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Ding N, Jiang Y, Liu H, Zheng F, Zhu S, Wang M, Yang M, Kong L, Xue H, Jin Z. Imaging Features of Breast Periductal Stromal Tumor: A Case Report. Front Oncol 2021; 11:577227. [PMID: 34722230 PMCID: PMC8555694 DOI: 10.3389/fonc.2021.577227] [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: 02/25/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022] Open
Abstract
Breast periductal stromal tumor (PDST) is a rare biphasic tumor, with both benign ductal epithelium and non-phyllodes sarcomatous stroma. Its imaging features were rarely reported due to the rarity. In this study, we describe the case of a 48-year-old female who presented with a palpable mass in the right breast. Presurgery imaging evaluations of full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and ultrasonography (US) were performed. The imaging features include the following: 1. multiple solid lobulated lesions comprising nearly the entire right breast; 2. hypoechoic heterogeneous masses with internal separations and abundant blood flow; 3. FFDM and DBT showed multiple irregular high-density masses with lobulated margin, partially integrated. The patient underwent extended mastectomy of the right breast. The surgical pathology confirmed a PDST. After excision of the mass, she was followed up in the outpatient clinic for 25 months without local recurrence or distant metastasis.
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Affiliation(s)
- Ning Ding
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ying Jiang
- Department of Pathology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haimin Liu
- Department of Medical Record, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fuling Zheng
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shenling Zhu
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ming Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Meng Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lingyan Kong
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huadan Xue
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Arab W, Moubarak M, Fattah S, Khazen J, Khaddage A, El Kassis N, Atallah D. Periductal stromal tumor of the breast in a young lady: A case report. Breast J 2021; 27:380-383. [PMID: 33474791 DOI: 10.1111/tbj.14158] [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: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
We present the case of a 30-year-old lady who underwent a core needle biopsy for a BIRADS 4 lesion of her left breast and was diagnosed as having a cellular fibroadenoma. The final diagnosis after excision returned to be a periductal stromal tumor (PST). An extremely rare entity, the PST is actually classified as a subtype of phyllodes tumor, with specific criteria that are only found upon histological examination of the specimen. Care should be taken when considering the diagnosis of fibroadenoma based only on clinical, radiological, and biopsy findings. Any nonclassical, clinical, or radiological findings should prompt a wide excision. Prognosis is generally good when clear margins are obtained and in the absence of malignant heterologous elements.
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Affiliation(s)
- Wissam Arab
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Malak Moubarak
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Samah Fattah
- Department of Pediatrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Joseph Khazen
- Department of Pathology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Abir Khaddage
- Department of Pathology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nadine El Kassis
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - David Atallah
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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Valente I, Ristani A, Mancini C, Martella E, Quartieri L, D'Aloia C. Management of a periductal stromal tumor in a young woman: Our breast unit experience. Breast J 2020; 26:1375-1378. [PMID: 32297694 DOI: 10.1111/tbj.13843] [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: 02/21/2020] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
Periductal stromal tumor (PDST) is a rare biphasic tumor of the breast that exhibits low-grade malignancy and intermediate behavior. It is characterized by proliferation of atypical spindle cells surrounding benign mammary ducts and infiltrating adjacent adipose tissue. PDST is distinguished from phyllodes tumor by its lack of leaf-like architecture; however, it is still unclear whether PDST is a separate entity or a certain spectrum of phyllodes tumor. Phyllodes tumors constitute a group of rare epithelial lesions of the breast which mainly develops at around 40-50 years. The histologic characteristics to be considered are many and often heterogeneous in the same lesion which makes interpretation in needle biopsy material difficult. Most phyllodes tumors have a benign nature, with a high rate of postsurgical recurrence. In the malignant form, metastases are described by distant hematogenous route; its indolent behavior implies a tight surgical management with precise excision of the lesion even if there is not, however, a unanimous consent on the parameters of accuracy of the margins.
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Affiliation(s)
- Irene Valente
- Breast Unit, Breast Imaging Department of Radiology, University Hospital of Parma, Parma, Italy
| | - Adela Ristani
- Breast Unit, Breast Imaging Department of Radiology, University Hospital of Parma, Parma, Italy
| | - Cristina Mancini
- Breast Unit, Department of Pathological Anatomy, University Hospital of Parma, Parma, Italy
| | - Eugenia Martella
- Breast Unit, Department of Pathological Anatomy, University Hospital of Parma, Parma, Italy
| | - Leonardo Quartieri
- Breast Unit, Breast Imaging Department of Radiology, University Hospital of Parma, Parma, Italy
| | - Cecilia D'Aloia
- Breast Unit, Breast Imaging Department of Radiology, University Hospital of Parma, Parma, Italy
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Abstract
Fibroepithelial breast lesions encompass a heterogeneous group of neoplasms that range from benign to malignant, each exhibiting differing degrees of stromal proliferation in relation to the epithelial compartment. Fibroadenomas are common benign neoplasms that may be treated conservatively. Phyllodes tumors are relatively rare lesions, and classified as benign, borderline, or malignant based on histologic evaluation of various parameters. The diagnostic interpretation of "gray-zone" fibroepithelial lesions often imposes formidable demands on a pathologist's skills. This article offers practical recommendations for the diagnostic workup of these lesions, including the appropriate utilization of ancillary investigations and the approach to core needle biopsies.
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Askan G, Arıbal E, Ak G, Kaya H. Periductal Stromal Tumor of the Breast: A Case Report and Review of the Literature. THE JOURNAL OF BREAST HEALTH 2016; 12:133-136. [PMID: 28331749 DOI: 10.5152/tjbh.2016.2889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/01/2016] [Indexed: 11/22/2022]
Abstract
We present a woman aged 50 years who underwent a Tru-cut biopsy for a BI-RADS 4 lesion on her right breast and received a histopathology diagnosis of a fibroadenoma. In her one year follow-up, the lesion had progressed and she underwent an excisional biopsy. Her final diagnosis was a periductal stromal tumor. Periductal stromal tumor is an extremely rare and different entity from phylloides tumor, which makes appropriate diagnosis difficult in Tru-cut biopsy and care should be taken. Lesion progression of should require a re-biopsy. Their tendency to recur warrants follow-up. We believe that radiologic, pathologic, and clinical correlation is key in decision-making and diagnosis of these tumors.
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Affiliation(s)
- Gökçe Askan
- Department of Pathology, Marmara University Hospital, İstanbul, Turkey
| | - Erkin Arıbal
- Department of Radiology, Marmara University Hospital, İstanbul, Turkey
| | - Gamze Ak
- Department of Pathology, Marmara University Hospital, İstanbul, Turkey
| | - Handan Kaya
- Department of Pathology, Marmara University Hospital, İstanbul, Turkey
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Michala L, Tsigginou A, Zacharakis D, Dimitrakakis C. Breast disorders in girls and adolescents. Is there a need for a specialized service? J Pediatr Adolesc Gynecol 2015; 28:91-4. [PMID: 25850589 DOI: 10.1016/j.jpag.2014.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/21/2014] [Accepted: 05/31/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Minor breast concerns in childhood and adolescence are common and lead to increased anxiety among young patients and their families, particularly due to high correlation with breast cancer. However, most breast services aim at managing adults and triaging patients with breast cancer, whereas adolescent medicine specialists or pediatricians are usually not appropriately trained to identify and treat breast pathology. METHODS We reviewed hospital records of all patients attending a pediatric and adolescent gynecology or breast clinic of a tertiary referral hospital, with a breast related symptom, between January 2009 and December 2011. We collected information regarding age at presentation, age at menarche, diagnosis, management and outcome. RESULTS We identified 81 patients of which 11 presented with an abnormal nipple or areolar secretion, 33 had a palpable lump, 20 had mastitis, and 16 had unequal breast development. One patient presented with virginal breast hypertrophy. Three out of 11 of the patients with an abnormal secretion had a cyst identified on ultrasonography. Out of the palpable lumps 12 were fibroadenomas, 3 were phyllodes tumors, and 14 were cystic in nature. The phyllodes tumors and half of the fibroadenomas were removed. The remaining fibroadenomas remain under regular ultrasonographic follow-up. All cases of mastitis were treated conservatively and resolved with broad spectrum antibiotic treatment. CONCLUSION In our series, no malignancies were identified. Although 8 patients required surgical treatment, the majority of cases were treated conservatively.
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Affiliation(s)
- Lina Michala
- 1(st)Department of Obstetrics and Gynaecology, University of Athens, Alexandra Hospital, Athens, Greece.
| | - Alexandra Tsigginou
- 1(st)Department of Obstetrics and Gynaecology, University of Athens, Alexandra Hospital, Athens, Greece
| | - Dimitris Zacharakis
- 1(st)Department of Obstetrics and Gynaecology, University of Athens, Alexandra Hospital, Athens, Greece
| | - Constantine Dimitrakakis
- 1(st)Department of Obstetrics and Gynaecology, University of Athens, Alexandra Hospital, Athens, Greece
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White SR, Auguste LJ, Guo H, Bhuiya T. Periductal Stromal Sarcoma of the Breast With Liposarcomatous Differentiation. Int J Surg Pathol 2015; 23:221-4. [DOI: 10.1177/1066896914567331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A biphasic tumor with features of benign ductal elements and a malignant stromal component that lacks the architecture of a phylloides tumor represents a diagnostic challenge. A 35-year-old woman presented with a painful mass located in the upper inner quadrant of the right breast. A biopsy revealed histologically that the tumor had a multinodular architecture with malignant spindle cells forming cuffs around multiple open benign ducts. No leaf-like architecture was present. In addition, liposarcomatous differentiation was seen in focal areas. Immunohistochemical staining showed positive for CD34, vimentin and CDK4, and negative for ER, PR, Her2/neu, CD10, CD117, p63, bcl-2, cytokeratin, and MDM2. A diagnosis of periductal stromal sarcoma with liposarcomatous differentiation was established. Following excision with mastectomy and adjuvant chemotherapy, the patient was disease-free for 10 years. To our knowledge, this is the first case report of periductal stromal sarcoma showing liposarcomatous differentiation.
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Affiliation(s)
| | - Louis J. Auguste
- Hofstra–North Shore Long Island Jewish School of Medicine, Hempstead, NY, USA
| | - Hua Guo
- Hofstra–North Shore Long Island Jewish School of Medicine, Hempstead, NY, USA
| | - Tawfiqul Bhuiya
- Hofstra–North Shore Long Island Jewish School of Medicine, Hempstead, NY, USA
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Abbasi SL, McNamara K, Absar MS, Darlington A, Clucas F, Titi S. Periductal stromal tumor of breast: a case report and a review of literature. KOREAN JOURNAL OF PATHOLOGY 2014; 48:442-4. [PMID: 25588637 PMCID: PMC4284492 DOI: 10.4132/koreanjpathol.2014.48.6.442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/05/2014] [Accepted: 09/16/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Salma L Abbasi
- Department of Pathology, The Royal Oldham Hospital, Oldham, UK
| | - Kate McNamara
- Breast Unit, North Manchester General Hospital, Manchester, UK
| | | | - Alison Darlington
- Department of Radiology, North Manchester General Hospital, Manchester, UK
| | - Francene Clucas
- Department of Radiology, North Manchester General Hospital, Manchester, UK
| | - Sami Titi
- Department of Pathology, The Royal Oldham Hospital, Oldham, UK
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Lan Y, Zhu J, Liu J, Yang H, Jiang Y, Wei W. Periductal stromal sarcoma of the breast: A case report and review of the literature. Oncol Lett 2014; 8:1181-1183. [PMID: 25120682 PMCID: PMC4114652 DOI: 10.3892/ol.2014.2294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 02/07/2014] [Indexed: 11/17/2022] Open
Abstract
Periductal stromal sarcoma (PSS), spindle and epithelioid types, is a rare subtype of malignant fibroepithelial tumor. The morphological characteristics of this neoplasm are different from phyllodes tumor and stromal sarcoma. PSS exhibits biphasic histology with benign ductal elements and a sarcomatous stroma composed of spindle cells and lacking phyllodes tumor architecture. The therapeutic management of PSS is based on wide surgery with free margins, and adjuvant therapies are not required. To the best of our knowledge, the recurrence of PSS in ≤5 months has not been reported in the literature to date. This report describes a 43-year-old woman who presented to our hospital with a recurrence of nodules in the left breast. The patient had undergone lumpectomy at a different hospital 5 months previously, and a diagnosis of phyllodes tumor was pathologically confirmed. On presentation at our hospital, the patient underwent a second lumpectomy. Histological examination revealed PSS and the patient underwent a simple mastectomy of the left breast with no adjuvant treatment (such as chemotherapy or radiotherapy). After 9 months of close follow-up examinations, no recurrence was observed. PSS is an extremely rare disease with low-grade sarcomatous behavior, which may evolve into a phyllodes tumor or an entity of breast cancer. Therefore, frequent follow-up examinations are required.
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Affiliation(s)
- Yandan Lan
- Department of Breast Surgery, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jia Zhu
- Department of Breast Surgery, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jianlun Liu
- Department of Breast Surgery, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Huawei Yang
- Department of Breast Surgery, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Yi Jiang
- Department of Breast Surgery, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Wei Wei
- Department of Breast Surgery, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
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