Primary Spindle Cell Sarcoma of the Breast

A Rare Case of High-Grade Spindle Cell Sarcoma of the Breast: A Case Report

Introduction

Spindle cell sarcomas are rare breast lesions which are difficult to diagnose due to resemblance with other breast lesions. Histopathological examination and immunohistochemical staining are essential for diagnosis.

Case Presentation

We present a rare case of a 15-year-old female presenting with high-grade rapidly progressive spindle cell sarcoma of the breast, differentiated as phyllodes tumor, with axillary lymph node involvement. Her lesion, on the left breast, measured 16.9 × 10.1 × 13.7 cm. Histology revealed malignant neoplasm arranged in sheets and individual neoplastic cells with an epithelioid to spindled morphology with scant cytoplasm and irregular nuclear membranes. Immunohistochemistry showed weakly positive focal CD-99, and negative WT-1, Myogenin, Desmin, p63, Cytokeratin, Synaptophysin, and CD-34 markers. She was successfully managed with modified radical mastectomy and discharged with regular follow-up advised.

Conclusion

Spindle cell sarcomas have a very aggressive course and prompt diagnosis, and management is mandatory for better patient outcomes. Modified radical mastectomy is the mainstay of treatment.

Successful management of primary sarcoma of the breast with complete pathological response: a case report

Primary sarcomas of the breast are extremely rare and heterogenous malignancies; they should be differentiated from phyllodes tumors. They are characterized by their high rate of recurrence, rapid growth and aggressive coarse. We present a case of a 41-year-old Palestinian female who presented with a recurrent breast mass. Biopsy showed primary sarcoma and imaging confirmed metastasis to axillary lymph nodes. The patient received six cycles of ifosfamide-adriamycin protocol resulting in complete pathological response. She underwent left sided modified radical mastectomy followed by radiation and six more cycles of the same protocol as adjuvant. Primary breast sarcomas are rare neoplasms that require multidisciplinary discussion to guide treatment. The approach to these tumors is chemotherapy followed by surgical resection when operable, in addition to local control via radiotherapy and adjuvant chemotherapy.

Primary dedifferentiated liposarcoma of the breast: A case report

Primary breast liposarcoma is an extraordinarily rare breast malignancy. Histological subtypes including dedifferentiated are confirmed after a thorough histopathological and immunohistochemistry analysis. Liposarcoma of the breast can mimic other breast lesions. Long‐term follow‐up is needed due to the risk of local recurrence and delayed dedifferentiation.

Analysis of Clinicopathological Characteristics and Prognosis of Carcinosarcoma of the Breast

Background. Few cases of carcinosarcoma of the breast have been reported because of its low incidence rate and rapid progression. Seeking effective therapeutic methods becomes urgent in clinical practice. This study was aimed to investigate the clinical characteristics of carcinosarcoma of the breast and to explore proper therapeutic methods for patients with this rare tumor. Methods. We conducted a retrospective analysis on 47 patients with carcinosarcoma of the breast receiving treatment in our hospital from 2003 to 2020. Most of these patients received primary surgery followed by adjuvant chemotherapy, while four patients had lumpectomy only. Statistics showed no preference in age and menopausal status of patients. Results. The overall survival rate and progression-free survival rate of all patients at a median follow-up time of 33 months were 63.8% and 57.4%, respectively. Tumor size at diagnosis and chemotherapy strategies were both significant prognostic factors in reference to disease-free survival (DFS) and overall survival (OS) of the patients (tumor size: $p=0.023$ for DFS and $p=0.021$ for OS; therapeutic method: $p=0.041$ for DFS and $p=0.024$ for OS). N stage at diagnosis was significant only with reference to overall survival of the patients ( $p=0.009$ ). EGFR expression was positive in some patients. Conclusions. Our results elucidated that the patients received comprehensive therapy, especially adjuvant chemotherapy was indispensable for better outcomes. Early detection and treatment were necessary for a higher survival rate when the tumor size was less than 5 cm without lymph node metastasis. Prospective outcomes with novel strategies targeting EGFR need to be further investigated.

Primary stromal sarcoma of breast: A case report and literature review

INTRODUCTION

Primary breast sarcoma (PBS) was first described in 1887 as a rare heterogeneous neoplasm arising from the mesenchymal tissue of the mammary gland accounting for less than 5% of all body soft-tissue sarcomas and less than 0.1% of all malignant tumors of the breast.

CASE PRESENTATION

A 31-year old lady presented with left breast mass which she felt four years before during which the mass increased in size from 1 to 6 cm in the largest diameter, diagnosed clinically as a benign fibroadenoma without any further cytological or histopathological confirmation. Histopathological examination of the excised breast mass reveals undifferentiated, primary stromal sarcoma of the breast (PSSB), which was followed by mastectomy three weeks later with reconstructive breast surgery with a total duration of follow-up of 3 years thereafter. This is the first case of PSSB reported in Jordan.

DISCUSSION/CONCLUSION

PSSB is the generic term given to malignant breast tumors thought to arise from the specialized mesenchymal stroma of the breast but lacking an epithelial component with a phylloides pattern. PSSB is difficult to diagnose preoperatively due to its rarity and inadequate imaging methods to establish an exact diagnosis. The histology of the patient mass may be the leading factor for the management of these tumors. Even in very young patients, a progressively growing breast mass should alert the clinician to investigate for malignancy and verify the results by biopsy. Surgery with adequate resection margins represents the only potentially curative modality with prognostic significance. Adjuvant chemotherapy and radiotherapy are not very beneficial. The prognosis is dismal for patients with lymph node involvement and the size of the tumor has a lesser bearing on the outcome.

Residual Breast Sarcoma Left to Heal by Secondary Intention Following Wide Local Excision: An Unorthodox Approach to a Rare Malignancy

Breast sarcomas remain a rare malignancy and are noted to portend a particularly dismal prognosis. Due to their high rates of recurrence, a surgical excision with negative margins remains the preferred treatment modality. Nevertheless, their sparse prevalence often poses a diagnostic conundrum. In this report, we chronicle the case of a 46-year-old female with a recurrent breast sarcoma that was treated with wide local excision. Interestingly, no flap reconstruction, skin graft surgery, or primary wound closure was performed, and the resultant wound was left to heal by secondary intention. The patient continues to do well to date, with no postoperative complications.

Primary Stromal Breast Sarcoma with Concomitant Contralateral Carcinoma: A Rare Case from Syria

Bilateral breast cancers are rare cases encountered and are usually the same type in both sides. Only very few cases were reported to have different histological types of neoplasia involving sarcoma. Moreover, sarcomas rarely originate from the breast as a primary lesion whereas the common presentation is having angiosarcoma following radiotherapy. In this report, we present a rare case of a Syrian 43-year-old woman having two distinct primary lesions in the breasts: invasive ductal carcinoma and contralateral stromal sarcoma.

Carcinosarcoma (Metaplastic Carcinoma) Breast: A Rare and Aggressive Primary – Report of Two Cases with Review of Literature

Carcinosarcoma (CS) also known as metaplastic carcinoma of the breast is a rare and aggressive type of malignancy with controversial origin. Currently, there are no standard treatment guidelines outlined, owing to the rarity of the disease, but according to the available literature, surgery followed by adjuvant radiation therapy has the greatest benefit. We are presenting two cases of CS of breast developing metastasis. One of the cases presented with lung metastasis during the course of follow-up and responded significantly to chemotherapy, and the other is currently receiving chemotherapy. The cases are being presented here along with the literature review enlightening the current knowledge and available treatment options.

Spindle cell sarcoma: a SEER population-based analysis

Due to the substantial limitation of study population, Spindle cell sarcoma (SCS) was unexplored comprehensively. In this study, we investigated the clinical characteristics and disease specific prognostic factors of SCS. 3299 SCS cases were identified and extracted from Surveillance, Epidemiology, and End Results (SEER) database (1973–2017). White people account for 79.1% with median age of 57 years without predominance in any gender. Significant disease specific survival (DSS) and overall survival (OS) were found differentiated in age, T stage, N stage, M stage, AJCC stage, SEER historic stage, tumor locations, surgery, and pathologic grade. In the multivariate Cox analysis, the age >64 years (for DSS, P < 0.001 and for OS, P < 0.001; Reference age ≤64 years), AJCC stage III (for DSS, P = 0.006 and for OS, P = 0.04; Reference: AJCC stage I), and non-surgical treatment (for DSS, P < 0.001 and for OS, P < 0.001; Reference: surgery) were independently associated with worse DSS and OS. In brief, our study demonstrated that SCS mostly found in white people at fifth to seventh decades of life without gender predilection. The patient’s age, AJCC stage, tumor location and surgery were independent prognostic indicators for both DSS and OS of SCS.

Rare variant of metaplastic carcinoma of the breast: a case report and review of the literature

Background

Metaplastic carcinoma encompasses a group of neoplasms characterized by differentiation of the neoplastic epithelium into squamous cells and/or mesenchymal-looking elements. Spindle cell carcinoma is a rare variant of this special histological type. Its prognosis remains poor, with a high rate of local recurrence and distant metastasis. To date, only a small number of cases have been described. There is no clear agreement on this histological subtype.

Case presentation

We report a case of a 53-year-old Moroccan woman who consulted our institution following palpation of a nodule of the left breast. Mammography in combination with breast ultrasonography revealed a lesion classified as Breast Imaging Reporting and Data System 4 with microcalcification. The patient was diagnosed with spindle cell carcinoma of the breast. The diagnosis was based primarily on histological and immunohistochemical studies of the breast biopsy and secondarily on the surgical specimen. No local or distant metastasis was found. The treatment used was total surgical excision followed by radiotherapy.

Conclusions

We describe the features (epidemiological, clinical, histological, immunohistochemical, and therapeutic outcomes) of our patient’s case and compare them with literature data.

Clear Cell Sarcoma: A Case Report and Review of Literature

Clear cell sarcoma (CCS), a deep-rooted tumor with a predilection for lower extremities, has a proclivity to involve the tendons and aponeuroses. This sarcoma is seen predominantly around the foot and ankle region. Diagnosis is mainly finalized using histological and immunohistochemical assessment. The main treatment strategy is surgery followed by chemotherapy. An erratic challenge is posed by histological similarity and immunohistochemical overlap to the diagnosis and distinguishing of clear cell sarcoma from primary or metastatic malignant melanoma (MM) which is more common. Here, we described a CCS case located in the left leg of a 37-year-old male patient.

Malignant mesenchymal tumor of male breast: primary chondrosarcoma

Breast Sarcomas have relatively been rare and accounted for 1% of all primary malignant tumors of the breast. Pure and primary chondrosarcoma of the male breast would be an extremely rare tumor. It might arise either from the breast stroma itself, or from underlying bone or cartilage. A 65-year-old man has presented with a rapidly growing breast mass since 5 months. Physical examination has established a large firm to hard mass with regular margins in the region of right breast. There was no axillary lymphadenopathy. Contrast enhanced MRI of breasts has shown a mixed-signal intensity multi lobulated cystic-solid mass (10.4 cm × 10.3 cm ×9.9 cm) appearing predominantly hyper intense on T2W and hypo intense on T1W. The tumor has diagnosed as a low-grade chondrosarcoma of the breast by histopathological and immunohistochemistry analysis. Right sided radical mastectomy with grafting has done. It has seemed to be very important to identify the mammary primary sarcomas as entity separated from the carcinomas of the breast.

Spontaneous regression of breast angiosarcoma after conservative treatment with radiotherapy: a case report and review of the literature

Angiosarcoma of the breast is a rare disease, and approximately 1 % of all affected patients are treated with breast-conserving therapy (BCT) and radiotherapy (RT) for primary breast cancer. The prognosis for this tumor is quite dismal, with high rates of recurrence and poor overall survival. This report presents the case of a 73-year-old female who underwent BCT followed by RT for left breast carcinoma 18 years previously. The patient visited the hospital with a complaint of a new mass in the left breast. The lesion initially decreased in size; however, it subsequently began to rapidly enlarge. A core needle biopsy of the mass was performed under ultrasonography, with a diagnosis of a spindle cell sarcoma, most conceivably an angiosarcoma, originating from the left breast, suspected to be induced by RT. The tumor was resected with the surrounding skin, and immunohistochemically diagnosed as angiosarcoma of the left breast, without evidence of breast cancer in any lesion, suggesting that RT induced the tumor formation. We herein report this rare case and the ultrasound imaging findings.

Primary spindle cell sarcoma of the breast masquerading as necrotizing fasciitis

Breast sarcomas are rare neoplasms arising from the few epithelial elements of the gland. It represents much <1% of all breast cancer. Of the heterogeneous group of sarcomas, the more common subtypes include spindle cell sarcoma. The main risk factor for the development of breast sarcomas is previous radiation therapy following breast-conservation surgery for breast cancer or non-Hodgkin's lymphoma. We report on an idiopathic presentation of spindle cell sarcoma in an otherwise healthy middle-aged woman. An emphasis is made on the rare occurrence of lymphatic metastasis. We discuss our recommended management strategy with particular reference to the benefit of multidisciplinary team decision-making.

A rare tumour of the breast: carcinosarcoma

Carcinosarcoma of the breast, also known as metaplastic carcinoma, is rare with very few cases reported in the literature. A 46-year old female patient presented with a mass in her left breast. Physical examination, ultrasonography and mammography findings were consistent with malignancy. The mass was totally removed. Histopathological examination revealed carcinosarcoma of the breast. Histologic grade of the tumour was III. Ki67 proliferation index was found 40% positive. Tumour cells were positive for p53 (70% positive), c-erb-B2 (5% positive), pancytokeratin and EMA in carcinomatous areas, and vimentin in sarcomatous areas. There was no metastasis in axillary lymph node and distant metastasis. The patient is receiving chemotherapy and is under follow-up in the 54th month. Along with a review of the literature, we present the information regarding the clinical and histological findings and treatment of the patient who was operated due to breast carcinosarcoma.

Malignant Mesenchymal Tumor of the Breast: Primary Chondrosarcoma

SUMMARY: BACKGROUND: Primary mesenchymal tumors are an extremely rare malignancy of the breast. CASE REPORT: A 52-year-old woman presented with a rapidly growing breast mass. Physical examination established a large and round mass with regular margins in the upper-outer quadrant of the right breast. Ultrasound showed a hypoechoic solid mass (41 × 36 mm) with lobulated contours. Mammography revealed a hyperdense and relatively regular-shaped mass giving the impression of a benign tumor. However, a pathologic report of atypical cells after fine needle aspiration necessitated surgical excision. The mass was removed with a wide local excision. The tumor was diagnosed as a high-grade chondrosarcoma of the breast by histopathological analysis. Following the final diagnosis, we performed a modified radical mastectomy based on the knowledge that this malignancy is generally refractory to radiotherapy. The regional lymph nodes and local adjacent tissues were free of metastasis. The tumor was negative for estrogen and progesterone receptors as well as HER2. CONCLUSION: Chondrosarcoma tends to grow rapidly. Physical examination usually reveals a large, round mass. The tumor is regular-shaped, round, and complex echoic on Mammography and ultrasound. It usually does not invade regional structures. Surgery remains the only effective treatment.