Stromal sarcoma of breast: a light and electron microscopic study

Radiation-induced Stromal Sarcoma of Breast: A Case Report and Literature Review

Introduction: Post-irradiation mammary stromal sarcoma (MSS) is a rare condition, and it is worth learning new knowledge from each case. Case Presentation: We present the case report of a 59-year-old female with a medical history of breast cancer, who presented with an axillary mass on the same side. The patient was further evaluated and finally diagnosed with MSS with chondroid differentiation. Thereafter, she underwent neoadjuvant chemotherapy to facilitate the surgical resection of the tumor. However, she experienced local progression and lung metastasis during chemotherapy. Conclusions: MSS with chondroid differentiation was resistant to the standard chemotherapy regimens of sarcoma. Radiotherapy is a potential choice in the case of chemoresistant MSS. Further trials may reveal this notion.

A Case of Malignant Phyllodes Tumor with Muscular and Fatty Differentiations

A 50-year-old female underwent surgical removal of a mammary phyllodes tumor, whose peculiar histologic feature was the coexistence of areas of liposarcoma and leiomyosarcoma. The morphologic differential diagnosis is briefly discussed.

Periductal stromal tumor: a rare lesion with low-grade sarcomatous behavior

Biphasic breast tumors with benign ductal elements and a sarcomatous stroma lacking a phyllodes architecture are a source of diagnostic problems, particularly because of the lack of an appropriate designation. At the Armed Forces Institute of Pathology, we have used the term "periductal stromal sarcoma" to distinguish these from phyllodes tumors. All cases coded as periductal stromal sarcoma or PDSH were retrieved from the files of the Armed Forces Institute of Pathology. Cases that fulfilled the following criteria were included in this study. The histologic features of periductal stromal sarcoma were defined as 1) a predominantly spindle cell stromal proliferation of variable cellularity and atypia around open tubules and ducts devoid of a phyllodes pattern, 2) one or more often multiple nodules separated by adipose tissue, 3) stromal mitotic activity of >/=3/10 high power fields, and 4) stromal infiltration into surrounding breast tissue. Criteria for periductal stromal hyperplasia included 1) nodular, bland stroma growing as cuffs around normal or altered ducts, 2) no to minimal atypia, and 3) at most 0-2 stromal mitotic figures per 10 high power fields. Immunohistochemistry was used to further characterize these neoplasms. Of the cases retrieved, 20 qualified as periductal stromal sarcoma and seven as periductal stromal hyperplasia. Patients with periductal stromal sarcoma ranged in age from 37 to 89 years (mean 55.3 years). The tumors measured 0.2-6.0 cm (mean 2.97 cm). Eighteen patients had excisional biopsies and two had partial mastectomies. Overall follow-up time ranged from 1 to 72 months (mean 25.3 months) with two patients (10%) showing recurrence or probable metastasis. The neoplastic cells of periductal stromal sarcoma were at least focally immunoreactive for CD34 (13 of 15), CD117 (6 of 15), less reactive for actin (HHF35, 2 of 15), and negative for estrogen and progesterone receptors. Periductal stromal sarcoma is a useful descriptive designation for generally low-grade biphasic tumors with sarcomatous stroma that do not have features of a phyllodes tumor. The development of focal phyllodes pattern in the recurrent tumor as well as development of a specific soft tissue sarcoma in one of the above cases suggest that some and possibly all periductal stromal sarcoma may evolve into a phyllodes tumor with time. Given the presence of infiltrative margins, excision with a rim of uninvolved tissue is required.

Benign and malignant neoplasms of myoepithelial cells: cytologic findings

We report two myoepithelial cell neoplasms; a salivary gland tumor was malignant and a breast neoplasm was benign. Both were studied histologically, immunohistochemically, cytologically, and ultrastructurally. The malignant myoepithelioma recurred twice and metastasized to one regional lymph node. This tumor was infiltrative with areas of necrosis and hemorrhage. It was composed of malignant-appearing spindle and plasmacytoid cells. Both types of cells were immunoreactive to muscle specific actin, S-100 protein, cytokeratin, vimentin, and neuron-specific enolase. Ultrastructurally, features of myoepithelial cells were seen. Fine-needle aspirate smears showed spindle and plasmacytoid cells, numerous mitoses, and malignant-appearing nuclei. Spindle-cell adenomyoepithelioma of the breast, a small well-circumscribed firm nodule, featured multiple lobules of spindle cells associated with clear-cell glands at the lobular periphery. Histologically and cytologically, the lesion was cellular but appeared benign. The differential diagnosis of myoepithelial neoplasms is discussed.

Adenomyoepithelioma (myoepithelioma) of the breast in a male

Adenomyoepithelioma (myoepithelioma) of the breast in a 47-year-old man is reported. The tumor consisted of a prominent proliferation of spindle cells surrounding mammary ducts. Immunohistochemical and electron microscopic observations confirmed the myoepithelial origin of these spindle cells. This is the first report of an adenomyoepithelioma of the breast that developed in a male.

Primary spindle-cell sarcomas of the breast: diagnosis by fine-needle aspiration

Primary breast sarcomas (excluding cytosarcoma phyllodes and its sarcomatous recurrences) are rare neoplasms. Few have been described in the aspiration cytology literature. We report the cytologic features of two cases of stromal sarcoma (both with the pattern of malignant fibrous histiocytoma) and two cases of angiosarcoma. The dominant cytologic features included individual atypical spindle cells and fragments of collagenous stroma. Tumor giant cells were present in one stromal sarcoma. Features of possible significance in the diagnosis of angiosarcoma include obvious vessel formation by atypical spindle cells, bridging of adjacent tumor fragments by spindle cells, and microacinar structures lined by atypical spindle cells. The differential diagnostic considerations in spindle-cell breast aspirations are discussed.

Cellular junctions in a spectrum of human malignant tumors

Cellular junctions in tumors are often considered a hallmark of epithelial differentiation. However, junctions are also seen in tumors having a different differentiation. This observation prompted us to study cellular junctions in malignant nonepithelial tumors. We found a variety of cellular junctions in such tumors, although the majority were poorly formed. This observation is of importance for diagnostic purposes. We have also tried to clarify the nomenclature of cellular junctions as applied in tumor diagnosis by proposing a systematic categorization of terms in everyday use by pathologists and by referring more extensively to the term paired subplasmalemmal densities (PSD) for non-well-formed junctions.

Spindle cell carcinoma of the breast: case report and review

Spindle cell carcinoma is a distinct, but unusual, variant of squamous cell carcinoma. It is seen most frequently in the upper aerodigestive tract and esophagus. The natural history seems to be similar to that of the more typical squamous cell carcinoma. A case of spindle cell carcinoma arising from the ductal epithelium of the breast is reported. The light and electron microscopic histology is described. A review of the literature suggests that this rare neoplasm should be managed in a fashion similar to that for more common types of epithelial breast duct malignancies.

Malignant myoepithelioma of the breast. An immunohistochemical study by light and electron microscopy

Myoepitheliomas of the breast are extremely rare; only four cases have been reported to date. It is not clear whether these tumors behave in a benign or malignant fashion, and no metastatic spread has been documented. We report a myoepithelioma of the breast with metastatic spread to an axillary lymph node. Myoepithelial cell (MEC) differentiation in the tumor was characterized using electron microscopic (EM) criteria. Immunologic investigations at the LM and EM levels showed that the tumor cells were positive for S100 protein, actin, and epidermal cytokeratin; these findings are indicative of MEC differentiation. By immuno-EM, cytokeratin filaments were present in a perinuclear location, while actin filaments were concentrated along the cell periphery. To the authors' knowledge, this is the first report of a breast myoepithelioma that has metastasized and also the first report of the immunologic characterization of a myoepithelioma at the light and electron microscopic levels.

Phyllodes tumour and stromal sarcoma of the breast: an ultrastructural comparison

The ultrastructure of the stromal cells of three benign and one malignant phyllodes tumours and three stromal sarcomas has been studied and compared with the stromal cells of two fibroadenomas and four normal lobules. One stromal sarcoma was possibly of nerve sheath origin, but the other two showed features in common with the phyllodes tumours and the fibroadenomas. Prominent electron dense cytoplasmic bodies with distinctive morphological features are described and a correlation with the degree of malignancy is postulated.

Karyotype analysis of a human mammary sarcoma explant in vitro

Karyotype of a fibroblastic SH-1 cell line derived from a human mammary sarcoma had 86 (80-92) chromosomes including 6 (4-7) markers, and a various number of double minutes. There were generally even numbers (e.g., 2, 4, etc.) of chromosomes in 17 intact and 3 common marker chromosomes. The t(3;14) and del(14), which had 2 each per s cell genome, were probably formed by the balanced translocation between nos. 3 and 14. Three other markers were single and contained a partial or entire no. 1. The presence of these latter markers was often accompanied by the decrease in the number of the intact no. 1, indicating that no. 1 was the only chromosome actively engaged in rearrangements during this stage of karyotypic diversification. Of the no. 2 and 7q that were over-represented on the per cell level, the 7q had a similar observation from many other solid tumors found in this and other laboratories. In contrast, none of the under-represented chromosomes had the concordant changes consistent to other tumors, although the frequent involvement of no. 9 in the chromosome rearrangements was seen in some human heteroploidies.

Spindle cell carcinoma of the breast. A clinocopathologic and ultrastructural study

The clinical and pathologic features in six cases of spindle cell carcinoma of the breast were reviewed. Histologically this tumor is characterized by sheets of spindle cells often containing squamous epithelial islands and numerous cystic spaces lined by epidermoid carcinoma or benign appearing squamous epithelium. Areas of transition from the squamous epithelium or epidermoid carcinoma to malignant spindle cells were seen in all cases. Features of squamous epithelial differentiation were found in the spindle areas of the one tumor examined by electron microscopy. The prognosis in this neoplasm is similar to that in the more common breast carcinomas. Spindle cell carcinoma therefore should be distinguished from fibrosarcoma, stromal sarcoma, and carcinosarcoma. Moreover, it should be separated from the broader category of "metaplastic carcinoma," since this term includes a heterogeneous group of tumors of uncertain histogenesis and prognosis.