Primary Desmoid Tumor (Extraabdominal Fibromatosis) of the Breast

Desmoidfibromatosis of the breast after breast reduction: A case report and a review of the literature

INTRODUCTION

Desmoids fibromatosis is a rare pathology whose definitive diagnosis is histological. Although it presents clinical and radiological similarities with breast carcinoma.

CASE REPORT

In this observation, we report a case of desmoids fibromatosis diagnosed in a 51-year-old female patient. The positive diagnosis was difficult to retain.

DISCUSSION

Desmoids fibromatosis remains a benign pathology with a high recurrence rate and a local aggressiveness requiring an enlarged lumpectomy with sufficient margins up to 3 cm.

CONCLUSION

Radiotherapy remains a therapeutic option in addition to surgery in incomplete sections and in case of multiple recurrences. The place of medical treatments, in particular anti-estrogens, is not clearly defined.

Fibromatosis of the breast in a male patient

Fibromatosis of the breast is a rare soft tissue lesion that arises from the mammary tissue or the pectoral fascia. We present a case of fibromatosis in a 39-year-old male patient who developed a right lateral breast mass in several weeks without prior trauma or surgery. Ultrasound-guided core needle biopsy findings included differential diagnoses of nodular fasciitis and fibromatosis. The patient was referred to a breast surgeon and underwent excisional biopsy. Final pathology report confirmed fibromatosis. The patient tolerated the surgery well and will continue to follow up post-operatively for recurrence.

Imaging findings of a biopsy-proven desmoid tumor of the axilla in a young female

Desmoid tumors (fibromatoses) are rare but locally aggressive tumors that do not metastasize. They are non-encapsulated, well-differentiated lesions made of fibroblasts and collagen, which mainly appear in the mesentery and abdominal wall. Rarely, these tumors can also occur in breasts, making up approximately 0.2% of all breast neoplasms. Treatment typically includes surgical excision and/or medical management.

We describe a case of a 31-year-old female presenting with a mass in her left axilla that was biopsy proven to be a desmoid tumor. In this case report, we discuss the various imaging findings present on ultrasound, mammography, computed tomography, and magnetic resonance imaging.

Desmoid fibromatosis of the breast occurring after breast reduction surgery mimicking a carcinoma: A rare case report

Introduction

Desmoid tumors are benign mesenchymal tumors developed at the expense of muscular fasciae and aponeuroses. The mammary localization is a rare entity, representing less than 0.2% of all breast tumors. It is characterized by a strictly local evolution and its tendency to recur without giving metastases. Its clinical and radiological presentation is similar to a breast carcinoma which is the main differential diagnosis.

Case presentation

Patient aged 51 years, primigravida primiparous, followed for right breast cancer diagnosed at the age of 49 years for which she received a right mastectomy and axillary lymphnode dissection and contralateral breast reduction. It was a 4 cm infiltrating ductal carcinoma, SBR III Luminal B, 0 N+/20 N with presence of fibrous mastopathy without sign of malignancy at the left breast reduction specimen.The patient received adjuvant chemotherapy, external radiotherapy and hormone therapy.One year after surgery, the patient returned for a four x 2 cm left breast nodule in the upper medial quadrant. The biopsy confirmed the diagnosis of fibromatosis of the breast. A wide local excision was performed.

Discussion

The etiology of this tumor is unknown, however, physical, hormonal and genetic factors play an important role in the development of desmoid tumor.The clinical presentation is similar to breast carcinoma, making it difficult to differentiate this tumor from breast carcinoma. Breast imaging techniques are not specific for desmoid fibromatosis. Treatment is based primarily on complete surgical excision.

Conclusion

Breast fibromatosis is a rare entity, clinically and radiologically mimicking breast cancer. Only histology will provide the diagnosis. The treatment of choice is based on complete surgical excision with healthy safety margins.

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Breast fibromatosis is an uncommon tumor with an uncertain etiology.

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A breast carcinoma is the main differential diagnosis.

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The current report discusses a case of desmoid type fibromatosis of the breast occurring after breast reduction surgery.

Desmoid fibromatosis of the breast; a rare case report

Introduction

Desmoid tumor is an uncommon tumor with variable spectrum ranged from being a locally lesion to an aggressive and destructive one. The current case aims to report a rare condition of desmoid type fibromatosis of the breast.

Presentation of case

A 59-year-old female presented with a right breast mass for 9-months. Mammography showed a small speculated iso-hyper dense mass, just anterior to the pectoralis muscle measuring about 15 mm (M5) in longest axis. Ultrasound examination revealed an irregular mass with internal vascularity and posterior shadowing in the right breast with a single borderline lymph node (25 ∗ 14 mm of 4 mm cortex). Wide local excision with sentinel axillary lymph nodes biopsy was performed. Histopathological examination of the specimen confirmed the diagnosis of desmoid type fibromatosis of the breast.

Discussion

The etiology of this tumor is unknown, however, physical, hormonal and genetic factors have a significant role in the development of desmoid tumor.

Conclusion

Desmid type fibromatosis of the breast is an uncommon, benign, locally aggressive fibroblastic tumor with lack of metastatic potential, it may present with features of malignancy.

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Desmoid tumor is an uncommon tumor.

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The occurrence of desmoid tumor in the breast is even rarer.

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Differentiation from malignant disease is a challenging task.

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The current report discusses a case of desmoid type fibromatosis of the breast.

Breast Fibromatosis: Radiologic-Pathologic Correlation

Fibromatosis of the breast is a rare, benign locally infiltrative tumor without metastatic potential. Patients typically present with a painless, palpable, firm breast mass, which may be mobile or fixed to the pectoralis muscle. While some cases are related to familial mutations in the adenomatous polyposis coli (APC) gene, the majority are sporadic due to somatic mutations or prior injury to the breast tissue. On mammography, fibromatosis is typically seen as an irregular, dense, spiculated mass. US demonstrates a hypoechoic, irregular mass with indistinct margins. Fibromatosis is indistinguishable from breast cancer on imaging, and core biopsy is required for definitive diagnosis. Wide local excision is the historical standard for treatment; however, recurrence rates are high, and other emerging therapies are being explored. This article reviews the clinical features, imaging and histopathologic findings, along with brief overview of management.

Desmoid Type Fibromatosis of the Breast Masquerading as Breast Carcinoma: Value of Dynamic Magnetic Resonance Imaging and Its Correlation

Desmoid type fibromatosis of the breast is a rare stromal tumor that accounts for <0.2% of all breast tumors. Bilateral and multicentric lesions are extremely rare, with only less than ten cases reported in the literature. Although benign, it is locally aggressive with frequent recurrence in up to almost one-third of the cases. We experienced our first case of bilateral multicentric breast fibromatosis in a 19-year-old woman, with a paternal aunt diagnosed with breast cancer at age 30, who presented to our institution with the chief complaint of retracted nipples for 1 year. The patient denied any history of trauma to her chest. Sonography showed suspicious bilateral hypoechoic masses. Magnetic resonance imaging (MRI) was performed for further evaluation because of the extensive involvement of both the breasts. This report aimed to illustrate the main clinical, radiological, and histopathological characteristics of this rare disease to increase awareness of this entity and discuss the role of MRI.

Desmoid Type Fibromatosis of the Breast: Ten-Year Institutional Results of Imaging, Histopathology, and Surgery

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.

A case report of desmoid type fibromatosis of the breast

Background. Desmoid type fibromatosis of the breast is a rare fibroblastic proliferative disease. It may be sporadic or associated with trauma, Gardner’s syndrome, etc. Desmoid tumour of the breast is a benign, locally aggressive disease. However, it does not metastasize. Case report. We report a case of a 65-year-old woman with right breast desmoid type fibromatosis. Conclusions. Diagnosis of breast desmoid tumour is difficult: clinically and radiologically it may mimic carcinoma. Definitive diagnosis is proved just by histopathological examination results. First choice treatment of breast fibromatosis is a radical surgical excision.

Recurrent desmoid tumor arising from latissimus dorsi flap: A case report

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.

Unusual Breast Neoplasm with Diagnostic and Management Challenges

With the growing awareness and availability of proper screening methods, detection of breast lump is increasing globally and is now a very sensitive issue for females. The treatment of these lumps ranges from lumpectomy to wide local excision to mastectomy; hence, a proper diagnosis is very important to prevent under- or overtreatment in patients. Breast lesions are the heterogeneous diseases encompassing several distinct entities with remarkably different characteristics. While the more common forms of breast cancers are well recognized and understood better, there are many important unusual lesions and malignancies that are less known and less appreciated and can be challenging to diagnose. In such cases, due to rarity of the disease and lack of adequate treatment protocol, managing the patients can be a challenging task for surgeons and oncologist as well. In this article, we have shared our institutional experience in unusual breast lesions with emphasis on diagnostic as well as management challenges faced.

Desmoid Tumor and Silicone Breast Implant Surgery: Is There Really a Connection? A Literature Review

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

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Screening-detected desmoid tumor of the breast: findings at conventional imaging and digital breast tomosynthesis

Desmoid tumor of the breast is a rare benign entity that usually is mistaken for carcinoma clinically and radiologically. We report two cases of desmoid tumor of the breast detected by mammography screening using digital breast tomosynthesis (DBT). The larger tumor was detected at both full-field digital mammography (FFDM) and DBT. The smaller desmoid tumor, however, was identified only at tomosynthesis. Mammographic and ultrasonographic findings at diagnostic work-up were consistent with carcinoma of the breast. Preoperative needle biopsies could not conclusively diagnose the lesions. Both patients underwent excisional biopsy and histopathology revealed fibromatosis of the desmoid type.

Fibromatosis, a benign breast disease mimicking carcinoma. A case report

Introduction

Fibromatosis is an uncommon breast lesion that can mimic breast carcinoma in its clinical presentation.

Case summary

We present a clinical case in which a diagnosis and treatment dilemma existed, in terms of ultrasound findings that were not clear and suspicious, as well as results of Fine needle aspiration cytology. Our findings are compared with previous published cases. Also, literature review regarding fibromatosis presentation and diagnosis has been discussed, as well as treatment options.

Conclusion

Management of breast fibromatosis remains controversial because of the low incidence and further efforts needed to establish evidence-based treatment guidelines.

Fibromatosis of the Breast: Diagnostic Accuracy of Core Needle Biopsy

OBJECTIVES

Fibromatosis of the breast is an uncommon neoplasm with potential for local recurrence. Treatment has traditionally been surgical excision with current trends toward conservative management. Given the option of observation after diagnosis by core needle biopsy (CNB), we sought to evaluate the accuracy of CNB for diagnosing fibromatosis.

METHODS

We identified a total of 31 cases in which fibromatosis had been diagnosed or included in the differential diagnosis on a CNB, an excision, or both. Morphology and immunohistochemical results were reviewed.

RESULTS

Aberrant nuclear immunoreactivity for β-catenin and absent staining for CD34 were the most useful studies to diagnose fibromatosis, and one or both were performed in 21 (68%) cases. High molecular weight cytokeratins and p63 were helpful to exclude spindle cell carcinoma. Of 26 cases confirmed as fibromatosis on excision, 22 (85%) were diagnosed as fibromatosis or fibromatosis was favored in the differential diagnosis on CNB. More frequent use of immunohistochemistry would likely have resulted in a greater number of definitive diagnoses. Fibromatosis was rarely mistaken for other nonmalignant stromal lesions, with no cases misdiagnosed as carcinoma.

CONCLUSIONS

CNB can be an accurate method of diagnosing fibromatosis, allowing observation for a select group of patients.

Radiologic images of an aggressive implant-associated fibromatosis of the breast and chest wall: case report and review of the literature

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.

Desmoid-type fibromatosis of the breast: A case report

Desmoid-type fibromatosis of the breast (also referred to as desmoid tumor or aggressive fibromatosis) is exceedingly rare. Although it does not metastasize, desmoid-type fibromatosisis is frequently locally aggressive. Recurrence is common (up to 35%), even after presumed total excision of the primary tumor [1]. The breast is an unusual location for the development of this tumor, with relatively few cases reported in the literature. We report a case of desmoid-type fibromatosis in the breast in a 31-year-old female who presented with a four-month history of a palpable left breast mass. Her imaging was discordant, so she underwent surgical excision of the mass. Multiple positive margins were present. She underwent re-excision to the level of the sternum medially. Final pathology showed a focally positive posterior margin, without muscle or fascial involvement. The patient's case was discussed at the multidisciplinary tumor board conference and no further intervention was recommended. To our knowledge, this is the first case report in the literature in which negative margins were unable to be achieved for desmoid tumors of the breast operatively.

Bilateral perirenal space fibromatosis with renal infiltration: case report and review of literature

Fibromatosis and/or desmoid tumors which constitute less than 1% of all neoplasms and 3.0% of all soft-tissue tumors are pathologically benign proliferations of the fibroblasts but are locally aggressive with infiltrative type of growth and tendency toward recurrence. Bilateral symmetrical perirenal involvement has been described in many conditions which can be renal, subcapsular, or perirenal in origin. However, bilateral perirenal fibromatosis as an isolated presentation was very uncommon. We report an exceptionally rare case of bilateral perirenal fibromatosis with renal infiltration.

Bilateral desmoid tumor of the breast: case seriesand literature review

Background

Desmoid tumor of the breast is very rare and locally aggressive but has no distant metastasis. Bilateral lesions are extremely rare, found in only 4% of patients. Two cases of bilateral desmoid tumor of the breast are reported. The clinical presentation, diagnosis, imaging, treatment, and follow-up outcomes of recurrence as well as a brief literature review are provided.

Case reports

Case 1 is a 31-year-old woman who presented with nipple retraction. An ultrasound revealed BIRAD V in both breasts. She underwent a bilateral excisional biopsy under ultrasound mark with the pathology result of extra-abdominal desmoid tumor in both breasts. The patient had a bilateral mastectomy with silicone implantation due to the involved margins by excision. She remained tumor free after 7-year follow-up. Case 2 is a 28-year-old woman who presented with a lump on her right breast that she had discovered ~2 months earlier. An ultrasound showed a spiculated mass in the right breast and some circumscribed hypoechoic masses in both breasts. A bilateral breast excision was done. The pathology result was an extra-abdominal desmoid tumor. She had recurrence on both sides and underwent a mastectomy and silicone implantation. The tumor has not recurred after 1-year follow-up.

Conclusion

Imaging cannot distinguish between benign breast lesions and malignancy. Pathology results are helpful in making a definitive diagnosis. Given that the desmoid tumor is locally aggressive, a local excision with clear margins is recommended. Chemotherapy and hormonal treatment are controversial.

Desmoid Tumor of the Chest Wall Mimicking Recurrent Breast Cancer: Multimodality Imaging Findings

Desmoid tumor of breast is a rare benign, locally aggressive tumor with a high recurrence rate. It has been associated with scar from previous breast surgery or trauma. Especially in breast cancer patients with previous operation history, it may simulate recurrent breast cancer clinically and radiologically. We presented multimodality imaging findings (ultrasound, computed tomography, magnetic resonance imaging and positron emission tomography/computed tomography) of chest wall desmoid tumor mimicking recurrent breast cancer in a 38-year-old patient with a history of left modified mastectomy. The desmoid tumor is a rare benign tumor that should be considered in the differential diagnosis of malignant local tumor recurrence after breast cancer operation. Biopsy was required for accurate diagnosis and wide local excision was its appropriate surgical management.

[Desmoid fibromatosis of the breast: a case report on and a review of the literature]

La fibromatose desmoïde mammaire est une entité rare, mimant sur le plan clinique et échographique un cancer du sein. Seule l'histologie apportera le diagnostic en objectivant une prolifération de cellule fusiforme (fibro et myofibroblastique sans atypies nucléaires), agencée en faisceaux, mêlés à des bandes de collagène, sans composante épithéliale. Le diagnostic différentiel se pose essentiellement avec le carcinome métaplasique à cellules fusiformes. L’évolution est strictement locale, avec un grand pouvoir récidivant. L'exérèse chirurgicale complète avec des marges saines (jusqu’à 3cm) est le traitement de choix, la radiothérapie reste une option thérapeutique en complément de la chirurgie dans les exérèses incomplètes et en cas de récidives multiples. A travers notre cas et une revue de la littérature, nous essayerons de mettre le point sur le diagnostic de cette entité rare et de sa prise en charge puisqu'elle va conditionner le pronostic.

Diagnosis and treatment of extraabdominal desmoid fibromatosis

INTRODUCTION

The desmoid fibromatosis is a very rare connective tissue disease which is recognized as semimalignant. The aim of this work is to review the relevant literature and to analyze the management of our patient collective.

MATERIAL AND METHOD

Surgery was performed on 7 patients with extraabdominal desmoid fibromatosis between August 1998 and May 2007. MRI examination as well as biopsy was carried out in all cases. All patients were operated on; the mean follow up was 4 years (1-7). Upon follow up, every patient has undergone clinical and MRI examination.

RESULTS

The results show that we have achieved R0 resection in 4 cases and R1 in two cases and Rx in one case. In 4 patients, no recurrence was observed after the single surgery performed in our hospital. In 2 patients a single revision surgery was performed in each case and yielded no further recurrence. In only one case, multiple surgeries (one primary and two revision surgeries) were necessary, after which no recurrence was reported.

CONCLUSION

The early diagnosis of the disease is of utmost importance to the success of the outcome. MRI examination and biopsy are mandatory. Surgery is the therapy of choice. The recurrence rate is high and is linked to the difficulty of recognition of the exact infiltrative extent of the tumour. This necessitates a close follow-up.

From the radiologic pathology archives: diseases of the male breast: radiologic-pathologic correlation

Male breast disease includes a variety of benign and malignant conditions, many of which are hormonally influenced. Gynecomastia and skin lesions account for the majority of conditions in symptomatic men with a palpable abnormality, and these conditions should be accurately recognized. Imaging patterns of gynecomastia include nodular, dendritic, and diffuse patterns. Histopathologically, the nodular and dendritic patterns correlate with the florid and quiescent (fibrotic) phases of gynecomastia, respectively. The diffuse pattern may have features of both phases and is associated with exposure to exogenous estrogen. Benign-appearing palpable masses in male patients should be approached cautiously, given the overlapping morphologic features of benign and malignant tumors. In addition to gynecomastia, other benign male breast tumors include lipoma, pseudoangiomatous stromal hyperplasia, granular cell tumor, fibromatosis, myofibroblastoma, schwannoma, and hemangioma. Male breast cancer accounts for 1% of all breast carcinomas. Invasive ductal carcinoma accounts for the majority of cases in adult males and typically appears as a subareolar mass without calcifications that is eccentric to the nipple. Other epithelial and mesenchymal tumors that may occur, albeit not as commonly as in women, include papillary carcinoma, invasive lobular carcinoma, adenoid cystic carcinoma, liposarcoma, dermatofibrosarcoma, pleomorphic hyalinizing angiectatic tumor, basal cell carcinoma of the nipple, hematopoietic malignancies, and secondary tumors. Knowledge of the natural history, clinical characteristics, and imaging features of tumors that occur in the male breast will help narrow the radiologic differential diagnosis and optimize treatment.

Breast fibromatosis mimicking breast carcinoma

Fibromatosis arising from the breast, also referred to as desmoid tumor, aggressive fibromatosis, or low-grade fibrosarcoma, is a rare benign entity, accounting for only 0.2% of all breast tumors. Associations with familial multicentric fibromatosis and trauma, including that resulting from surgical intervention, have been reported. Awareness of this lesion is important, as the diagnosis has often been confused with that of breast carcinoma. We present the case of a 30-year-old white woman who presented with a palpable mass within the medial portion of her right breast. She reported breast carcinoma in both her paternal grandmother and maternal aunt. Subsequent mammographic and sonographic evaluation demonstrated an irregular solid mass within the posteromedial portion of the right breast. Ultrasound-guided core needle biopsy revealed low-grade myofibroblastic proliferation consistent with breast fibromatosis. The lesion was surgically resected via wide local excision. Follow-up mammograms performed 1 and 2 years after resection demonstrated no radiographic evidence of recurrence.

Bilateral breast fibromatosis: case report and review of the literature

Fibromatosis or desmoid tumor is a benign, slow-growing fibroblastic neoplasm originating from musculoaponeurotic stromal elements. These tumors are characterized by an infiltrative and locally aggressive growth pattern, frequent recurrences, but no metastatic potential. The etiology is unknown, but these tumors have been associated with trauma and genetic disorders. Breast fibromatosis is exceedingly rare and often misdiagnosed, comprising only 0.2% of breast tumors. Clinically, it might mimic other breast lesions, such as carcinoma. Only approximately 6 case series and 100 case reports of this disorder affecting the breast are documented, and only 5 cases of bilateral breast fibromatosis have been reported. We describe the case of a 20-year-old woman who presented to our institution with firm, nontender masses palpable in both breasts. Prior ultrasound was suspicious for carcinoma, and breast core biopsies were suggestive of phyllodes tumor. An excisional biopsy was necessary to establish the diagnosis of breast fibromatosis for both masses. A review of articles published on desmoid tumors and breast fibromatosis was performed with emphasis on articles published in the last 10 years. Fibromatosis should be considered in the differential diagnosis of patients presenting with hard breast lumps suspicious of other diseases.

Mammary fibromatosis

OBJECTIVE

This article illustrates the imaging findings that have pathologic correlation and the clinical presentation of mammary fibromatosis.

CONCLUSION

Mammary fibromatosis is a rare, benign, nonmetastasizing stromal tumor. It presents clinically and radiologically as a palpable, spiculated, and locally invasive tumor that is suspicious for malignancy. MRI is ideal for evaluation of chest wall involvement. Although histologically benign, the tumor is locally aggressive and has significant recurrence rates. On occasion, recurrence may require radical surgery.

Desmoid Tumors (Fibromatoses) of the Breast: A 25-Year Experience

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.