affiliation(s)
- Lei Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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30
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Zhou ZR, Wang CC, Yang ZZ, Yu XL, Guo XM. Phyllodes tumors of the breast: diagnosis, treatment and prognostic factors related to recurrence. J Thorac Dis 2016; 8:3361-3368. [PMID: 28066617 DOI: 10.21037/jtd.2016.11.03] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Phyllodes tumors of the breast are rare tumor types that consist of 0.3-1.0% in all breast tumors. The naming and classification of breast phyllodes tumor have been debated for years. Based on the classification criteria modified by WHO in 2003, this review mainly introduced the clinicopathologic characteristics, pre-operational diagnosis and the treatment of breast phyllodes tumors, and also summarized the prognostic factors related to tumor recurrence.
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Affiliation(s)
- Zhi-Rui Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China;; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Chen-Chen Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China;; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhao-Zhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China;; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xiao-Li Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China;; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xiao-Mao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China;; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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31
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32
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Breast sarcomas and malignant phyllodes tumours: comparison of clinicopathological features, treatment strategies, prognostic factors and outcomes. Breast Cancer Res Treat 2016; 159:229-44. [DOI: 10.1007/s10549-016-3946-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
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33
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Srinivasamurthy BC, Kulandaivelu AR, Saha K, Saha A. Primary undifferentiated pleomorphic sarcoma of the breast in a young female: a case report. World J Surg Oncol 2016; 14:186. [PMID: 27421259 PMCID: PMC4947292 DOI: 10.1186/s12957-016-0947-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Undifferentiated pleomorphic sarcoma is a rare entity and requires extensive immunohistochemical markers to differentiate it from other tumors of the breast. Case presentation We present a 29-year-old female with a left breast lump for 2 months. Initial diagnosis of malignant spindle cell tumor was done on core biopsy following which total mastectomy was done. After extensive sampling, on histology, highly pleomorphic spindle cells palisading the area of geographic necrosis with very high atypical mitosis were seen. As there was diagnostic difficulty, immunohistochemical antibody panel was used and diagnosis of undifferentiated pleomorphic sarcoma of the breast was made by exclusion. Conclusions Core biopsy with immunostaining is possibly superior to FNA as an initial diagnostic modality for breast masses with atypical features.
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Affiliation(s)
- Banushree C Srinivasamurthy
- Department of Pathology, All India Institute of Medical Sciences, Sijua Village, Dumduma, Bhubaneswar, Orissa-17, India. .,Present Address: Department of Pathology, Indira Gandhi Medical College, Puducherry, 605113, India.
| | | | - Kaushik Saha
- Department of Pathology, All India Institute of Medical Sciences, Sijua Village, Dumduma, Bhubaneswar, Orissa-17, India
| | - Arpita Saha
- Department of Pathology, All India Institute of Medical Sciences, Sijua Village, Dumduma, Bhubaneswar, Orissa-17, India
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34
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Shah S, Rosa M. Radiation-Associated Angiosarcoma of the Breast: Clinical and Pathologic Features. Arch Pathol Lab Med 2016; 140:477-81. [DOI: 10.5858/arpa.2014-0581-rs] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast angiosarcoma is an unusual malignancy accounting for approximately 1% of soft tissue sarcomas. It can occur as a primary form without a known precursor or as a secondary form associated with radiotherapy. Adjuvant radiotherapy has a significant role in preventing local recurrence in women treated with conservation therapy for early stage breast carcinoma or multicentric tumors. Postradiation angiosarcoma usually affects the dermis of the breast within the radiation field and may occasionally develop in the breast parenchyma. Compared with the latency of other radiation-associated sarcomas, the latency for breast radiation-associated angiosarcoma is relatively short with a median of 6 years. The risk of developing secondary angiosarcoma does not outweigh the benefit of treatment; therefore, radiation therapy continues to be a mainstay modality in the treatment of breast cancer patients. Early detection is essential because angiosarcomas are associated with a poor prognosis. Wide surgical resection is the standard treatment for these tumors.
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Affiliation(s)
| | - Marilin Rosa
- From the Departments of Anatomic Pathology (Drs Shah and Rosa) and Women's Oncology (Dr Rosa), Moffitt Cancer Center, Tampa, Florida
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35
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Huang IH, Wu YY, Huang TC, Chang WK, Chen JH. Statistics and outlook of primary hepatic angiosarcoma based on clinical stage. Oncol Lett 2016; 11:3218-3222. [PMID: 27123094 DOI: 10.3892/ol.2016.4348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/24/2016] [Indexed: 12/13/2022] Open
Abstract
Hepatic angiosarcoma is a rare condition that has been associated with exposure to colloidal solutions of thorium dioxide, vinyl chloride, arsenic and radiation. Therapeutic guidelines have not been definitively established due to the small number of cases of this disease. The present study reviewed 28 cases of hepatic angiosarcoma from studies that had been published between January 2000 and December 2012, in addition to 6 cases diagnosed at Tri-Service General Hospital (Taipei, Taiwan). Clinical staging was based on American Joint Committee on Cancer staging system for soft tissue sarcoma (2014). With a mean follow-up of 27.5 months (range, 0.27-102 months), 18% (6/34) of the patients survived. The 1-, 3- and 5-year survival rates were 68.0±9.3, 42.1±10.2 and 32.7±9.8% for patients with stage I disease (mean follow-up, 32.7 months), whilst the 1- and 3-year survival rates were 33.3±15.7 and 22.2±13.9% for patients with stage IV disease (mean follow-up, 13.0 months). Determining an appropriate therapeutic strategy for this patient group is necessary. New studies encompassing larger patient populations are required in order to analyze and define standard prognostic parameters and to standardize a treatment approach for this extremely rare neoplasm.
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Affiliation(s)
- I-Hsuan Huang
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C
| | - Yi-Ying Wu
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C
| | - Tzu-Chuan Huang
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C
| | - Wei-Kuo Chang
- Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C
| | - Jia-Hong Chen
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C.; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan R.O.C
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36
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Lim SZ, Ong KW, Tan BKT, Selvarajan S, Tan PH. Sarcoma of the breast: an update on a rare entity. J Clin Pathol 2016; 69:373-81. [PMID: 26729013 DOI: 10.1136/jclinpath-2015-203545] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/07/2015] [Indexed: 11/03/2022]
Abstract
Breast sarcoma is a rare condition. It consists of a heterogeneous group of non-epithelial tumours arising from the mesenchymal tissue of the breast. It has a distinctly different natural history, treatment response and prognosis as compared with carcinoma of the breast. A different diagnostic approach and treatment strategy have to be defined for this group of tumours. Due to its rarity, the current understanding on breast sarcoma is limited and is mostly based on small retrospective case series or case reports. Hence, the management generally follows the algorithms derived from randomised control trials of soft tissue sarcomas in the extremities and chest wall. Through this review, we discuss the results of major retrospective studies on breast sarcomas including data on epidemiology, aetiology, diagnostic approach, treatment strategies and outcomes of this challenging and potentially aggressive condition.
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Affiliation(s)
- Sue Zann Lim
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Kong Wee Ong
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | | | | | - Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore
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37
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Askan G, Arıbal E, Ak G, Kaya H. Periductal Stromal Tumor of the Breast: A Case Report and Review of the Literature. THE JOURNAL OF BREAST HEALTH 2016; 12:133-136. [PMID: 28331749 DOI: 10.5152/tjbh.2016.2889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/01/2016] [Indexed: 11/22/2022]
Abstract
We present a woman aged 50 years who underwent a Tru-cut biopsy for a BI-RADS 4 lesion on her right breast and received a histopathology diagnosis of a fibroadenoma. In her one year follow-up, the lesion had progressed and she underwent an excisional biopsy. Her final diagnosis was a periductal stromal tumor. Periductal stromal tumor is an extremely rare and different entity from phylloides tumor, which makes appropriate diagnosis difficult in Tru-cut biopsy and care should be taken. Lesion progression of should require a re-biopsy. Their tendency to recur warrants follow-up. We believe that radiologic, pathologic, and clinical correlation is key in decision-making and diagnosis of these tumors.
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Affiliation(s)
- Gökçe Askan
- Department of Pathology, Marmara University Hospital, İstanbul, Turkey
| | - Erkin Arıbal
- Department of Radiology, Marmara University Hospital, İstanbul, Turkey
| | - Gamze Ak
- Department of Pathology, Marmara University Hospital, İstanbul, Turkey
| | - Handan Kaya
- Department of Pathology, Marmara University Hospital, İstanbul, Turkey
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38
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Hu QC, Mei X, Feng Y, Ma JL, Yang ZZ, Shao ZM, Yu XL, Guo XM. Early Local Recurrence Presents Adverse Effect on Outcomes of Primary Breast Sarcoma: A Retrospective Study From Single Institute in China. Medicine (Baltimore) 2016; 95:e2422. [PMID: 26735546 PMCID: PMC4706266 DOI: 10.1097/md.0000000000002422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Primary breast sarcomas (PBSs) are spectrum heterogeneous sarcomas in breast and the optimal treatment for them is still under discussion. Our study was to investigate clinical characteristics and identify potential prognostic factors for this rare malignancy. The authors retrospectively reviewed 38 patients with PBSs between October 2000 and February 2014 in FuDan University Shanghai Cancer Center. Local control rate and overall survival (OS) were determined by Kaplan-Meier actuarial method. Univariate analysis and Cox proportional hazards model were applied to identify potential prognostic factors. With median follow-up of 40.19 months, 14 patients (14/38) were found with local recurrence. Extensive operation like mastectomy was not superior to local resection (P = 0.167). Three-year recurrence-free survival and OS rate were 61.9% and 89%, respectively. Larger tumor size and local recurrence were indicated as unfavorable prognostic factors in univariate analysis. Cox model identified narrow interval of recurrence free survival as an unfavorable factor (P = 0.048). Surgery remains crucial treatment for PBSs. Mastectomy, however, is not routinely necessary if clear margin could be achieved by local excision. Early recurrence indicates a poor OS.
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Affiliation(s)
- Qun-Chao Hu
- From the Department of Radiation Oncology (QH, XM, YF, JM, ZY, XY, XG); Department of Breast Surgery (ZS), Fudan University Shanghai Cancer Center; Department of Oncology, (QH, XM, YF, JM, ZY, ZS, XY, XG); Shanghai Medical College, Fudan University, Shanghai, China; and Suzhou Municipal Hospital, Suzhou, China (QH)
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39
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Banys-Paluchowski M, Burandt E, Quaas A, Wilczak W, Geist S, Sauter G, Krawczyk N, Pietzner K, Paluchowski P. Liposarcoma of the breast arising in a malignant phyllodes tumor: A case report and review of the literature. World J Clin Oncol 2015; 6:174-178. [PMID: 26468454 PMCID: PMC4600192 DOI: 10.5306/wjco.v6.i5.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/27/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
Liposarcoma of the breast is a very rare malignant tumor. It can clinically manifest as a palpable breast mass and mimic primary breast cancer. We report an unusual case of a 51-year-old female who presented with an asymptomatic right breast mass, which was histologically diagnosed as well differentiated liposarcoma arisen within malignant phyllodes tumor. The patient underwent breast conserving surgery, received no adjuvant treatment and is disease-free after 2 years. Radiological and histopathological features are presented and described in detail. Data from the literature are presented and therapy recommendations discussed.
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40
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Masai K, Kinoshita T, Jimbo K, Asaga S, Hojo T. Clinicopathological features of breast angiosarcoma. Breast Cancer 2015; 23:718-23. [DOI: 10.1007/s12282-015-0630-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/23/2015] [Indexed: 11/24/2022]
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41
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Tajima S, Koda K, Fukayama M. Primary leiomyosarcoma of the breast with prominent osteoclastic giant cells: A case expressing receptor activator of NF-κB ligand (RANKL). Pathol Int 2015. [PMID: 26150133 DOI: 10.1111/pin.12328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/05/2015] [Indexed: 11/26/2022]
Abstract
Primary sarcomas of the breast are rare, accounting for less than 1% of all breast neoplasms. Leiomyosarcoma is one of the least common breast sarcoma subtypes, and less than 50 cases of primary breast leiomyosarcomas have been reported in the English literature. In other types of leiomyosarcoma, osteoclastic giant cells (OGCs) are occasionally admixed with tumor cells; however, this is rarely seen in primary breast leiomyosarcoma. We herein present the case of a 50-year-old woman with OGC-containing primary breast leiomyosarcoma whose tumor cells showed positive immunostaining for receptor activator of NF-κB ligand (RANKL). The presence of OGCs in tumors generally indicates tumor aggressiveness. This is true for leiomyosarcoma of the soft tissue and might be true for leiomyosarcoma of primary breast origin. Regarding RANKL expression, in giant cell tumor of bone (GCTB) in which OGCs expressing RANK were abundant, tumor cells are known for expressing RANKL. Therapy targeting RANKL decreases the number of tumor cells of GCTB. Our findings are clinically relevant as they indicate that RANKL expression should be investigated in various tumors containing OGCs. This might lead to the development of future molecule-targeted therapy.
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Affiliation(s)
- Shogo Tajima
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Koda
- Department of Pathology, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Abstract
A 54-year-old woman had a primary breast sarcoma with rapid enlargement in 3 months. The mass became so huge that it was more than 20 cm in diameter and occupied the entire right breast on presentation. Extraosseous uptake was present in this mass and demonstrated a unique picture, mimicking the posture of a racing driver who holds a helmet under the armpit, on the bone scan.
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43
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Abstract
Primary leiomyosarcoma of the breast is an extremely rare neoplasm. Only few cases have been reported in the literature. We report here a case of breast leiomyosarcoma in a 44-years-old female and we discuss the data of the existing literature.
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44
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Tashjian R, Gilani SM, Falk J, Kelly MJ, Ockner D, Danforth R. Primary inflammatory malignant fibrous histiocytoma of the breast: A case report of an unusual variant and review of the literature. Pathol Res Pract 2013; 209:534-9. [DOI: 10.1016/j.prp.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/12/2013] [Accepted: 05/21/2013] [Indexed: 11/28/2022]
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45
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Lahat G, Lev D, Gerstenhaber F, Madewell J, Le-Petross H, Pollock RE. Sarcomas of the breast. Expert Rev Anticancer Ther 2013; 12:1045-51. [PMID: 23030224 DOI: 10.1586/era.12.82] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sarcomas of the breast are a rare group of heterogeneous mesenchymal tumors accounting for less than 1% of all breast malignancies. Owing to the rarity of the disease, current knowledge is mostly based on numerous case reports and relatively small retrospective series; unlike epithelial breast cancer, there is no high level evidence to support a standard of care for primary and/or adjuvant therapy. To overcome this relative shortage of data, most therapeutic strategies for breast sarcoma are extrapolated from current treatment for soft tissue sarcoma in other locations, mainly of the extremities and thoracic wall. In general, the therapeutic approach to sarcoma of the breast should be based on a multidisciplinary strategy including surgery, radiation to improve local control and systemic chemotherapy in selected patients. This review discusses the results of the key larger retrospective studies including data on incidence, etiology, presentation, diagnosis, management and prognosis of this challenging rare disease entity.
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Affiliation(s)
- Guy Lahat
- Department of Surgery, Sourasky Medical Center, Tel-Aviv, Israel.
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46
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Malignant fibrous histiocytoma of the breast in young male patient: a case report and a review of the literature. Case Rep Oncol Med 2013; 2013:524305. [PMID: 23573437 PMCID: PMC3612459 DOI: 10.1155/2013/524305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/20/2013] [Indexed: 11/22/2022] Open
Abstract
Malignant Fibrous Histiocytoma (MFH) is a fairly common tumor in the deep soft tissues: the most frequent primary sites are the lower (49%) and upper (19%) limbs, but it has been reported even in the retroperitoneum and abdomen (16%), while localization in the breast is extremely rare (1-2). Breast cancer is rarely seen in males, accounts for approximately 1% of all breast cancer, and the breast sarcomas constitute less than 1% of breast tumors in both sexes. In the review of the literature, this is the third male and first young male with MFH. Here, we present a 37-years-old male patient who is diagnosed to have malignant fibrous histiocytoma in a variant of pleomorphic fusiform cell localized in the left breast. Following the wide local excision, the patient was given an adjuvant 50 Gy of external radiotherapy. He remained alive and well after 42 months of followup. We believe that reporting such few cases would contribute to forming treatment algorithms of rare tumors.
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Balbi G, Di Martino L, Pitruzzella G, Pitruzzella D, Grauso F, Napolitano A, Seguino E, Gioia F, Orabona P. Undifferentiated pleomorphic sarcoma with osteoclast-like giant cells of the female breast. World J Surg Oncol 2013; 11:21. [PMID: 23351285 PMCID: PMC3579744 DOI: 10.1186/1477-7819-11-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 01/06/2013] [Indexed: 11/25/2022] Open
Abstract
The authors describe a case of undifferentiated pleomorphic sarcoma of the breast occurring in a 50-year-old woman who presented with a palpable mass in her right breast. She first noticed the mass one month previously. Core needle biopsy showed connective tissue including epithelioid and spindle cells. The patient underwent total mastectomy without axillary lymph node dissection. Based on examination of the excised tumor, the initial pathologic diagnosis was atypical spindle-shaped and ovoid cells with uncertain malignant potential. Histological findings with immunomarkers led to the final diagnosis of undifferentiated pleomorphic sarcoma. This case highlights a rare and interesting variant of primary breast sarcoma and the important role of immunohistochemistry in defining histological type and differential diagnosis. Hence, undifferentiated pleomorphic sarcoma has been a diagnosis of exclusion performed through sampling and critical use of ancillary diagnostic techniques.
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Affiliation(s)
- Giancarlo Balbi
- U.O. Ginecologia ed Ostetricia, Seconda Università degli Studi di Napoli, c/o S. Anna e S. Sebastiano Hospital, Caserta, Italy.
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48
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Malignant fibrous histiocytoma of the breast: a case report. Case Rep Pathol 2012; 2012:579245. [PMID: 22953136 PMCID: PMC3420691 DOI: 10.1155/2012/579245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 01/15/2012] [Indexed: 11/29/2022] Open
Abstract
This paper concerns a case of Malignant Fibrous Histiocytoma (MFH) of the Breast in a 73-years-old woman. A lump was found in her right breast, measuring 1.7 cm in diameter. Surgical excision followed, and pathology revealed a highly atypical spindle cell tumor. Immunohistochemistry along the histological features, excluded the possibility of carcinoma, malignant phyllodes tumor, or another type of pure sarcoma. There was no history of previous irradiation in the region. MFH is among the rarest types of sarcoma of the breast, and most of the times behaves aggressively. Excision with wide, free-of-tumor margins is the most effective treatment, when feasible.
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Kim YS, Kim YJ, Yim KI, Park WC. A case report of primary breast angiosarcoma with fatal pulmonary hemorrhage due to thrombocytopenia. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:251-5. [PMID: 22493767 PMCID: PMC3319780 DOI: 10.4174/jkss.2012.82.4.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 09/19/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
Abstract
Primary angiosarcomas of the breast are rare malignancy that account for fewer than 0.04% of all malignant breast tumors. The prognosis is poor. Surgery is the first line of treatment for angiosarcoma. Adjuvant chemotherapy and radiotherapy have been tried, but their efficacy remains controversial. Here we present the case of a 47-year-old woman with a palpable left breast mass that was diagnosed as a primary angiosarcoma. The patient underwent modified radical mastectomy with adjuvant chemotherapy and radiotherapy. Postoperatively, eighteen months later, the angiosarcoma recurred. The patient returned complaining of dyspnea and hemoptysis and was found to have a large pleural effusion. She developed a gradual onset of thrombocytopenia that persisted despite platelet transfusions. Finally, the patient died of respiratory failure secondary to pulmonary hemorrhage.
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Affiliation(s)
- Yong-Seok Kim
- Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea
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Primary leiomyosarcoma of breast in an adolescent girl: a case report and review of the literature. Case Rep Pathol 2012; 2012:491984. [PMID: 22953134 PMCID: PMC3420689 DOI: 10.1155/2012/491984] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 01/16/2012] [Indexed: 12/28/2022] Open
Abstract
Leiomyosarcoma of the breast is a rare neoplasm, primarily reported in older women. Only 44 cases have been reported in world literature and to the best of our knowledge, no case has been reported from India till date. We report a case of primary breast leiomyosarcoma in an adolescent girl who underwent a lumpectomy for rapidly increasing lump in the left breast. Here we report the histological findings and immunohistochemical profile of this entity, along with a review of existing literature.
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