Leiomyoma of the breast parenchyma: a case report and review of the literature

Leiomyoma of the Breast: A Report of a Rare Case of a Benign Breast Tumor From the Caribbean

Leiomyomas are benign mesenchymal stromal tumors of smooth muscle; while these are more traditionally found in the uterus, in rare cases, they can also be found in the breast, particularly in the subareolar region. Clinically and radiographically, these tumors are very similar to fibroadenomas but can be definitively distinguished based on distinctive histopathological features. Surgical management for breast leiomyomas has previously included procedures ranging from lumpectomy to mastectomy; however, resection of the tumor with free margins is the most well-recognized treatment for breast leiomyomas.

Ultrasound-guided microwave ablation for giant breast leiomyoma: A case report

Rationale

Breast leiomyoma is the rarest non-epithelial tumor of the breast. As a benign tumor, its main treatment is regular follow-up. Surgical treatment is often used in clinical practice when patients have symptoms or strongly require treatment. However, if the tumor is large or located around the nipple or areola, the cosmetic effect of surgery is not good, so it is urgent to find new treatment methods. We pioneered the use of microwave ablation in the treatment of giant breast leiomyoma and achieved good results.

Patient concerns

A 37-year-old female was admitted to hospital because she found a breast mass of approximately 8 cm. She had no obvious clinical symptoms, but had great psychological pressure.

Diagnosis

Pathological biopsy showed leiomyoma followingly the surgical operation of giant breast leiomyoma was planned. However, the breast mass was large, and the postoperative scar would affect the breast appearance.

Interventions

The consent was obtained from the patient and her family. The Ultrasound-guided microwave ablation was successfully performed.

Outcomes

The patient was followed up for 10 months, and the tumor volume ablation rate was 69.8%. The cosmetic effect of breast was excellent.

Lessons

To our knowledge, this is the first case to using microwave ablation (MWA) for the treatment of breast leiomyoma. Ultrasound-guided MWA can be used for the treatment of breast leiomyoma, especially when the mass is large and requires traditional surgical resection. It can effectively improve the breast aesthetics and further improve the quality of life of patients. However, it is only a case report, and needs more research to verify MWA in breast leiomyoma.

Intraparenchymal breast leiomyoma and atypical leiomyoma

Background

Breast leiomyoma is a rare benign mesenchymal tumor, accounting for less than 1% of all breast neoplasms. Cases of breast atypical leiomyoma is even more rarely reported and its diagnostic criteria together with its clinical courses is not cleared defined.

Case presentation

We described two patients with breast leiomyomas. One has unilateral benign breast leiomyoma, the other one has bilateral breast leiomyomas. For the bilateral case, the left-side tumor was diagnosed as benign leiomyoma while the right-side tumor was diagnosed as atypical leiomyoma. The morphological features that lead to the diagnosis of atypical leiomyoma are its invasive growth pattern, mild nuclear atypia, and mitotic figures up to 3mitoses/10HPF.

Conclusions

Atypical breast leiomyoma appears to behave like benign leiomyoma without recurrence in our study with nine-year follow-up. Due to the limited experience, cases presented as atypical intraparenchymal breast leiomyoma should be closely followed.