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Torrado C, Camaño M, Hindi N, Ortega J, Sevillano AR, Civantos G, Moura DS, Dimino A, Martín-Broto J. Antiangiogenics in Malignant Granular Cell Tumors: Review of the Literature. Cancers (Basel) 2023; 15:5187. [PMID: 37958362 PMCID: PMC10650106 DOI: 10.3390/cancers15215187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Granular cell tumors (GCT) represent 0.5% of all soft tissue sarcomas (STS), and when metastatic, they exhibit aggressive behavior and determine limited survival. Metastatic GCTs are relatively chemo-resistant; however, there is growing evidence of the benefit of using pazopanib and other targeted therapies in this histology. This is a review of the role of pazopanib and other targeted therapies in the treatment of GCTs, along with some insights on pathology and molecular biology described in GCTs. From 256 articles found in our search, 10 case-report articles met the inclusion criteria. Pazopanib was the most employed systemic therapy. The median reported time on therapy with pazopanib was seven months. Eight out of ten patients (80%) experienced disease control with pazopanib, while four out of ten (40%) patients achieved an objective RECIST response. Molecular studies suggested that antitumoral effects of pazopanib in GCT might be due to a loss-of-function of ATP6AP1/2 genes which consequently enhance signaling through several molecular pathways, such as SFKs, STAT5a/b, and PDGFR-β. Other reported targeted therapies for malignant GCTs included pazopanib in combination with crizotinib, which showed disease control for four months in one patient, and a PI3K inhibitor which achieved disease control for nine months in another patient. Dasatinib and megestrol were ineffective in two other different patients. Pazopanib has been demonstrated to be active in advanced GCTs and may be considered as a preferable treatment option.
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Affiliation(s)
- Carlos Torrado
- Medical Oncology Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain;
| | - Melisa Camaño
- Medical Oncology Department, National Cancer Institute, 11600 Montevideo, Uruguay;
| | - Nadia Hindi
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain
- General de Villalba University Hospital, 28400 Madrid, Spain
| | - Justo Ortega
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain
- General de Villalba University Hospital, 28400 Madrid, Spain
| | - Alberto R. Sevillano
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain
- General de Villalba University Hospital, 28400 Madrid, Spain
| | - Gema Civantos
- Pathology Department, Hospital Virgen del Rocío, 41013 Sevilla, Spain;
| | - David S. Moura
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
| | - Alessandra Dimino
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, 90127 Palermo, Italy;
| | - Javier Martín-Broto
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; (N.H.); (J.O.); (A.R.S.); (D.S.M.)
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain
- General de Villalba University Hospital, 28400 Madrid, Spain
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Zhu M, Xu H, Chen Y, Peng Y. Multimodal ultrasonography findings of extramammary granular cell tumors: Two case reports. Front Oncol 2023; 13:1136770. [PMID: 37020870 PMCID: PMC10067867 DOI: 10.3389/fonc.2023.1136770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/10/2023] [Indexed: 04/07/2023] Open
Abstract
Extramammary masses are infrequently encountered in breast examinations. They may occur in the chest wall and axilla as neighbors of the breast. It is important to determine the nature of the lesion. However, some benign tumors, such as granular cell tumors (GCTs), also show malignant characteristics, which leads to misdiagnosis. To the best of our knowledge, multimodal ultrasound features of GCT have not been elucidated. We report two cases of women with GCTs encountered upon breast cancer screening; the tumor was not located in breast tissue. The first patient was a 37-year-old woman who presented with a slow-growing mass in the right breast and the GCT was located in the pectoralis major muscle. The second patient was a 52-year-old woman who presented with a palpable left axillary mass and the GCT was located in the axilla. Mammography failed to detect the masses in the two patients upon breast cancer screening. However, two-dimensional ultrasonography revealed a solid heterogeneous hypoechoic mass. Shear wave elastography showed that the masses had an increased hardness compared with the surrounding tissue. Further contrast-enhanced ultrasonography showed that the contrast patterns of the two masses were different. In case one, contrast-enhanced ultrasonography showed an inhomogeneous annular high enhancement, and the dynamic curve showed rapid enhancement and regression. In case two, contrast enhanced ultrasound showed slight enhancement around the lesion but no enhancement inside. Postoperative pathology confirmed that the GCT was benign in both cases. The patients showed no signs of recurrence at the 2-year follow-up. Here, we report two cases and present the multimodal ultrasonography findings of this tumor for the first time. Radiologists and surgeons should be aware of these imaging manifestations and include them in their differential diagnoses.
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Affiliation(s)
- Meng Zhu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Huan Xu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yujuan Chen
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yujuan Chen, ; Yulan Peng,
| | - Yulan Peng
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yujuan Chen, ; Yulan Peng,
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Pankratjevaite L, Igbokwe MM, Benian C, Lelkaitis G. Granular cell tumour of the breast: A case report. Breast Dis 2023; 42:219-222. [PMID: 37482972 DOI: 10.3233/bd-220063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Breast granular cell tumour (GCT) is a rare but usually benign lesion. PRESENTATION OF CASE We report a case of a woman with breast GCT. CONCLUSION Clinically and radiologically, GCT may mimic breast carcinoma. A conclusive diagnosis is made after a histopathological examination of the lesion. The treatment of choice is surgery.
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Affiliation(s)
- Lina Pankratjevaite
- Department of Breast Surgery, Herlev & Gentofte University Hospital, Copenhagen, Denmark
| | | | - Cemil Benian
- Department of Radiology, Herlev & Gentofte University Hospital, Copenhagen, Denmark
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Oberc A, Armstrong K, Ko HM, Grant A, Mullen JBM, Williams P. Case report of a breast granular cell tumor in a young transgender man. Int J Surg Case Rep 2022; 93:106978. [PMID: 35364393 PMCID: PMC8971622 DOI: 10.1016/j.ijscr.2022.106978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alexander Oberc
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.
| | | | - Hyang-Mi Ko
- Laboratory Medicine Program, Department of Pathology, Toronto General Hospital and University Health Network, Toronto, Ontario, Canada.
| | - Allison Grant
- University of Toronto, Joint Department of Medical Imaging University Health Network, Mount Sinai Hospital, Women's College Hospital, Canada.
| | - J Brendan M Mullen
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.
| | - Phillip Williams
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
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Olivier L, Naraynsingh V, Hassranah D, Cassim C. Abrikossoff Tumor Clinically Mimicking Carcinoma in Accessory Axillary Breast Tissue. Cureus 2022; 14:e21733. [PMID: 35145827 PMCID: PMC8803373 DOI: 10.7759/cureus.21733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/05/2022] Open
Abstract
Abrikossoff tumors are rare benign soft-tissue lesions also known as granular cell tumors (GCT). The histogenesis of these tumors was initially considered to be myogenic but recent studies have revealed a neuroectodermal origin. GCTs of the breast may mimic breast carcinoma based on the triad of radiological, clinical, and pathological features. This hallmark trait lends to the misdiagnosis of these tumors and their subsequent inappropriate management. We report a rare case of a 28-year-old female patient with an accessory axillary breast GCT. The diagnosis, histogenesis, and management of Abrikossoff tumors of the breast are discussed.
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Ghannam SM, Carter GJ, Villatoro TM, Berg WA. Granular Cell Tumor of the Breast: Radiologic-Pathologic Correlation. JOURNAL OF BREAST IMAGING 2021; 3:473-481. [PMID: 38424797 DOI: 10.1093/jbi/wbab041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Indexed: 03/02/2024]
Abstract
Granular cell tumor (GCT) is an uncommon neoplasm arising from perineural Schwann cells that can arise anywhere in the body and is particularly rare in the breast. Imaging typically shows an irregular, noncalcified mass with high density on mammography and intense posterior shadowing on US that mimics malignancy. Benign GCTs can be locally aggressive and invade the skin or chest wall. Core biopsy is necessary for diagnosis. Polygonal- to spindle-shaped cells with prominent cytoplasmic eosinophilic granules show S-100 and CD68 staining on immunohistochemistry and lack cytokeratin, estrogen, or progesterone expression. The vast majority of GCTs are benign, albeit locally infiltrative, tumors cured by wide local excision.
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Affiliation(s)
- Suzanne M Ghannam
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Gloria J Carter
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Tatiana M Villatoro
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Wendie A Berg
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Department of Radiology, Pittsburgh, PA, USA
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Rossi ED, Pantanowitz L, Hornick JL. Cytologic and histological features of rare nonepithelial and nonlymphoid tumors of the thyroid. Cancer Cytopathol 2021; 129:583-602. [PMID: 33493367 DOI: 10.1002/cncy.22404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022]
Abstract
Thyroid tumors can be classified into epithelial, nonepithelial, and nonprimary lesions. Nonepithelial thyroid tumors are rare. They can be of primary origin within the thyroid gland, arise secondary to contiguous growth from adjacent tissues, or represent metastatic disease. The incidence of nonepithelial tumors of the thyroid is only 1% to 2%, most of which are lymphomas; the remainder includes mesenchymal and histiocytic tumors. This review examines the cytohistological features of various nonepithelial and nonlymphoid tumors of the thyroid, including vascular lesions, neural tumors (including granular cell tumor and paraganglioma), smooth muscle tumors, solitary fibrous tumor, histiocytic neoplasms (eg, Langerhans cell histiocytosis and Rosai-Dorfman disease), and follicular dendritic cell sarcoma. Their differential diagnosis is discussed, including recommendations to prevent the pitfall of mistaking these rare tumors for more common epithelial thyroid neoplasms.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
RATIONALE Granular cell tumor of the breast (GCTB) is a benign rare tumor. There are limited reports on its imaging manifestations. GCTB is often misdiagnosed as breast cancer, which results in unnecessary radical mastectomy and excessive treatment. In this article, we have reported a case of a 56-year-old postmenopausal woman with GCTB and highlighted the imaging features to differentiate this rare tumor from breast cancer. PATIENT CONCERNS A 56-year-old postmenopausal patient had a chief complaint of a subcutaneous nodule in the upper outer quadrant of her right breast for 2 months. She underwent physical examination, color Doppler ultrasonography, mammography, magnetic resonance, and postoperative pathology. DIAGNOSES The final diagnosis was GCTB. The tumor cells were intermingled with the fibrous stroma and normal breast parenchyma and showed positive immunoreaction to S-100, CD68, and neuron-specific enolase. INTERVENTIONS The patient underwent lumpectomy and sentinel lymph node biopsy. OUTCOMES The patient recovered well after lumpectomy and had no complications during the 2-year follow-up. LESSONS There are some important imaging features of GCTB that can be used to distinguish it from breast carcinoma to reduce misdiagnosis.
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Abreu N, Filipe J, André S, Marques JC. Granular cell tumor of the breast: correlations between imaging and pathology findings. Radiol Bras 2020; 53:105-111. [PMID: 32336825 PMCID: PMC7170582 DOI: 10.1590/0100-3984.2019.0056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To review the imaging features of granular cell tumors of the breast (on mammography, ultrasound, and magnetic resonance imaging), establishing a pathological correlation, in order to familiarize radiologists with this entity and make them aware of the differential diagnoses, other than malignancy, of lesions with spiculated margins. Materials and Methods We reviewed the medical records (from a clinical-pathology database and picture archiving and communication system) of five patients with a pathologically confirmed diagnosis of granular cell tumor of the breast, treated at the Portuguese Oncology Institute of Lisbon, in the city of Lisbon, Portugal, between January 2012 and December 2018. Results All five tumors exhibited imaging features highly suggestive of malignancy (BI-RADS 5 lesions), namely spiculated margins, significant depth, and posterior acoustic shadowing (on ultrasound). One tumor showed a kinetic curve indicative of washout on magnetic resonance imaging, two were adherent to the pectoralis muscle, and one was accompanied by skin retraction. Pathology provided the definitive diagnosis in all cases. Conclusion Granular cell tumors of the breast pose a diagnostic challenge because they can present with clinical and imaging features mimicking malignancy, and the diagnosis is therefore provided by pathology. Radiologists should be familiarized with this entity, so they can be aware of the fact that breast lesions with spiculated margins can be indicative of diagnoses other than malignancy.
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Affiliation(s)
- Natacha Abreu
- Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Lisboa, Portugal
| | - Juliana Filipe
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisboa, Portugal
| | - Saudade André
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisboa, Portugal
| | - José Carlos Marques
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisboa, Portugal
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Khattab RA, Rowe JJ, Booth CN, Sneige N, Fong N, Pantanowitz L, Oshilaja O, Brainard JA, Downs-Kelly EP, Dawson A, Sturgis CD. Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses. Diagn Cytopathol 2019; 47:1100-1118. [PMID: 31343114 DOI: 10.1002/dc.24288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 11/06/2022]
Abstract
The Uniform Approach to Breast Fine Needle Aspiration Biopsy was put forward by a learned group of breast physicians in 1997. This landmark manuscript focused predominantly on diagnosis and reporting of mammary epithelial lesions. Today, most American practitioners turn initially to core biopsy rather than aspiration biopsy for the first line diagnosis of solid breast lesions; however, recent efforts from the International Academy of Cytology have produced a system called the Standardized Reporting of Breast Fine Needle Aspiration Biopsy Cytology (colloquially labeled in 2017 as the "Yokohama System"), suggesting a new interest in breast fine needle aspiration (FNA), especially in resource limited settings or clinical practice settings with experienced breast cytopathologists. Fibroepithelial lesions of the breast comprise a heterogeneous group of biphasic tumors with epithelial and stromal elements. Mesenchymal lesions of the breast include a variety of neoplasms of fibroblastic, myofibroblastic, endothelial, neural, adipocytic, muscular, and osteo-cartilaginous derivations. The cytology of mesenchymal breast lesions is infrequently described in the literature and is mainly limited to case reports and small series. This illustrated review highlights the cytologic features of fibroepithelial and mesenchymal mammary proliferations and discusses differential diagnoses and histomorphologic correlates.
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Affiliation(s)
- Ruba A Khattab
- Department of Pathology, University Hospitals of Case Western Reserve University, Cleveland, Ohio
| | - J Jordi Rowe
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Nour Sneige
- Department of Pathology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas
| | - Nancy Fong
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Andrea Dawson
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
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Al-Balas M, De Leo A, Serra M, Santini D, Taffurelli M. Granular cell tumour of the breast: A rare presentation of a breast mass in an elderly female with a subsequent breast cancer diagnosis. SAGE Open Med Case Rep 2019; 7:2050313X19841154. [PMID: 31007916 PMCID: PMC6457014 DOI: 10.1177/2050313x19841154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/07/2019] [Indexed: 12/28/2022] Open
Abstract
A 74-year-old female patient presented with a hard breast mass and dimpling with
a clinical suspicion of a carcinoma. Histological evaluation revealed a granular
cell tumour. Granular cell tumour is a rare neoplasm, mostly benign in origin
that may arise in every body site, 5%–15% of cases occur in the breast. It is
strongly suggested that granular cell tumours origin is Schwann cells.
Clinically, granular cell tumours presentation may mimic mammary carcinoma and
their similar features on mammography and ultrasound make it difficult to
differentiate between them.
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Affiliation(s)
- Mahmoud Al-Balas
- Department of General and Specialized Surgery, The Hashemite University, Zarqa, Jordan
| | - Antonio De Leo
- Pathology Unit, S.Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Margherita Serra
- Department of the Health of Woman, Child and Urological Diseases, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Mario Taffurelli
- Department of the Health of Woman, Child and Urological Diseases, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Simoes CC, Qiu S, Nguyen QD, Hatch SS, He J. Rare Mesenchymal Breast Entities that Mimic Malignancy: A Single-institution Experience of a Challenging Diagnosis. Cureus 2019; 11:e4000. [PMID: 30989009 PMCID: PMC6445563 DOI: 10.7759/cureus.4000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Benign mesenchymal tumors of the breast are rare and may mimic invasive carcinoma on imaging and morphology, thus becoming clinically challenging for clinicians, radiologists, and pathologists. To improve the understanding of these lesions and to avoid erroneous diagnosis and inappropriate treatment, we report our institution’s experience with seven cases of granular cell tumor (GCT) and myofibroblastoma (MFB) in the past 10 years. Materials and methods Seven cases of benign mesenchymal tumors of the breast were identified at the University of Texas Medical Branch from 2008 to 2018. Breast biopsies were collected from all patients after mammography and ultrasound imaging classified their results as suspicious or highly suggestive of malignancy by the Breast Imaging Reporting and Data System (BI-RADS ≥ 4A). All cases were reviewed to study the morphologic features and their immunoprofiles. The demographic characteristics, methods of treatment, postoperative pathological results, and follow-up results of the cases were then analyzed and compared to peer-reviewed literature. Results The study consisted of five females and two males with a mean age of 50 years in the GCT patients and 62 years in MFB patients. We identified four cases of GCT and three cases of MFB. The mean tumor size was 1.9 cm. Clinically, five patients presented with a palpable nontender mass, one with breast asymmetry, and one was asymptomatic. All patients underwent imaging studies prior to core needle biopsy. BI-RADS was ≥4B in patients with GCT and 4A-C in MFB. Definitive diagnosis was made by histopathology and confirmed by immunohistochemistry in accordance with the features described in the literature. Six patients underwent wide excision. The mean follow-up duration was 44.5 months. All patients remained well, without recurrence. Conclusions MFB and GCT can mimic malignant neoplasms and the clinical significance of these entities lies primarily in their recognition as distinctive benign neoplasms. The gold standard for the diagnosis of GCT and MFB is histopathology. All the cases in our series were clinically or radiologically mistaken for carcinoma, which has been largely reported in the literature. Pathologists should bear this in mind to avoid misdiagnosis and unnecessary treatment.
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Affiliation(s)
- Camila C Simoes
- Pathology, The University of Texas Medical Branch, Galveston, USA
| | - Suimin Qiu
- Pathology, University of Texas Medical Branch, Galveston, USA
| | - Quan D Nguyen
- Radiology, University of Texas Medical Branch, Galveston, USA
| | - Sandra S Hatch
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Galveston, USA
| | - Jing He
- Pathology, University of Texas Medical Branch, Galveston, USA
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