Mesenchymal tumors and tumor-like lesions of the breast: a contemporary approach review

Demystifying Breast Disease Markers

Breast imaging radiologists regularly perform image-guided biopsies of suspicious breast lesions based on features that are associated with a likelihood of malignancy ranging from 2% to greater than 95% (Breast Imaging Reporting and Data System categories 4 and 5). As diagnostic partners, pathologists perform histopathologic assessment of these tissue samples to confirm a diagnosis. Correlating the imaging findings with the histopathologic results is an integral aspect of multidisciplinary breast care. Assessment of radiologic-pathologic concordance is vital in guiding appropriate management, as it enables identification of discordant results, minimizing the chance of misdiagnosis. Undersampling can lead to false-negative results, with the frequencies of false-negative diagnoses varying on the basis of multiple factors, including biopsy type (eg, core needle, vacuum-assisted needle), needle gauge, and type of lesion sampled at biopsy (ie, mass, calcifications, asymmetry, architectural distortion). Improving a radiologist's knowledge of macroscopic and microscopic breast anatomy and more common breast diseases and their expected imaging findings ensures more accurate radiologic-pathologic correlation and management recommendations. The histopathologic and molecular characteristics of biopsy-sampled breast lesions aid in making an accurate diagnosis. Hematoxylin-eosin staining provides critical morphologic details, whereas immunohistochemical staining enables molecular characterization of many benign and malignant lesions, which is critical for tailored treatment. The authors review commonly encountered benign and malignant breast diseases, their corresponding histopathologic phenotypes, and the histopathologic markers that are essential to clinching the diagnosis of these entities. As part of a multidisciplinary team that provides optimal patient care, radiologists should be knowledgeable of the foundations of histopathologic diagnosis and the implications for patient management to ensure appropriate radiologic-pathologic concordance. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

A malignant transformation of borderline phyllodes tumor to fibrosarcoma breast: A rare case report

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.

Male Breast Cancer in Togo: Imaging and Clinicopathological Findings

Background

Breast cancer in men is a rare condition, often diagnosed late. The purpose of this study was to describe its epidemiological, histopathological, and radiographic aspects in Togo.

Materials and Methods

This was a descriptive retrospective study on cases of breast cancer in humans diagnosed histologically at the Laboratory of Anatomy Pathological and Imagery of the University Hospital in Lomé, over a period of 25 years (1995 to 2019). The parameters studied were epidemiological, anatomopathological, and imaging.

Results

Eighty-two (82) cases were diagnosed, an annual frequency of 3.28 cases. The mean age was 45 ± 2.5 years; the range was 27-63 years. The family history of 47 patients (57.32%) was known. Carcinomas represented the predominant histological group with predominantly nonspecific invasive carcinoma (87.5%). These cancers were diagnosed at late stages (75.71% grade II). They were mainly of luminal B profile (38.75%) and associated with mutations of the BRCA2 and BRCA1 genes in 14.63% of the cases. The lesions were classified ACR 5 in 61.5% (11/18). Two cases of breast angiosarcoma were diagnosed by the identification of CD31 markers and factor VIII in immunohistochemistry. Hormone therapy such as tamoxifen was prescribed in all luminal patients (43 patients). Radiotherapy was administered to 15 patients (18.3%), with acute toxicity in 20% of the cases. After a median follow-up of 36 months, the evolution was complete remission in 27 patients (32.93%).

Conclusion

Breast cancer in men is rare, often diagnosed late with a poor prognosis.

[Inflammatory myofibroblastic tumor of the breast: A rare entity]

Also known as inflammatory pseudotumor, inflammatory myofibroblastic tumor is now considered a true low-grade neoplasm. Although the lung is the most common site, it has been described in many other locations, including the breast; the first report of breast involvement was by Pettinato et al. in 1988. We report the case of a 52-year-old perimenopausal woman presenting with a slow-growing mass in her right breast. Mammography revealed a well demarcated lesion which was hypoechoic on ultrasound. A needle biopsy was performed yielding an initial diagnosis of myofibroma and the mass was resected. Histopathology of the 5-cm tumor revealed a fusocellular proliferation with a striking presence of inflammatory cells, morphologically and immunohistochemically concordant with inflammatory myofibroblastic tumor. The patient underwent further surgery to ensure free margins and after a negative extension study (PET-CT) is receiving no further therapy. To date, she has shown no signs of recurrence 8 months postoperatively. Inflammatory myofibroblastic tumor of the breast is very infrequent, with less than 30 reported cases. Differential diagnosis with both benign and malignant entities is extensive and it may precede or coexist with carcinoma of the adjacent breast. Although it is considered a low-malignant potential lesion, there are well documented cases of recurrence and even metastasis. Surgical resection with wide margins is the primary treatment and no systemic therapy is indicated; however, clinical follow-up is mandatory as there are no well-established criteria as yet to predict the biological behavior of this tumor.

Step by step approach to rare breast lesions containing spindle cells

Differential diagnosis of spindle cell lesions of breast is challenging for certain reasons. The most important reason is the presence of cytological atypia and mitosis in all three conditions: reactive, benign, and malignant. Patients diagnosed with benign and malignant tumor/tumor-like lesions that had spindle cell components following the histopathological examination were included in the study. The patients’ medical records were accessed to obtain the clinical history, follow-up notes, and radiological findings. Following histopathological, immunohistochemical, and clinical evaluations, the patients were diagnosed as follows: pseudoangiomatous stromal hyperplasia (PASH), bilateral desmoid-type fibromatosis (FM), adenomyoepithelioma (AME), myofibroblastoma (MFB), malignant phyllodes tumor (MF), high-grade AS, post-chemotherapy osteosarcoma (OS) + Paget’s disease, and metaplastic carcinoma (MC). An algorithmic approach should be used in the diagnosis; cellular structure, presence and grade of atypia, growth pattern, mitotic activity, immunohistochemical staining, and clinical and radiological features should be evaluated together. Detection of some molecular changes can be useful in differential diagnosis.