Inflammatory pseudotumor (myoblastic tumor) of the breast: a case report and review of the literature

Clinicopathological Features of Inflammatory Myofibroblastic Tumor in the Breast

Inflammatory myofibroblastic tumor (IMT) is a mesenchymal spindle cell tumour with low malignant potential which is extremely rare in breasts. Because of the lack of typical imaging and clinical characteristics of IMT, it is easy to misdiagnose before operation. We now report a case of a 37-year-old woman presenting with a mass in her left breast. Ultrasound showed a well-circumscribed lesion in the lower outer quadrant. The patient underwent lumpectomy, and histopathology revealed a tumor which was composed of fusiform cells and inflammatory cells. Immunohistochemistry (IHC) showed tumor cells are positive for vimentin, ALK, BCL2, and SMA. The FISH test demonstrated ALK (2p23) chromosomal translocation (ALK positive). The final diagnosis of breast IMT was rendered with nonclassical morphology. Postoperative 30-month follow-up no evidence showed residual tumor or recurrence. As a very rare tumor, breast IMT could be easily misdiagnosed clinically and pathologically. Complete surgical resection of the tumor is preferred, and it has the risk of recurrence and metastasis.

Inflammatory myofibroblastic tumor after breast prosthesis: A case report and literature review

BACKGROUND

Inflammatory myofibroblastic tumors (IMTs) are defined as tumors composed of differentiated myofibroblastic spindle cells, usually accompanied by numerous plasma cells and lymphocytes, and classified as intermediate (occasionally metastatic) by the World Health Organization. Its pathogenesis and biological behavior have not yet been elucidated. Breast IMT is extremely rare, and prosthesis implantation combined with IMT has not been reported. This study reports a case of IMT following resection of a malignant phyllodes tumor of the left breast and implantation of a prosthesis.

CASE SUMMARY

A 41-year-old female presented to our hospital with a mass in the left breast for 3 mo. The patient had undergone resection of a large mass in her left breast pathologically diagnosed as a malignant phyllodes tumor and implantation of a prosthesis five years prior. Ultrasonic examination revealed an oval mass in the left breast, and the patient underwent left breast mass resection and prosthesis removal. Light microscopy revealed the spindle cells to be diffusely proliferated, with a large number of neutrophils, lymphocytes, and plasma cell infiltration. Immunohistochemical staining revealed that the spindle cells were partially positive for smooth muscle actin, which is positive for BCL-2 and cluster of differentiation (CD) 99 but were negative for anaplastic lymphoma kinase, cytokeratin, S-100 protein, desmin, and CD34. The final diagnosis was IMT. No recurrence or metastasis was observed during the 5-year postoperative follow-up.

CONCLUSION

Prosthesis implantation may be one of the causes of IMT, but further investigation is necessary to prove it.

Practical approach to diagnosis of bland-looking spindle cell lesions of the breast

The diagnosis of bland-looking spindle cell lesions of the breast is often challenging because there is a close morphological and immunohistochemical overlap among the different entities. The present review will discuss reactive spindle cell nodule/exuberant scar, nodular fasciitis, inflammatory pseudotumor, myofibroblastoma (classic type), lipomatous myofibroblastoma, palisaded myofibroblastoma, benign fibroblastic spindle cell tumor, spindle cell lipoma, fibroma, leiomyoma, solitary fibrous tumor, myxoma, schwannoma/neurofibroma, desmoid-type fibromatosis, dermatofibrosarcoma protuberans, low-grade fibromatosis-like spindle cell carcinoma, inflammatory myofibroblastic tumor and low-grade myofibroblastic sarcoma arising in the breast parenchyma. The pathologist should be aware of each single lesion to achieve a correct diagnosis to ensure patient a correct prognostic information and therapy. Accordingly representative illustrations and morphological/immunohistochemical diagnostic clues will be provided.

Bilateral Inflammatory Pseudotumour of the Breast: A Case Report and Review of the Literature

Inflammatory tumour (IPT) consists of spindle cells, mature plasma cells, histiocytes, lymphocytes and eosinophils. Most frequently presenting in the respiratory tract it can also affect other sites such as breast. This case was a 73-year old woman presenting with a left breast lump, clinically indeterminate (P3), proven on biopsy to be IPT. Seven years later she returned with bilateral breast lumps and underwent triple assessment followed by wide excisions which confirmed the diagnosis of IPTs. Because it can be difficult to differentiate IPT from a low-grade spindle cell metaplastic breast carcinoma (SpCMBC) wide excision to achieve clear margins should be achieved to exclude malignancy.

Imaging findings of inflammatory myofibroblastic tumor in breast: A case report

RATIONALE

Inflammatory myofibroblastic tumors (IMTs), particularly breast IMTs, are rare neoplastic lesions typically associated with a favorable prognosis. Breast IMTs are easily misdiagnosed as other types of malignant lesions, and therefore there is a significant unmet need for a better preoperational differential diagnosis based on imaging manifestations. Here, we report the imaging findings of a breast IMT and compare our findings with previously published features of breast IMTs.

PATIENT CONCERNS

The patient, a 43-year-old female, reported the presence of a palpable lump within her left breast. An ultrasound examination revealed an irregular hypoechoic mass with unclear boundaries. Mammography demonstrated a mass of heterogeneous and striped density with granular calcification. Magnetic resonance image (MRI) inspection displayed an irregular tissue lump with an undistinguishable boundary and a further dynamic contrast-enhanced MRI disclosed an associated efflux change.

DIAGNOSES

Breast inflammatory myofibroblastic tumors.

INTERVENTIONS

Breast needle biopsy and mammary resection were performed. Pathological staining of the bulk resected tumor after preoperative preparation revealed that the tumor-like tissue was enriched for spindle cells arranged in fascicular clusters. Histopathological diagnosis and immunohistochemistry confirmed the mass as being a breast IMT.

OUTCOMES

No metastatic recurrence was found during 6-month or 1-year follow-ups.

LESSONS

Breast IMTs commonly develop in elderly women with atypical imaging features. They are primarily composed of lobular soft tissues infiltrated with an abundant focal blood supply and granular calcification. Development of breast IMTs is closely related to trauma. A preliminary diagnosis of such masses can be made based on combined manifestations of both clinical and imaging features, while a final confirmation still requires pathological staining. Imaging examinations are of value for such tumors to define the lesion edges and their associations with adjacent tissues.

Inflammatory myofibroblastic tumors of the breast with simultaneous intracranial, lung, and pancreas involvement: ultrasonographic findings and a review of the literature

We encountered a case of inflammatory myofibroblastic tumor (IMT) of the breast with simultaneous intracranial, lung, and pancreas involvement. Here, we present the clinical imaging results and report the significance of sonographic findings of breast IMT along with a review of the literature. A 16-year-old girl with a history of subarachnoidal hemorrhage was admitted to our hospital due to tonic-clonic seizure. Computed tomography (CT) and magnetic resonance imaging (MRI) showed multiple intracranial, lung, and pancreas mass lesions and a solitary mass lesion in the right breast. Breast ultrasonography showed a circumscribed oval-shaped hypoechoic mass with a central hyperechoic region. Power Doppler sonography revealed an unusual spiral-shaped flow signal. Breast tumorectomy was performed for definitive diagnosis, and pathological analysis indicated IMT. A literature review indicated that ultrasonographic findings of IMT of the breast are nonspecific, as in other systems or organs. It would be difficult to make a diagnosis of IMT of the breast preoperatively due to its rarity and the lack of specificity of clinical imaging findings. In addition, it is better to consider the possibility of IMT of the breast especially in younger patients without an obvious family history of hereditary breast cancer.

Inflammatory myofibroblastic tumor of the breast

Inflammatory myofibroblastic tumors (IMTs) of the breast represent extremely rare lesions. Due to the scarcity of reports, their natural history, recurrence, and metastatic potential remain poorly defined. We report on a case of a primary breast IMT in a postmenopausal female patient treated successfully with breast conserving surgery and review the literature pertaining to this rare entity.

23-Year-Old Female with an Inflammatory Myofibroblastic Tumour of the Breast: A Case Report and a Review of the Literature

Purpose: Inflammatory myofibroblastic tumours (IMT) are a subcategory of inflammatory pseudotumours (IPT). They arise most commonly in the abdominopelvic region, lung and retroperitoneum, but virtually any anatomical site may be involved. Predominantly children and adolescents are affected and there is a tendency for local recurrence. In the literature up to the present, 20 patients have been reported with an IPT/IMT of the breast. We would like to present another patient with this unusual tumour entity of the breast and discuss the literature. Patient and Examinations: A 23-year-old woman presented with a painless lump in her left breast. There was no history of breast cancer in her family. Sonography showed a hypoechoic heterogeneous solid mass with irregular margins. A core needle biopsy revealed a tumour of high cellularity and a densely collagenous background. Immunohistochemically, the spindle-shaped cells were immunoreactive to smooth muscle actin and ALK-1 protein. Additional FISH analysis proved ALK rearrangements on chromosome 2p23 leading to the diagnosis of an IMT. Wide surgical excision was performed with no evidence of local recurrence after 12 months. Conclusion: Three of the above mentioned 20 patients with IMT/IPT of the breast developed a recurrent tumour, none presented with distant metastasis. A significant recurrence rate of 15 % leads to a clinically and sonographically close follow-up in these patients.

Primary inflammatory myofibroblastic tumor of the breast with rapid recurrence and metastasis: A case report

Primary inflammatory myofibroblastic tumor (IMT) of the breast is extremely rare; only 19 cases have been reported in the English literature. In the present study, we present a case of IMT in a 56-year-old female patient who was admitted to our hospital due to a mass found in her right breast. Mammogram and ultrasound revealed a well-circumscribed mass and surgery was performed. Histopathologically, the lesion was composed of spindle and inflammatory cells, including plasma cells and lymphocytes. Mitotic figures were not observed. Immunohistochemically, the tumor cells were positive for SM-actin, anaplastic lymphoma kinase (ALK) and vimentin and focal positive for desmin, but negative for NSE, S-100, CD117, CD34, NF, CD21, CD35 and CD68. Thus, we made a diagnosis of IMT and advised regular follow-up. However, the patient had local recurrence and metastasis to the left groin area 3, 7 and 10 months after the initial surgery. Notably, the histopathological characteristics of the recurrent and metastatic foci were similar to those of the initial specimen, but mitotic figures were clearly observed. Thus, we conclude that IMT shows occasionally malignant biological behavior although it is a neoplasm of intermediate biological potential that frequently recurs and rarely metastasizes. We advise that clinical physicians should regularly follow up patients after focal resection for IMT.