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Kangas-Dick A, Ali M, Poss M, Khoury T, Takabe K. Diagnosis and Management of Desmoid Fibromatosis of the Breast. World J Oncol 2024; 15:394-404. [PMID: 38751692 PMCID: PMC11092408 DOI: 10.14740/wjon1844] [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: 02/20/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Desmoid fibromatosis of the breast (also known as desmoid tumor of the breast) is a rare entity infrequently encountered by oncologists and surgeons caring for patients with breast disease. The current body of literature is highly reliant on case series and extrapolations from other sites of desmoid tumor-related disease. Much remains unclear regarding the pathological origins, natural history, and response to treatment of this condition. Traditional treatment strategies have centered on surgical resection, which may result in significantly disfiguring cosmetic and functional outcomes, frequent need for re-operation, and associated morbidity. There are limited data to support the superiority of upfront surgical resection when compared to medical therapy or watchful waiting strategies. Current treatment guidelines for desmoid tumors do not focus on the breast as a site of disease and are purposefully ambiguous due to the paucity of evidence available. We aim to review the literature concerning desmoid fibromatosis of the breast and propose an algorithm for current evidence-based management of this rare disease in the context of our experience with this pathology at a high-volume quaternary referral center.
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Affiliation(s)
- Aeryn Kangas-Dick
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Muhammad Ali
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mariola Poss
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA
- Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo 160-8402, Japan
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama 236-004, Japan
- Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
- Department of Breast Surgery, Fukushima Medical University, Fukushima, Japan
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Möllhoff N, Ehrl D, Fuchs B, Frank K, Alt V, Mayr D, Braig D, Giunta RE, Hagen C. [Breast implant-associated squamous cell carcinoma: a systematic literature review]. HANDCHIR MIKROCHIR P 2023; 55:268-277. [PMID: 37473774 DOI: 10.1055/a-2108-9111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Breast implant-associated squamous cell carcinoma (BIA-SCC) is being discussed as a distinct malignant tumour entity originating from the implant capsule. The FDA and the ASPS published a safety communication on BIA-SCC in 2022, with a first case report of BIA-SCC having been published in the 1990s. This manuscript summarises the current scientific data on this rare tumour entity. MATERIAL AND METHODS This systematic literature review from two independent databases includes all publications of cases with histopathologically confirmed BIA-SCC. Data extraction included study design, demographic data, implant information and details regarding diagnosis and treatment. RESULTS Nineteen cases of BIA-SCC with a mean age of 57±10 years were reported in 16 publications. In most cases, the indication was aesthetic augmentation (n=13). Both silicone (n=11) and saline (n=7) implants with different surfaces (smooth n=3, textured n=3, polyurethane n=1) were used. Symptoms such as unilateral swelling (n=18), pain (n=14) and erythema (n=5) occurred on an average of 23±9 years after implantation. Imaging showed fluid collection (n=8) or a tumour mass (n=4) around the breast implant. The most common surgical treatment was explantation with capsulectomy. Metastasis was described in 6 cases. CONCLUSIONS BIA-SCC is a malignant tumour entity associated with breast implant capsules. Based on current low-quality data (level of evidence class V), no definitive conclusion regarding correlation and causality of SCC in patients with breast implants can be drawn. There is an urgent need for national and international breast implant and breast cancer registries to obtain valid data on the incidence, pathogenesis and clinical presentation of rare tumour entities.
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Affiliation(s)
- Nicholas Möllhoff
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Denis Ehrl
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Benedikt Fuchs
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Konstantin Frank
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
- Ocean Clinic, Marbella, Spain
| | - Verena Alt
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Doris Mayr
- Pathologisches Institut, Ludwig-Maximilians-Universität München, München, Deutschland
| | - David Braig
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Riccardo E Giunta
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Christine Hagen
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
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3
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Vorstenbosch J, Chu JJ, Ariyan CE, McCarthy CM, Disa JJ, Nelson JA. Clinical Implications and Management of Non-BIA-ALCL Breast Implant Capsular Pathology. Plast Reconstr Surg 2023; 151:20e-30e. [PMID: 36194076 PMCID: PMC9797444 DOI: 10.1097/prs.0000000000009780] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
SUMMARY The breast implant capsule is a dynamic structure that forms following the implantation of a device. Although normally benign, increased awareness of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) highlights that disease may arise from the capsule. BIA-ALCL presents as a late seroma or mass but explains few of the late seromas found in breast implant patients. To date, many of these seromas lack a clear cause and are often described as "idiopathic." Several benign and malignant breast implant capsular diseases can cause a late seroma or mass, including breast implant-associated squamous cell carcinoma. Similar to early reports of BIA-ALCL, these conditions are rare and largely limited to case reports or series. The purpose of this special topic is to present a narrative review highlighting capsular abnormalities that contribute to the formation of late seroma or mass in an attempt to broaden the differential diagnosis and help plastic surgeons identify the cause. Specifically, we review the presentation and management of BIA-ALCL, synovial metaplasia, capsular epithelialization, late hematoma, double capsule, breast cancer, squamous cell carcinoma, mesenchymal tumor, and B-cell lymphoma. Although rare, plastic surgeons should consider these capsular conditions as causes of late seromas and masses. Usually, these conditions may be diagnosed by following the National Comprehensive Cancer Network screening guidelines for BIA-ALCL. Thorough evaluation and workup of late seromas and masses may lead to improved characterization of these rare breast implant capsular conditions and improve our understanding of their pathophysiology and management.
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Affiliation(s)
- Joshua Vorstenbosch
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charlotte E. Ariyan
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colleen M. McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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4
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Onafowokan OO, Aujla R, Eastley N, Ashford RU. Desmoid fibromatosis associated with Endobutton use for anterior cruciate ligament reconstruction. BMJ Case Rep 2022; 15:e250747. [PMID: 35580938 PMCID: PMC9114958 DOI: 10.1136/bcr-2022-250747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Oluwatobi O Onafowokan
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK
- Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
| | - Randeep Aujla
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK
- Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
| | - Nicholas Eastley
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK
- Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
| | - Robert U Ashford
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK
- Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
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5
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Lorenzen J, Cramer M, Buck N, Friedrichs K, Graubner K, Lühr CS, Lindner C, Niendorf A. Desmoid Type Fibromatosis of the Breast: Ten-Year Institutional Results of Imaging, Histopathology, and Surgery. Breast Care (Basel) 2020; 16:77-84. [PMID: 33708054 DOI: 10.1159/000507842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 04/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Desmoid type fibromatoses has proven to be a diagnostic and therapeutic challenge, as they often appear primarily as a carcinoma of the breast with a high recurrence risk. Patients A digital archive search was performed for the period from 2009 to the end of 2018. Inclusion criteria consisted of histological examination of at least the surgical specimen in the reference pathology department and at least a second opinion diagnosis in the reference radiology department. Results A total of 14 women and 1 man underwent surgery on desmoid type fibromatosis of the breast. The average patient age was 49 years (range: 22-72 years). The mean tumor size was 2.2 cm (range: 0.8-4.2 cm). The tumor was detectable in mammography in 12 out of 13 patients and in all 15 patients in sonography. MRI was performed preoperatively in 6 patients; in all of the patients, the tumor was visualized with inhomogeneous contrast enhancement. In the imaging procedures, all desmoid type fibromatoses were classified as suspicious. Performing the core biopsy, preoperative histology confirmed desmoid fibromatosis in 12 out of 15 patients. Nuclear stain for ß-catenin was positive in 7 out of 10 patients. Negative staining was found for AE1/A3 in 10 out of 10 and CD34 in 12 out of 12 patients. In all of the patients, a single-stage operation without the detection of border-forming tumor margins was performed. The follow-up interval ranged from 16 to 96 months (mean: 44.86 months, median: 43 months). In this follow-up period, no patient was diagnosed with desmoid tumor recurrence. Conclusion In imaging, desmoid type fibromatosis of the breast has typical malignancy-related criteria. Extensive preoperative diagnostics enable the planning of complete primary excision of the lesion and reduce the recurrence risk.
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Affiliation(s)
| | | | - Nina Buck
- Radiologische Allianz, Hamburg, Germany
| | | | - Kirsten Graubner
- Department of Gynecology and Obstetrics, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
| | | | - Christoph Lindner
- Department of Gynecology and Obstetrics, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
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6
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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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7
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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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8
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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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9
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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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10
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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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11
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12
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Fernandes JW, Pace D. The sling lift: a new procedure for lower eyelid rejuvenation. Aesthetic Plast Surg 2013; 37:180-4. [PMID: 23288101 DOI: 10.1007/s00266-012-0042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/29/2012] [Indexed: 11/24/2022]
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13
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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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14
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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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15
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Al-Khyatt W, Goyal A, Mansel RE. Nipple-sparing skin-sparing mastectomy and vertical latissimus dorsi flap reconstruction for bilateral fibromatosis of the breast. Clin Breast Cancer 2010; 10:E1-2. [PMID: 20133249 DOI: 10.3816/cbc.2010.n.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fibromatosis of the breast results in aggressive, infiltrative lesions with a tendency for local recurrence. A case of bilateral fibromatosis of the breast treated with nipple-sparing skin-sparing mastectomy and vertical latissimus dorsi flap reconstruction occurring in 22-year-old woman is described herein.
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Affiliation(s)
- Waleed Al-Khyatt
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom
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16
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Balzer BL, Weiss SW. Do biomaterials cause implant-associated mesenchymal tumors of the breast? Analysis of 8 new cases and review of the literature. Hum Pathol 2009; 40:1564-70. [DOI: 10.1016/j.humpath.2009.03.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/17/2009] [Accepted: 03/26/2009] [Indexed: 11/26/2022]
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17
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Li A, Lui CY, Ying M, Mak KL, Lam HS. Case of fibromatosis of male breast. AUSTRALASIAN RADIOLOGY 2007; 51 Spec No.:B34-6. [PMID: 17875152 DOI: 10.1111/j.1440-1673.2007.01803.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Extra-abdominal fibromatosis of the breast is rare with the clinical and radiological features closely resembled malignant breast tumour. We describe, in a 40-year-old Chinese male patient with a palpable left breast mass, the clinical, radiological and pathological features of this benign though locally aggressive tumour.
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Affiliation(s)
- A Li
- Department of Radiology and Organ Imaging, United Christian Hospital, Hong Kong.
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18
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Neuman HB, Brogi E, Ebrahim A, Brennan MF, Van Zee KJ. Desmoid Tumors (Fibromatoses) of the Breast: A 25-Year Experience. Ann Surg Oncol 2007; 15:274-80. [PMID: 17896146 DOI: 10.1245/s10434-007-9580-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 07/26/2007] [Accepted: 07/27/2007] [Indexed: 01/14/2023]
Abstract
BACKGROUND Breast desmoid tumors are rare and often clinically mistaken for carcinoma. We reviewed our 25-year institutional experience with breast desmoid tumors. METHODS A search of pathology and sarcoma databases (1982-2006) identified 32 patients with pathologically confirmed breast desmoids. Records were retrospectively reviewed. RESULTS Median presentation age was 45 years (range, 22-76). Eight patients (25%) had prior history of breast cancer and 14 (44%) of breast surgery, with desmoids diagnosed a median of 24 months postoperatively. All presented with physical findings. Mammography visualized the mass in 6/16, ultrasound in 9/9, and magnetic resonance imaging (MRI) in 8/8 patients in whom it was performed. In 15 patients with attempted needle biopsy, fine needle aspiration was inconclusive (9/9 patients), and core biopsy demonstrated a spindle cell lesion (6/7 patients). Treatment was surgical, with median tumor size of 2.5 cm (range, 0.3-15). Eight patients (29%) had recurring tumors at a median 15 months. Patients with recurring tumors were younger (median age: 28 vs. 46 years, p = 0.03). A trend toward more frequent recurrences in patients with positive (5/9 patients) versus negative (3/19 patients) margins (p = 0.07) and larger tumors (p = 0.12) was observed. CONCLUSIONS In our series, breast desmoids presented as palpable masses suspicious for carcinoma clinically and radiographically. Therapy remains primarily surgical, and core biopsy aided in operative planning. Recurrences are common, with younger age and possibly positive margin status and larger tumor size associated with increased risk of recurrence. As 5/9 patients with positive and 3/19 patients with negative margins experienced recurrences, clinical judgment should be used prior to extensive and potentially deforming resections.
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Affiliation(s)
- Heather B Neuman
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA
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Povoski SP, Jimenez RE. Fibromatosis (desmoid tumor) of the breast mimicking a case of ipsilateral metachronous breast cancer. World J Surg Oncol 2006; 4:57. [PMID: 16925827 PMCID: PMC1563468 DOI: 10.1186/1477-7819-4-57] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 08/22/2006] [Indexed: 11/21/2022] Open
Abstract
Background Fibromatosis or desmoid tumor of the breast is an extremely rare entity. While it lacks a metastatic potential, it can grow aggressively in a locally infiltrating pattern. The failure to recognize this as a finite entity within the breast can lead to local recurrence after incomplete excision. Case presentation We report a case of a 70 year old patient with a remote history of invasive breast cancer (treated twelve years earlier by lumpectomy, axillary lymph node dissection, postoperative radiation therapy, and five years of tamoxifen) who developed fibromatosis within another quadrant of the same breast that clinically, mammographically, and sonographically mimicked that of the development of an ipsilateral metachronous breast cancer. After the initial diagnosis of fibromatosis was made on a minimally invasive ultrasound guided biopsy, it was successfully treated by wide local excision. Conclusion After appropriate recognition, wide local excision can be the appropriate surgical management strategy for fibromatosis of the breast.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Rafael E Jimenez
- Department of Pathology, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, 43210, USA
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Povoski SP, Marsh WL, Spigos DG, Abbas AE, Buchele BA. Management of a patient with multiple recurrences of fibromatosis (desmoid tumor) of the breast involving the chest wall musculature. World J Surg Oncol 2006; 4:32. [PMID: 16768799 PMCID: PMC1524961 DOI: 10.1186/1477-7819-4-32] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Accepted: 06/12/2006] [Indexed: 12/03/2022] Open
Abstract
Background Fibromatosis or desmoid tumor is a rare soft tissue tumor that lacks a metastatic potential, but is characterized by a locally aggressive and infiltrating growth pattern and a high propensity toward local recurrence if incompletely excised. Case presentation We report a patient with three post-surgical recurrences of fibromatosis of the breast over a seven year period. The fibromatosis was found to be involving the chest wall musculature and causing persistent and worsening pain. An aggressive operative strategy was undertaken, consisting of mastectomy with en bloc resection of the underlying chest wall musculature, ribs, and parietal pleura. Conclusion Aggressive surgical management of fibromatosis of the breast with suspected chest wall involvement is appropriate to attempt to obtain a long-term durable cure.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute of The Ohio State University, Columbus, Ohio, 43210, USA
| | - William L Marsh
- Department of Pathology, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute of The Ohio State University, Columbus, Ohio, 43210, USA
| | - Dimitrios G Spigos
- Department of Radiology, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute of The Ohio State University, Columbus, Ohio, 43210, USA
| | - Abbas E Abbas
- Division of Thoracic Oncology, Department of Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute of The Ohio State University, Columbus, Ohio, 43210, USA
| | - Brentley A Buchele
- Division of Plastic Surgery, Department of Surgery, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute of The Ohio State University, Columbus, Ohio, 43210, USA
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Schwarz GS, Drotman M, Rosenblatt R, Milner L, Shamonki J, Osborne MP. Fibromatosis of the breast: case report and current concepts in the management of an uncommon lesion. Breast J 2006; 12:66-71. [PMID: 16409590 DOI: 10.1111/j.1075-122x.2006.00187.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fibromatosis is an uncommon breast lesion that can mimic breast carcinoma in its clinical presentation. We present a case in which excisional biopsy was necessary to establish a diagnosis of fibromatosis. Clinical, diagnostic imaging, and pathologic features are discussed. Magnetic resonance imaging (MRI) has emerged as a tool for further characterization of breast lesions and as a screening modality in high-risk patient populations. Ours marks the second case in which dynamic MRI has been correlated with histologically confirmed primary mammary fibromatosis. Unlike the previous report, MRI in this case mimics breast carcinoma in its morphologic and pharmacokinetic features of enhancement. Wide local excision with clear margins remains the treatment of choice. Current data on radiotherapy and pharmacologic therapy for mammary fibromatosis are reviewed.
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Affiliation(s)
- Graham S Schwarz
- Department of Surgery, The Breast Center, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York 10021, USA
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23
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Zlotecki RA, Scarborough MT, Morris CG, Berrey BH, Lind DS, Enneking WF, Marcus RB. External beam radiotherapy for primary and adjuvant management of aggressive fibromatosis. Int J Radiat Oncol Biol Phys 2002; 54:177-181. [PMID: 12182989 DOI: 10.1016/s0360-3016(02)02926-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To review a large single-institution experience in the management of aggressive fibromatosis to determine the effectiveness of external beam radiotherapy (EBRT) and identify the presentation and treatment variables predictive of locoregional control. METHODS AND MATERIALS Between 1975 and 2000, 72 patients were treated with EBRT for a pathologically confirmed diagnosis of aggressive fibromatosis. Thirty patients were treated at the primary presentation and 42 at the time of a locoregional recurrence. Minimal 2-year follow-up data were available for 65 patients (median 6 years). Megavoltage irradiation with 60Co to 20 MV photons or electron therapy was used for all patients. Most patients were treated after attempted complete surgical resection; 16 patients underwent pretreatment biopsy alone. The prescribed treatment was standard (1.8 Gy) daily fractions in 42 cases and 1.2 Gy fractions b.i.d. in 23 cases. The median prescribed dose was 54 Gy. The prognostic variables and treatment results were evaluated by Kaplan-Meier actuarial analysis. RESULTS Locoregional control was achieved in 52 of 65 patients. The 5-year actuarial locoregional control was 83%. Locoregional failure occurred in 13 patients (11 in patients with recurrent tumors). Only two failures occurred within the irradiation fields; nine failures occurred at the field margins. Eleven patients were salvaged by surgery: wide excision in nine and amputation in two. The only prognostic factor significant for locoregional control was primary vs. recurrent presentation (p = 0.0193). The 5-year locoregional control rates for irradiation at initial presentation and at recurrence were 96% and 75%, respectively. The variables without significance for locoregional control included primary tumor location, surgical procedures performed, resection margins, and gross vs. microscopic residual tumor at irradiation. Lymphedema was the most common late effect, occurring in 7 patients, 5 with prior treatment. Bone fracture occurred in 3 patients; all 3 had fibromatosis involving the bone at presentation but without recurrence at the time of fracture. CONCLUSION EBRT is effective treatment for aggressive fibromatosis. The probability of locoregional control decreases with multiple prior recurrences.
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Affiliation(s)
- Robert A Zlotecki
- Department of Radiation Oncology, Health Science Center, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA.
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Abraham SC, Reynolds C, Lee JH, Montgomery EA, Baisden BL, Krasinskas AM, Wu TT. Fibromatosis of the breast and mutations involving the APC/beta-catenin pathway. Hum Pathol 2002; 33:39-46. [PMID: 11823972 DOI: 10.1053/hupa.2002.30196] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Fibromatoses of the breast are nonmetastasizing tumors, but can be infiltrative and locally recurrent. Breast fibromatoses are rare, and their specific genetic alterations have not been elucidated. However, their occasional occurrence in patients with familial adenomatous polyposis (FAP) and their morphologic identification with other deep fibromatoses (desmoid tumors) suggest that alterations of the APC/beta-catenin pathway might be involved in the pathogenesis of sporadic and FAP-associated breast fibromatoses. We analyzed somatic beta-catenin and APC gene mutations in 33 breast fibromatoses (32 sporadic and 1 FAP-associated) using immunohistochemistry for beta-catenin, 5q allelic loss assays, and direct DNA sequencing for exon 3 of the beta-catenin gene and the mutation cluster region of the APC gene. Nuclear accumulation of beta-catenin was present in the stromal tumor cells in most (82%) cases but not in normal stroma or mammary epithelial cells. Somatic alterations of the APC/beta-catenin pathway were detected in 79% of breast fibromatoses, including activating beta-catenin gene mutations in 15 cases and somatic APC alterations (mutation or 5q allelic loss or both) in 11. These findings indicate that alterations of the APC/beta-catenin pathway with resultant nuclear translocation of beta-catenin are important in the pathogenesis of both sporadic and FAP-associated breast fibromatosis. The spectrum of beta-catenin and APC alterations is similar to that described for desmoid tumors of the abdomen, paraspinal region, and extremities.
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Affiliation(s)
- Susan C Abraham
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205-2196, USA
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