Malignant schwannoma of the breast

Unusual primary breast cancer - malignant peripheral nerve sheath tumor: a case report and review of the literature

Background

Sarcomas are a rare type of breast malignancies and malignant peripheral nerve sheath tumors of the breast are even rarer. There are no specific clinical and radiological features for the diagnosis of this tumor and histological features are also reported to be nonspecific. Therefore, immunohistochemistry is required for its diagnosis. A definitive treatment protocol is unavailable because of its rarity.

Case presentation

We report a case of a sporadic form of breast malignant peripheral nerve sheath tumor found in a 16-year-old Asian Bangladeshi girl. She experienced local recurrence and she had multiple left breast lumps four times in a very short period after repeated surgeries. However, she was later managed successfully with chemotherapy and locoregional radiotherapy. A chemotherapy protocol with ifosfamide, vincristine, and actinomycin was used and radiotherapy was given with a total dose of 50 Gy given in 25 fractions of 2 Gy by a 6 MV photon linear accelerator followed by 10 Gy boost given in 5 fractions of 2 Gy by 9 MeV electron energy. With more than 3 years of periodic follow-up, she is still well without any locoregional and metastatic recurrence.

Conclusions

This report suggests proper immunohistochemical analysis whenever a breast sarcoma is found in order to find a rare histological variety. We believe that malignant peripheral nerve sheath tumor of the breast can be managed by total mastectomy followed by adjuvant chemotherapy and radiotherapy. Long-term meticulous follow-up is required to develop an optimum therapeutic strategy.

Primary well differentiated breast liposarcoma with divergent cartilagenous differentiation: a case report

Primary liposarcomas of the female and male breasts are very rare. Heterologous differentiation in adipocytic tumors is also an exceedingly rare phenomenon, which is occasionally reported in the literature. We describe the case of a 22 year-old female who presented with a relatively large left breast mass which was clinically diagnosed as a case of giant fibroadenoma, but histologically showed a well differentiated liposarcoma with evidence of extensive chondroid differentiation. The mammographic and radiological features are presented and correlated with the histopathological appearances together with literature review and comparison with similar reported cases.

Breast schwannoma

Schwannomas arise from Schwann cells of the peripheral nerve sheath. The most common locations include the head, neck, and extensor surfaces of the extremities. Intramammary schwannomas are very rare and account for only 2.6% of schwannomas. A review of the English literature reveals 27 such cases of breast schwannoma. In this paper we describe another such rare case.

Malignant peripheral nerve sheath tumor of the breast: case report

BACKGROUND

Malignant peripheral nerve sheath tumor is a rare soft tissue sarcoma of ectomesenchymal origin. It is the malignant counterpart of benign soft tissue tumors like neurofibromas and schwannomas and may often follow them. Common sites include deeper soft tissues, usually in the proximity of a nerve trunk. Breast is an extremely rare location of this lesion and presentation as a breast lump in the absence of pain or previous benign neural tumor is even rarer.

CASE PRESENTATION

A 38-year-old female presented with complaints of painless, hard breast lump for three months which was clinically suspected to be a ductal carcinoma with inconclusive fine needle aspiration cytology. Histopathology revealed a malignant spindle cell tumor which was confirmed to be malignant peripheral nerve sheath tumor on the basis of immunopositivity for vimentin, neurone specific enolase and S-100.

CONCLUSION

To the best of our knowledge only six such case reports have been published in literature. The differential diagnosis of malignant peripheral nerve sheath tumor should be considered by the clinician as well as the pathologists in the work-up of a breast neoplasm as treatment and prognosis of this rare malignancy is different.

A giant malignant peripheral nerve sheath tumour of the breast: CT and pathological findings

Malignant peripheral nerve sheath tumour (MPNST) is a rare soft tissue sarcoma. In particular, primary MPNST of the breast is extremely rare. We report a case of a giant malignant peripheral nerve sheath tumour involving the entire right breast, which was not associated with neurofibromatosis type 1 (NF-1) or previous radiation therapy. A CT scan showed a huge heterogeneous soft tissue mass with well-enhanced nodules at its periphery and low-density internal necrosis, which was confirmed by modified radical mastectomy.