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Hammood ZD, Salih AM, Kakamad FH, Abdullah AM, Ali BS, Pshtiwan LRA. Desmoid fibromatosis of the breast; a rare case report. Int J Surg Case Rep 2021; 87:106363. [PMID: 34562723 PMCID: PMC8473648 DOI: 10.1016/j.ijscr.2021.106363] [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: 05/22/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction Desmoid tumor is an uncommon tumor with variable spectrum ranged from being a locally lesion to an aggressive and destructive one. The current case aims to report a rare condition of desmoid type fibromatosis of the breast. Presentation of case A 59-year-old female presented with a right breast mass for 9-months. Mammography showed a small speculated iso-hyper dense mass, just anterior to the pectoralis muscle measuring about 15 mm (M5) in longest axis. Ultrasound examination revealed an irregular mass with internal vascularity and posterior shadowing in the right breast with a single borderline lymph node (25 ∗ 14 mm of 4 mm cortex). Wide local excision with sentinel axillary lymph nodes biopsy was performed. Histopathological examination of the specimen confirmed the diagnosis of desmoid type fibromatosis of the breast. Discussion The etiology of this tumor is unknown, however, physical, hormonal and genetic factors have a significant role in the development of desmoid tumor. Conclusion Desmid type fibromatosis of the breast is an uncommon, benign, locally aggressive fibroblastic tumor with lack of metastatic potential, it may present with features of malignancy. Desmoid tumor is an uncommon tumor. The occurrence of desmoid tumor in the breast is even rarer. Differentiation from malignant disease is a challenging task. The current report discusses a case of desmoid type fibromatosis of the breast.
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Affiliation(s)
- Zuhair D Hammood
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; School of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; School of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq.
| | - Ari M Abdullah
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Sulaimani Teaching Hospital, Sulaimani, Kurdistan, Iraq
| | - Bakhan Sharif Ali
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq
| | - Lana R A Pshtiwan
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq
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2
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Liu H, Zeng H, Zhang H, Wang H, Cheng Z, Hu Y, Wu Z. Breast fibromatosis: Imaging and clinical findings. Breast J 2020; 26:2217-2222. [PMID: 32754995 DOI: 10.1111/tbj.14008] [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] [Received: 06/29/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
Breast fibromatosis is a rare histologically benign tumor with local aggressive potential, and imaging and clinical findings of breast fibromatosis require attention. We retrospectively evaluated the images of 20 patients with histologically proven breast fibromatosis on mammography, magnetic resonance imaging (MRI), and ultrasonography. The lesions were assessed concerning the location, fascia involvement, imaging characteristics, and follow-up outcomes. Altogether, there were 22 lesions: 10 lesions involved the superficial fascia system including four lesions additionally involving the deep fascia and pectoralis major, and 12 lesions were inside the glandular parenchyma with two lesions originated from the prior surgery site. The detection rates of mammography, ultrasound, and MRI for breast fibromatosis were 33.3% (3/9), 90% (18/20), and 100% (3/3), respectively. We found that fascia involvement may be a characteristic of breast fibromatosis. The lesion located inside glandular parenchyma is prone to be underestimated, whereas combined MR with ultrasound is recommended for the diagnosis. The complete excision with negative margins is important for a good prognosis.
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Affiliation(s)
- Haiqing Liu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hong Zeng
- Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hanchen Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hongli Wang
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ziliang Cheng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yue Hu
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhuo Wu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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3
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Complicaciones infrecuentes de las prótesis de mama. RADIOLOGIA 2020; 62:266-279. [DOI: 10.1016/j.rx.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/10/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
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4
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Sánchez Rubio N, Lannegrand Menéndez B, Duque Muñoz M, Montes Fernández M, Ciudad Fernández M. Uncommon complications of breast prostheses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lewin AA, Moy L. Unknown Case #2: Part 2. JOURNAL OF BREAST IMAGING 2019; 1:264-266. [PMID: 38424749 DOI: 10.1093/jbi/wbz004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 03/02/2024]
Affiliation(s)
- Alana A Lewin
- New York University School of Medicine, Department of Radiology, Center for Biomedical Imaging, New York, NY
| | - Linda Moy
- New York University School of Medicine, Department of Radiology, Center for Biomedical Imaging, New York, NY
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Michelow P, Field AS. Spindle Cell Lesions of the Breast on Fine-Needle Aspiration Biopsy: A Miscellany of Masses. Acta Cytol 2019; 63:328-339. [PMID: 31117069 DOI: 10.1159/000500703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/02/2019] [Indexed: 12/17/2022]
Abstract
A variety of primary breast and metastatic lesions to the breast can present with spindle cell cytomorphology. These lesions may range from benign reactive or inflammatory lesions to high-grade malignancies. Spindle cell lesions of the breast are not often seen on fine-needle aspiration biopsy (FNAB) but need to be correctly managed when they are encountered. While mesenchymal lesions of the breast have a spindle morphology, lesions derived from the epithelium and myoepithelium can be spindled as well. By assessing if the lesion comprises spindle cells only or if other components such as epithelial cells are apparent and then determining whether the spindle cells appear bland or pleomorphic, together with close clinicoradiologic correlation and prudent use of ancillary tests, a variety of lesions can be diagnosed on FNAB. However, core needle biopsy or excision biopsy may be required in some patients. The cytomorphology, ancillary studies, and clinicoradiologic findings of a range of spindle cell lesions of the breast are further discussed.
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Affiliation(s)
- Pamela Michelow
- Department of Anatomical Pathology, Faculty of Health Science, University of the Witwatersrand and Cytology Unit, National Health Laboratory Service, Johannesburg, South Africa,
| | - Andrew S Field
- Department of Anatomical Pathology, St Vincent's Hospital, and University of New South Wales and Notre Dame University Medical Schools, Sydney, New South Wales, Australia
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7
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Recurrent desmoid tumor arising from latissimus dorsi flap: A case report. Clin Imaging 2018; 53:191-194. [PMID: 30419413 DOI: 10.1016/j.clinimag.2018.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/20/2022]
Abstract
Fibromatosis or desmoid tumor in the breast is a very rare benign soft tissue tumor. We report a case of recurrent desmoid tumor arising from latissimus dorsi flap after lumpectomy for breast carcinoma. To our knowledge, this is the first case of desmoid tumor arising from the latissimus dorsi flap. Despite its benignity, desmoid tumor is often locally aggressive, therefore timely diagnosis and proper management are very important. Imaging and pathological diagnosis as well as treatment management are discussed. High clinical suspicion and multidisciplinary approach are essential for prompt diagnosis and management. Wide surgical resection is required, but there is no consensus regarding treatment due to limited data.
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8
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Morales RD, Mendoza AG, Luces C, Abreu EB, Romero G, Pérez G, Russo L. Aggressive breast fibromatosis following augmentation mastoplasty: a series of case reports. Ecancermedicalscience 2018; 12:833. [PMID: 29910830 PMCID: PMC5985752 DOI: 10.3332/ecancer.2018.833] [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] [Received: 08/15/2017] [Indexed: 11/06/2022] Open
Abstract
Aggressive fibromatosis comprises connective tissue tumours that represent 0.03% of all bodily neoplasms, occurring more often in the abdominal wall, mesentery, and extremities; its location in the breast constitutes a very infrequent type of lesion. Its pathogenesis is diverse and its relationship with augmentation mastoplasty is still unclear. Four cases of aggressive breast fibromatosis following augmentation mastoplasty are reported in this article.
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Affiliation(s)
- Rafael Delgado Morales
- Department of Digestive Pathology, Soft Tissue Tumors and Melanoma, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | - Armando Gil Mendoza
- Department of Digestive Pathology, Soft Tissue Tumors and Melanoma, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | - Carmen Luces
- Department of Digestive Pathology, Soft Tissue Tumors and Melanoma, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | | | - Gabriel Romero
- Department of Mammary Pathology, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | - Gabriel Pérez
- Department of Mammary Pathology, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | - Leonardo Russo
- Department of Mammary Pathology, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
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9
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Desmoid Tumor and Silicone Breast Implant Surgery: Is There Really a Connection? A Literature Review. Aesthetic Plast Surg 2018; 42:59-63. [PMID: 28842766 DOI: 10.1007/s00266-017-0948-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/17/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Desmoid tumors are borderline tumors of the connective tissue, arising in the musculo-aponeurotic stromal elements. A desmoid tumor (DT) has an infiltrative and locally aggressive growth pattern and usually does not metastasize; however, it has a high recurrence and complication rate. DT located in the breast (BDT) represents a rare extra-abdominal form. Recently, the presence of breast silicone implants was suggested by several researchers as a risk factor for developing BDT. OBJECTIVES The goal of this review is to investigate the possible correlation between BDT and breast implant surgery. METHODS We conducted a literature review of BDT-reported cases, associated with breast implant surgery. RESULTS The search revealed 36 cases of BDT associated with silicone breast implants. CONCLUSIONS Based on the reviewed data, the incidence of BDT following breast implant surgery is lower than BDT in the general population. At the moment, a possible association between breast implants and the development of breast desmoid tumors cannot be unequivocally confirmed. A world registry with accurate documentation of each case of BDT associated with breast implant surgery should be performed for future investigation. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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10
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Fibromatosis of the breast mimicking cancer: A case report. Radiol Case Rep 2017; 13:1-5. [PMID: 29487630 PMCID: PMC5826686 DOI: 10.1016/j.radcr.2017.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 12/29/2022] Open
Abstract
Breast fibromatosis, also referred to as desmoid tumor or aggressive fibromatosis, is a very rare, locally aggressive disease that does not metastasize. Bilateral lesions are extremely rare and are found in only 4% of patients with breast fibromatosis. Tumor recurrence following surgery occurs in 18%-29% of patients, most often within the first 2 years after surgery. In this report, we discuss a case of breast fibromatosis, mimicking a breast carcinoma both clinically and radiologically, that presented clinically with dimpling of the skin of the left breast in a 31-year-old woman. The patient relapsed a few months after surgery, with a multicentric and bilateral disease.
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11
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12
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Radiologic images of an aggressive implant-associated fibromatosis of the breast and chest wall: case report and review of the literature. Radiol Case Rep 2017; 12:431-438. [PMID: 28828097 PMCID: PMC5551988 DOI: 10.1016/j.radcr.2017.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 01/19/2023] Open
Abstract
Fibromatosis of the breast is a rare benign disease compromising <0.2% of all primary breast tumors. Although the chest wall is a common location, occurrences of implant-associated fibromatosis of the breast are extremely rare; only 33 cases have been reported. We present a case of a 42-year-old female who underwent breast augmentation with silicone breast implants, and 2 years later developed an aggressive implant-associated fibromatosis of the breast and chest wall. On imaging studies, the tumor mimicked breast carcinoma, and despite chemotherapy, the fibromatosis rapidly enlarged and was locally invasive requiring wide surgical excision. Unlike previously reported imaging findings, magnetic resonance imaging revealed an oval circumscribed mass with fringe-like internal architecture. We provide a review of the literature and discuss the imaging features of implant-associated fibromatosis of the breast.
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13
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Oh C, Hammoudeh ZS, Carlsen BT. Desmoid tumor following abdominally-based free flap breast reconstruction. Gland Surg 2017; 6:89-92. [PMID: 28210557 DOI: 10.21037/gs.2016.06.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Desmoid tumors are fibroblastic connective tissue tumors that most commonly develop within the anterior abdominal wall. The etiology of desmoid tumors has not been well defined; however, hereditary, hormonal, traumatic, and surgery-related causes have been implicated. Desmoid tumors are believed to arise from musculoaponeurotic structures. Development in the breast is very rare. Several reports of desmoid tumors arising in the vicinity of the fibrous capsule of a breast implant have been described, but to date, the authors are not aware of any published cases following autologous breast reconstruction. This report describes a desmoid tumor developing after a muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction and subsequent surgical management.
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Affiliation(s)
- Christine Oh
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ziyad S Hammoudeh
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian T Carlsen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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14
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Wongmaneerung P, Somwangprasert A, Watcharachan K, Ditsatham C. Bilateral desmoid tumor of the breast: case seriesand literature review. Int Med Case Rep J 2016; 9:247-51. [PMID: 27578999 PMCID: PMC5001652 DOI: 10.2147/imcrj.s106325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Desmoid tumor of the breast is very rare and locally aggressive but has no distant metastasis. Bilateral lesions are extremely rare, found in only 4% of patients. Two cases of bilateral desmoid tumor of the breast are reported. The clinical presentation, diagnosis, imaging, treatment, and follow-up outcomes of recurrence as well as a brief literature review are provided. Case reports Case 1 is a 31-year-old woman who presented with nipple retraction. An ultrasound revealed BIRAD V in both breasts. She underwent a bilateral excisional biopsy under ultrasound mark with the pathology result of extra-abdominal desmoid tumor in both breasts. The patient had a bilateral mastectomy with silicone implantation due to the involved margins by excision. She remained tumor free after 7-year follow-up. Case 2 is a 28-year-old woman who presented with a lump on her right breast that she had discovered ~2 months earlier. An ultrasound showed a spiculated mass in the right breast and some circumscribed hypoechoic masses in both breasts. A bilateral breast excision was done. The pathology result was an extra-abdominal desmoid tumor. She had recurrence on both sides and underwent a mastectomy and silicone implantation. The tumor has not recurred after 1-year follow-up. Conclusion Imaging cannot distinguish between benign breast lesions and malignancy. Pathology results are helpful in making a definitive diagnosis. Given that the desmoid tumor is locally aggressive, a local excision with clear margins is recommended. Chemotherapy and hormonal treatment are controversial.
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Affiliation(s)
| | | | - Kirati Watcharachan
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chagkrit Ditsatham
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]. ACTA ACUST UNITED AC 2015; 44:1030-48. [PMID: 26530177 DOI: 10.1016/j.jgyn.2015.09.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning rare benign breast tumors: Abrikossoff (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma. METHODS Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and international databases. RESULTS For erosive adenomatosis of the nipple, surgical excision is recommended to exclude Paget's disease or cancer (grade C). When surgery is performed for breast desmoid tumor or syringomatous adenoma, free margins are recommended (grade C). Without clinico-radio-histologic discordance, surgical abstention may be proposed for Abrikossoff tumor (granular cell tumor), cytosteatonecrosis, galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma (grade C).
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17
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Malowany JI, Kundu U, Santiago L, Krishnamurthy S. Fine-needle aspiration detects primary neuroendocrine carcinoma of the breast in a patient with breast implants. Cytojournal 2015; 12:1. [PMID: 25685170 PMCID: PMC4325382 DOI: 10.4103/1742-6413.149844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/17/2014] [Indexed: 11/04/2022] Open
Abstract
Breast augmentation with implantation represents a challenge for subsequent radiographic imaging and pathological sampling. Fine-needle aspiration biopsy (FNAB) is an excellent technique to sample suspicious lesions that are adjacent to fragile implants. We report a case of a 51-year-old woman with breast implants presenting with an initial diagnosis of fibroadenoma by imaging studies. A definite diagnosis of mammary carcinoma with plasmacytoid cells was made on ultrasound (US)-guided FNAB of the breast mass with rapid on-site evaluation which initiated core needle biopsy of the mass and subsequent mastectomy with sentinel lymph node biopsy. Our case exemplifies the role of US-guided FNAB for the initial investigation of breast masses in patients with implants. In addition, the case illustrates the cytomorphological features of the tumor cells in primary neuroendocrine carcinoma of the breast.
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Affiliation(s)
- Janet I Malowany
- Address: Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0053, Houston, TX 77030, USA
| | - Uma Kundu
- Address: Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0053, Houston, TX 77030, USA
| | - Lumarie Santiago
- Address: Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0053, Houston, TX 77030, USA
| | - Savitri Krishnamurthy
- Address: Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0053, Houston, TX 77030, USA
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Roussin S, Mazouni C, Rimareix F, Honoré C, Terrier P, Mir O, Dômont J, Le Péchoux C, Le Cesne A, Bonvalot S. Toward a new strategy in desmoid of the breast? Eur J Surg Oncol 2015; 41:571-6. [PMID: 25639193 DOI: 10.1016/j.ejso.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/16/2014] [Accepted: 01/07/2015] [Indexed: 01/25/2023] Open
Abstract
AIM To report initial results of observation as well as surgery in patients with desmoid tumors (DTs) of the breast, a rare tumor for which data are scarce. PATIENTS AND METHODS The initial approaches were categorized as either front-line loco-regional treatment [(surgery or radiotherapy group, SRG) n = 20] or initial observation [(no surgery/no radiotherapy group, NSRG) n = 11]. RESULTS A total of 27 women and 4 men were assessed between 1992 and 2013 and included in this study. Patient characteristics were adequately balanced in the 2 groups. Fifteen patients (48.4%) had a past history of breast surgery in the previous 24 months. The median initial DT size on MRI was 50 mm. The median follow-up was 36 months. In the SRG, 8/20 patients (40%) experienced recurrence. The median time to recurrence was 29 months. During the study period, 6 patients in the SRG (30%) received a mastectomy at the time of diagnosis (n = 3) or at relapse (n = 3), 7 patients (35%) received a thoracic wall resection and 8 patients (40%) received radiotherapy at the time of diagnosis (n = 2) or at recurrence (n = 5). In the NSRG, the median tumor size change was -4 mm (range -13 to +20). Three patients changed treatment strategies during the observation period; one received surgery, and 2 were administered anti-hormonal treatment. CONCLUSIONS Loco-regional treatments of breast DTs resulted in undesired disfigurement. Front-line observation yielded encouraging results and could enable the identification of patients who require loco-regional treatment. This strategy needs further evaluation.
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Affiliation(s)
- S Roussin
- Department of Surgical Oncology, Sarcoma Unit, Gustave Roussy Cancer Center, Grand Paris, France
| | - C Mazouni
- Department of Surgical Oncology, Breast and Plastic Surgery Unit, Gustave Roussy Cancer Center, Grand Paris, France
| | - F Rimareix
- Department of Surgical Oncology, Breast and Plastic Surgery Unit, Gustave Roussy Cancer Center, Grand Paris, France; Department of Surgical Oncology, Sarcoma Unit, Gustave Roussy Cancer Center, Grand Paris, France
| | - C Honoré
- Department of Surgical Oncology, Sarcoma Unit, Gustave Roussy Cancer Center, Grand Paris, France
| | - P Terrier
- Department of Pathology, Gustave Roussy Cancer Center, Grand Paris, France
| | - O Mir
- Department of Medical Oncology, Sarcoma Unit, Gustave Roussy Cancer Center, Grand Paris, France
| | - J Dômont
- Department of Medical Oncology, Sarcoma Unit, Gustave Roussy Cancer Center, Grand Paris, France
| | - C Le Péchoux
- Department of Radiation Oncology, Gustave Roussy Cancer Center, Grand Paris, France
| | - A Le Cesne
- Department of Medical Oncology, Sarcoma Unit, Gustave Roussy Cancer Center, Grand Paris, France
| | - S Bonvalot
- Department of Surgical Oncology, Sarcoma Unit, Gustave Roussy Cancer Center, Grand Paris, France.
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Puvanesarajah V, Lina IA, Liauw JA, Hsu W, Burger PC, Witham TF. Desmoid Tumor Formation following Posterior Spinal Instrumentation Placement. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 4:137-42. [PMID: 24436712 PMCID: PMC3836896 DOI: 10.1055/s-0033-1357356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 07/18/2013] [Indexed: 12/12/2022]
Abstract
Study Design Case report. Objective The objective of the article is to illustrate a case of desmoid tumor (DT) formation after posterior instrumentation of the thoracic spine. Methods A 57-year-old woman presented with lower extremity clumsiness, balance, and ambulation difficulty resulting from spinal cord compression due to an upper thoracic atypical vertebral hemangioma. Ten months after undergoing embolization, resection, and placement of instrumentation for this lesion, the patient developed a growing mass at the rostral end of the incision. Biopsy revealed desmoid fibromatosis. The mass was removed via an en bloc resection. Histology revealed an infiltrative DT above the laminectomy site abutting the instrumentation. Results At 2-year follow-up, there was no evidence of recurrence of the tumor. Conclusion Paraspinal DTs have been reported in the literature to develop after surgical procedures of the spine. Often times, patients attribute swelling or fullness at the site of their surgery to scar tissue formation or instrumentation. One must consider the possibility of a DT in the setting of reported surgical site fullness or mass after spine surgery. It is thought that postoperative inflammation present in the surgical bed may promote formation of DTs. Instrumentation may also contribute to inflammation and increase the likelihood of developing a DT. Generous margins must be taken to prevent recurrence.
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Affiliation(s)
- Varun Puvanesarajah
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ioan A Lina
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jason A Liauw
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Wesley Hsu
- Department of Neurosurgery, Wake Forest University Baptist Medical Center, Baltimore, Maryland, United States
| | - Peter C Burger
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Lattin GE, Jesinger RA, Mattu R, Glassman LM. From the radiologic pathology archives: diseases of the male breast: radiologic-pathologic correlation. Radiographics 2013; 33:461-89. [PMID: 23479708 DOI: 10.1148/rg.332125208] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Male breast disease includes a variety of benign and malignant conditions, many of which are hormonally influenced. Gynecomastia and skin lesions account for the majority of conditions in symptomatic men with a palpable abnormality, and these conditions should be accurately recognized. Imaging patterns of gynecomastia include nodular, dendritic, and diffuse patterns. Histopathologically, the nodular and dendritic patterns correlate with the florid and quiescent (fibrotic) phases of gynecomastia, respectively. The diffuse pattern may have features of both phases and is associated with exposure to exogenous estrogen. Benign-appearing palpable masses in male patients should be approached cautiously, given the overlapping morphologic features of benign and malignant tumors. In addition to gynecomastia, other benign male breast tumors include lipoma, pseudoangiomatous stromal hyperplasia, granular cell tumor, fibromatosis, myofibroblastoma, schwannoma, and hemangioma. Male breast cancer accounts for 1% of all breast carcinomas. Invasive ductal carcinoma accounts for the majority of cases in adult males and typically appears as a subareolar mass without calcifications that is eccentric to the nipple. Other epithelial and mesenchymal tumors that may occur, albeit not as commonly as in women, include papillary carcinoma, invasive lobular carcinoma, adenoid cystic carcinoma, liposarcoma, dermatofibrosarcoma, pleomorphic hyalinizing angiectatic tumor, basal cell carcinoma of the nipple, hematopoietic malignancies, and secondary tumors. Knowledge of the natural history, clinical characteristics, and imaging features of tumors that occur in the male breast will help narrow the radiologic differential diagnosis and optimize treatment.
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Affiliation(s)
- Grant E Lattin
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
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Desmoid tumor following augmentation mammoplasty with silicone implants. Arch Plast Surg 2013; 40:470-2. [PMID: 23898455 PMCID: PMC3724019 DOI: 10.5999/aps.2013.40.4.470] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/24/2013] [Accepted: 04/25/2013] [Indexed: 11/25/2022] Open
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Akhavan A, Binesh F, Kargar K, Navabii H. Juvenile female with chest wall fibromatosis located posteriorly to the right breast: radiation therapy or wait and watch? BMJ Case Rep 2013; 2013:bcr-2012-006355. [PMID: 23429011 DOI: 10.1136/bcr-2012-006355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fibromatosis is a slow-growing monoclonal proliferation of fibroblasts. Although histologically benign it is locally invasive and can recur, however, without metastatic potential. Extra-abdominal fibromatosis is not common. Surgical resection is the cornerstone of treatment and radiation therapy is used in incomplete resection, however, its role is not proved through prospective randomised trials. This article presents a 17-year-old Iranian girl with chest wall fibromatosis located just behind the right breast. The patient was operated with positive margin, however, we decided to postpone radiation therapy because of potential risks.
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Affiliation(s)
- Ali Akhavan
- Department of Radiotherapy, Shahid Sadoghi University of Medical Sciences, Yazd, Iran.
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Un caso de tumor desmoide. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2013. [DOI: 10.1016/j.gine.2011.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kim T, Jung EA, Song JY, Roh JH, Choi JS, Kwon JE, Kang SY, Cho EY, Shin JH, Nam SJ, Yang JH, Choi YL. Prevalence of the CTNNB1 mutation genotype in surgically resected fibromatosis of the breast. Histopathology 2012; 60:347-56. [PMID: 22211293 DOI: 10.1111/j.1365-2559.2011.04072.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS To investigate CTNNB1 mutation and β-catenin expression in resected breast fibromatosis and to identify potential molecular markers of fibromatosis of the breast. METHODS AND RESULTS We selected 12 patients with fibromatosis of the breast who underwent surgical resection and were confirmed by histological examination. Ultrasonography findings for 10 patients were reviewed and only two cases were suspicious for fibromatosis on imaging. On core needle biopsy for pre-operative diagnoses, only three cases were histologically suspicious for fibromatosis. Mutations in exon 3 of CTNNB1 were detected by direct DNA sequencing in nine (75.0%) cases: all were c.121G>A (p.T41A), which was much more frequent in breast fibromatoses than in other soft tissue lesions. Nuclear β-catenin expression was observed in all cases and the level of expression was higher in cases with mutation. In eight of nine cases, the matched biopsy specimen showed the same CTNNB1 mutation status as the pre-operative specimen. CONCLUSIONS In the majority of cases, clinical presentation and breast imaging are highly suspicious for carcinoma. Definitive pre-operative pathological diagnosis by core needle biopsy is difficult. CTNNB1 mutation and nuclear β-catenin expression are frequently detected in sporadic breast fibromatoses, suggesting their potential as a useful tool to distinguish breast fibromatoses from other neoplasms.
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Affiliation(s)
- Taeeun Kim
- Department of Pathology, Gachon University Gil Hospital, Incheon, Korea
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Sinha A, Hansmann A, Bhandari S, Gupta A, Burling D, Rana S, Phillips RK, Clark SK, Goh V. Imaging assessment of desmoid tumours in familial adenomatous polyposis: is state-of-the-art 1.5 T MRI better than 64-MDCT? Br J Radiol 2012; 85:e254-61. [PMID: 22215881 DOI: 10.1259/bjr/42420290] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Desmoid tumour is a common extraintestinal manifestation of patients with familial adenomatous polyposis (FAP) who have undergone prophylactic colectomy. We aimed to determine whether MRI provides equivalent or better assessment of desmoid tumours than CT, the current first-line investigation. METHODS Following ethics approval and informed consent, FAP patients with known desmoid tumour underwent contrast-enhanced 64-slice multidetector CT (MDCT) and 1.5 T MRI (incorporating T(1) weighted, T(2) weighted, short tau inversion-recovery and T(1) weighted with contrast, axial, sagittal and coronal sequences). The number, site, size, local extent, tumour signal intensity and desmoid-to-aorta enhancement ratio were analysed. RESULTS MRI identified 23 desmoid tumours in 9 patients: 9 intra-abdominal desmoid (IAD) tumours, 10 abdominal wall desmoid (AWD) tumours and 4 extra-abdominal desmoid (EAD) tumours. CT identified only 21 desmoids; 1 EAD and 1 AWD were not identified. The two modalities were equivalent in terms of defining local extent of desmoid. Five IAD tumours involved the bowel, six caused ureteric compression and none compromised the proximal superior mesenteric artery. There was no difference in median desmoid size: 56.7 cm(2) (range 2-215 cm(2)) on MDCT and 56.3 cm(2) (3-215 cm(2)) on MRI (p=0.985). The mean MRI enhancement ratio, at 1.12 (standard deviation 0.43), was greater than the CT enhancement ratio, which was 0.48 (0.16) (p<0.0001). High signal intensity on T(2) MRI was associated with increased MRI enhancement ratio (p=0.006). CONCLUSIONS MRI is at least equivalent (and may be superior) to MDCT for the detection of desmoid tumours in FAP. Coupled with the advantage of avoiding radiation, it should be considered as the primary imaging modality for young FAP patients.
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Affiliation(s)
- A Sinha
- Polyposis Registry, St Mark's Hospital, Harrow, UK
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Desmoid tumors of the bilateral breasts in a patient without Gardner syndrome: a case report and review of literature. Ann Plast Surg 2011; 69:220-2. [PMID: 21629058 DOI: 10.1097/sap.0b013e31821e8faf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Desmoid tumors constitute 0.02% to 0.03% of all tumors. Consequently, few case reports exist for breast desmoids, even fewer identifying bilateral disease. We present a case report of a patient with bilateral breast desmoids and shoulder desmoid without evidence of FAP or Gardner syndrome. This case report explores the clinical, radiographic, pathologic, and treatment elements for desmoid tumors as well as a review of the literature.
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Long X, Qiao Q. Breast fibromatosis after hydrophilic polyacrylamide gel injection for breast augmentation: a case report and review of the literature. CHINESE MEDICAL SCIENCES JOURNAL = CHUNG-KUO I HSUEH K'O HSUEH TSA CHIH 2011; 26:126-128. [PMID: 21703122 DOI: 10.1016/s1001-9294(11)60032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Xiao Long
- Division of Plastic Surgery, Peking Union Medical College Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College , Beijng 100730, China
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