Leiomyosarcoma of the breast —a case report and an electron microscopic study—

Breast Leiomyosarcoma: A Systematic Review and Recommendations for Management

Background

Leiomyosarcomas of breast are very rare tumors, with only 54 cases reported in the literature to date.

Methods

We report a case of leiomyosarcoma in a 52-year-old woman who presented with a painless left breast mass in the upper outer quadrant of her left breast. It measured about 6 cm in diameter and was located within the breast parenchyma with no skin involvement. Mammogram was suggestive of BI-RADS IV lesion, and core biopsy of the lesion was inconclusive.

Results

Histopathology and immunohistochemistry of the excision biopsy of the mass confirmed the diagnosis of leiomyosarcoma approaching the specimen margins. The patient underwent simple mastectomy, which did not reveal any residual tumor or additional lesions. Follow-up for a year after her mastectomy did not show any local or systemic recurrence.

Conclusions

We reviewed the literature and summarize our findings as recommendations for management of leiomyosarcoma of breast.

Primary leiomyosarcoma of breast in an adolescent girl: a case report and review of the literature

Leiomyosarcoma of the breast is a rare neoplasm, primarily reported in older women. Only 44 cases have been reported in world literature and to the best of our knowledge, no case has been reported from India till date. We report a case of primary breast leiomyosarcoma in an adolescent girl who underwent a lumpectomy for rapidly increasing lump in the left breast. Here we report the histological findings and immunohistochemical profile of this entity, along with a review of existing literature.

Primary leiomyosarcoma of the breast treated by partial resection of the breast including nipple and areola: report of a case

A 46-year-old female patient presented with a tumor measuring 0.5 cm in diameter under the areola of the breast. Because no definite malignancy was found with inspection and palpation, imaging analysis, or with a fine-needle aspiration cytology examination, follow-up observation was recommended. When the patient visited the hospital 6 months later, the mass was 0.9 cm in diameter. The tumor was excised and histopathologically diagnosed as a leiomyosarcoma. Subsequently, the patient underwent a partial resection of the breast, including the nipple and areola. A follow-up examination revealed no evidence of distant metastasis or local recurrences 8 years 4 months after the surgery. Primary leiomyosarcoma of the breast is extremely rare. Only 33 cases, which are reviewed in the present study, have been previously reported in the literature.

Primitive leiomyosarcoma of the breast: case report and review of the literature

Sarcomas of the breast account for under 1% of breast tumours. Leiomyosarcomas are less common, being a subgroup of sarcomas of the breast. Only 23 cases with immunohistochemical or electron microscopy confirmation are reported in the literature. The case of a 58-year-old woman with a leiomyosarcoma 4 cm in diameter in the upper external quadrant of the right breast is presented. Mammography and sonography were compatible with a fibroadenoma or phylloides tumour, and fine-needle aspiration (FNA) suggested medullary carcinoma. The patient underwent a Madden-type modified radical mastectomy and axillary lymphadenectomy. Adjuvant chemotherapy was implemented with Adriamycin (four cycles of 21 days). One year after surgery the patient is tumour free.

Primary leiomyosarcoma of the breast: diagnosis, management and outcome. A report of a new case and review of literature

Primary leiomyosarcoma of the breast is very rare and represents a diagnostic challenge. Only 16 cases have been reported in the English language literature. We report another new case and have analysed reports of the previous cases aiming to present a simple evidence-based approach to the clinical, radiological and pathological diagnosis of this rare tumour. The average age of presentation is 56 years. All neoplasms have been limited to the breast at the time of diagnosis. The usual presentation is a slowly growing mass, but in the current case report the patient present with mastalgia. There is always a possibility of local recurrence or distant spread, which can occur many years after primary surgery. Leiomyosarcoma must be histologically distinguished from leiomyoma and the presence of >3 mitoses per 10 high-power fields is usually indicative of malignancy. Immunohistochemistry is helpful to confirm diagnosis. As this is a slow-growing malignant tumour with a propensity for local recurrence, total mastectomy is the treatment of choice. The tumour is not hormone-dependent and hormone manipulation is not a treatment option.

Primary Leiomyosarcoma of the Breast: A Case Report with Review of the Literature

Breast sarcomas account for about 1% of all malignant breast cancers. Leiomyosarcoma (LMS), one of the rarest, was first described 20 years ago, and yet few published reports exist. A case of primary LMS in a 25-year-old woman is presented and is only the 18th well-documented case in the literature. The clinical presentation, diagnosis, therapy, and pathologic features are reviewed.

Leiomyosarcoma of the breast: a difficult diagnosis on fine-needle aspiration biopsy

Leiomyosarcoma of the breast is rarely encountered in fine-needle aspiration (FNA) cytologic material. We report a case of primary leiomyosarcoma of the breast in a 52-yr-old female. Aspiration cytology showed large, dissociated round to spindle cells with abundant vacuolated cytoplasm, pleomorphic nuclei, prominent nucleoli, and occasional intranuclear cytoplasmic invaginations. Mitotic figures, osteoclast-like giant cells, and stromal fragments were identified. A diagnosis of malignant neoplasm representing either a sarcoma, a poorly differentiated carcinoma, or a metaplastic carcinoma was made. The patient underwent a wide excision of the lesion after negative work-up. Histologic examination and immunohistochemical studies established the diagnosis of leiomyosarcoma. This case is presented here because we feel that, although FNA cytology with eventual ancillary studies is a valuable diagnostic tool to evaluate any breast mass, malignant spindle cell neoplasms of the breast still represent a diagnostic challenge for the cytopathologist. Recognition of all cytologic features of leiomyosarcoma may help to formulate a correct diagnosis.

Stromal sarcoma of the breast with leiomyosarcomatous pattern

We report an unusual case of stromal sarcoma of the breast with leiomyosarcomatous pattern, which recurred locally and was finally treated by radical mastectomy. The tumor was composed of pleomorphic and hyperchromatic spindle-shaped cells arranged in an interdigitating fascicle. The nuclei were of moderate to severe atypia. An average of 10 mitoses per 10 high-power fields was seen. Immunohistochemically, the stromal cells were positive for vimentin and alpha-smooth muscle actin, but negative for S-100 protein, cytokeratin and desmin. The average Ki-67 (MIB1) labeling index in the stromal cells was 34%. Electron microscopic evaluation revealed further evidence of smooth muscle differentiation; stromal cells had frequently indented nuclei, well-developed rough endoplasmic reticulum, thin basal lamina and dense patch-like structures within the cytoplasm. Analysis of previous literature on 17 cases reveals mitotic activity of the tumor seemingly of little prognostic value. This case indicated difficulty in diagnosing leiomyosarcoma. The risk of local recurrence remains even if the surgical margin is free of tumor cells.

Leiomyosarcoma of the breast; cytological and histological features, with a review of the literature

This report describes the cytological and histological features of a leiomyosarcoma of the breast. The differential diagnosis of this rare tumour is discussed. Eleven well documented cases of leiomyosarcoma of the breast have been reported previously and details of these are included in this review.