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Markov D, Uchikov P, Timonov P, Markov G, Poryazova E. Primary pleomorphic breast sarcoma - a case report. Folia Med (Plovdiv) 2024; 66:568-573. [PMID: 39257259 DOI: 10.3897/folmed.66.e120391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/03/2024] [Indexed: 09/12/2024] Open
Abstract
Primary mammary sarcomas are very rare, histologically heterogeneous non-epithelial malignant neoplasms. Primary undifferentiated pleomorphic sarcoma is a rare malignant mesenchymal tumor in the breast. It is characterized by marked cellular atypism and pleomorphism. Isolated cases with an aggressive course and poor prognosis have been commonly described in the literature. We present a rare case of a 62-year-old woman with an 18-cm solid tumor of the left breast, 6 months old, which grew rapidly during the last month. Physical examination and mammography revealed no enlarged lymph nodes in the left axilla. A total mastectomy was performed. The diagnosis of undifferentiated pleomorphic sarcoma is challenging due to the lack of specific immunohistochemical markers. It can only be made after excluding other types of soft tissue sarcomas. This report discusses the histopathological and immunohistochemical studies that were conducted. Our case is distinguished from others with the same diagnosis by the atypical clinical presentation, which is painless, and the spontaneous bleeding, as well as the large size of the tumor.
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2
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Bishr MK, Banks J, Abdelaziz MS, Badawi M, Crane PW, Donigiewicz UJ, Elkorety M, Girgis M, Humphreys A, Isherwood J, Kahan J, Keelan S, Lindqvist EK, Nixon I, Sackey H, Sars C, Soliman H, Touqan N, Remoundos DD, Ahmed M. Multidisciplinary Management of Phyllodes Tumours and Breast Sarcoma: A Cross-sectional Survey of Clinical Practice across the UK and Ireland. Clin Oncol (R Coll Radiol) 2024; 36:e31-e39. [PMID: 38294995 DOI: 10.1016/j.clon.2023.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 02/02/2024]
Abstract
AIMS Phyllodes tumours and breast sarcomas are uncommon tumours and their rarity poses significant challenges in diagnosis and management. This cross-sectional study was conducted to evaluate the multidisciplinary clinical practice for these tumours across the UK and Ireland, with the aim of identifying gaps in knowledge and providing direction for establishing national guidelines. MATERIALS AND METHODS An international survey was adapted and circulated to breast and/or sarcoma surgeons and oncologists in the UK and Ireland through national organisations. Multidisciplinary team (MDT) responses were analysed anonymously. RESULTS Twenty-eight MDTs participated in this study, predominately from high-volume units (85.5%). Although only 43% of the surveyed units were part of a trust that holds a sarcoma MDT, 68% of units managed malignant phyllodes and angiosarcoma, whereas 64.5% managed soft-tissue sarcoma of the breast. Across all subtypes, axillary surgery was recommended by 14-21% of the MDTs and the most recommended resection margins for breast surgery were 'no tumour on ink' in benign phyllodes (39%) and 10 mm in the remaining subtypes (25-29%). Immediate breast reconstruction was supported by 11-18% of MDTs for breast sarcoma subtypes, whereas 36% and 32% advocated this approach in benign and borderline phyllodes tumours, respectively. Adjuvant radiotherapy and chemotherapy were recommended by up to 29% and 11% of the MDTs, respectively. CONCLUSION The results of this study demonstrate a wide variation in clinical practice across the surveyed MDTs. As only 28 MDTs participated in our study, with under-representation from low-volume units, our results might be an underestimation of the variability in practice across the UK and Ireland. This multi-institutional study sheds light on controversial aspects in the management of phyllodes tumours and breast sarcoma, identifies the need for national guidelines to inform best practice, and calls for the centralisation of the management of breast sarcoma within specialist centres.
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Affiliation(s)
- M K Bishr
- The Royal Marsden NHS Foundation Trust, London, UK.
| | - J Banks
- The Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - M S Abdelaziz
- National Cancer Institute, Cairo University, Cairo, Egypt; University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Badawi
- East Sussex Healthcare Trust, Conquest Hospital, St Leonards-on-sea, UK
| | - P W Crane
- Queen Elizabeth II Hospital, Welwyn Garden City, UK
| | | | - M Elkorety
- West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
| | - M Girgis
- West Suffolk NHS Hospital, Bury St Edmunds, UK
| | - A Humphreys
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - J Isherwood
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - J Kahan
- Velindre Cancer Centre, Cardiff, UK
| | - S Keelan
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - E K Lindqvist
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
| | - I Nixon
- Management Science, Business School, Strathclyde University, Glasgow, UK; The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - H Sackey
- Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - C Sars
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - H Soliman
- Kings' College Hospital, Orpington, UK
| | - N Touqan
- Manchester University NHS Foundation Trust, North Manchester General Hospital, Manchester, UK
| | - D D Remoundos
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Ahmed
- University College London Hospitals NHS Foundation Trust, London, UK
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3
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Radu I, Scripcariu V, Panuța A, Rusu A, Afrăsânie VA, Cojocaru E, Aniței MG, Alexa-Stratulat T, Terinte C, Șerban CF, Gafton B. Breast Sarcomas-How Different Are They from Breast Carcinomas? Clinical, Pathological, Imaging and Treatment Insights. Diagnostics (Basel) 2023; 13:diagnostics13081370. [PMID: 37189471 DOI: 10.3390/diagnostics13081370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Breast sarcoma (BS) is a very rare and poorly studied condition. This has led to a lack of studies with a high level of evidence and to low efficacy of current clinical management protocols. Here we present our experience in treating this disease in the form of a retrospective case series study including discussion of clinical, imaging, and pathological features and treatment. We also compare the main clinical and biological features of six cases of BS (phyllodes tumors were excluded) with a cohort of 184 patients with unilateral breast carcinoma (BC) from a previous study performed at our institution. Patients with BS were diagnosed at a younger age, presented no evidence of lymph node invasion or distant metastases, had no multiple or bilateral lesions, and underwent a shorter length of hospital stay versus the breast carcinoma group. Where recommended, adjuvant chemotherapy consisted of an anthracycline-containing regimen, and adjuvant external radiotherapy was delivered in doses of 50 Gy. The comparison data obtained from our BS cases and the ones with BC revealed differences in diagnosis and treatment. A correct pathological diagnosis of breast sarcoma is essential for the right therapeutic approach. We still have more to learn about this entity, but our case series could add value to existing knowledge in a meta-analysis study.
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Affiliation(s)
- Iulian Radu
- First Surgical Oncology Unit, Department of Surgery, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Viorel Scripcariu
- First Surgical Oncology Unit, Department of Surgery, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andrian Panuța
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinic of Plastic and Reconstructive Microsurgery, Emergency Clinical Hospital "Sf. Spiridon", 700111 Iasi, Romania
| | - Alexandra Rusu
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Vlad-Adrian Afrăsânie
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I-Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Maria Gabriela Aniței
- First Surgical Oncology Unit, Department of Surgery, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Teodora Alexa-Stratulat
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Terinte
- Department of Pathology, Regional Institute of Oncology, 700483 Iasi, Romania
| | | | - Bogdan Gafton
- Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
- Department of Oncology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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Yam MK. A 53-year-old female with a large breast sarcoma: A case report from Hong Kong. Radiol Case Rep 2022; 17:3055-3058. [PMID: 35769124 PMCID: PMC9234154 DOI: 10.1016/j.radcr.2022.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022] Open
Abstract
Breast sarcomas are very rare and are aggressive tumors associated with a poor prognosis. We present a case of a 53-year-old female who presented to the hospital after noticing a palpable mass in the right breast. Mammography, ultrasound, and MRI investigations were done. The patient was treated with radical mastectomy combined with both neoadjuvant and adjuvant chemoradiotherapy. Undifferentiated pleomorphic breast sarcoma was later diagnosed.
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Cubas Farinha N, Teixeira W, Roque D, Livraghi S. Large mirror brain metastases from primary undifferentiated sarcoma of the breast: case report and review of the literature. CNS Oncol 2022; 11:CNS85. [PMID: 35535978 PMCID: PMC9134969 DOI: 10.2217/cns-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
Primary breast sarcomas are rare high-grade tumors with a reported incidence of <1% of breast malignancies. Its dissemination to the CNS is exceptional and only one is found in the literature. The authors described the case of a 22-year-old female with history of a breast undifferentiated sarcoma that present with two large bilateral retrolenticular brain metastases. Both lesions were excised in the same procedure and she underwent adjuvant therapy. She died 24 months after surgery. Despite being aggressive lesions, aggressive treatment of primary breast sarcomas including brain metastases excision, should be considered in order to improve overall survival.
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Affiliation(s)
- Nuno Cubas Farinha
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - Wilson Teixeira
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - Diogo Roque
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - Sergio Livraghi
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
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A rare case report of breast sarcoma. Radiol Case Rep 2021; 16:1047-1050. [PMID: 33680274 PMCID: PMC7917451 DOI: 10.1016/j.radcr.2021.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/13/2021] [Accepted: 02/13/2021] [Indexed: 11/21/2022] Open
Abstract
Malignant tumors that originate from the mesenchymal tissue of the mammary gland, known as breast sarcomas, are very rare and can be divided into 2 types: primary and secondary (therapy-related development). Breast sarcomas are aggressive tumors associated with a poor prognosis. Treatment options include the coordination of surgery, chemotherapy, and radiotherapy. We present a case of a 51-year-old female who presented to the hospital after noticing a palpable mass in the left breast and bloody nipple discharge. These symptoms lasted for more than 4 months. Postoperative histopathology revealed an undifferentiated pleomorphic breast sarcoma. After 8 months of treatment, the patient experienced metastasis to the brain and lungs.
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7
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Al-Wiswasy M, Al-Balas M, Al-Saffar R, Al-Balas H. Primary stromal sarcoma of breast: A case report and literature review. Breast Dis 2021; 40:199-205. [PMID: 33720870 DOI: 10.3233/bd-201012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Primary breast sarcoma (PBS) was first described in 1887 as a rare heterogeneous neoplasm arising from the mesenchymal tissue of the mammary gland accounting for less than 5% of all body soft-tissue sarcomas and less than 0.1% of all malignant tumors of the breast. CASE PRESENTATION A 31-year old lady presented with left breast mass which she felt four years before during which the mass increased in size from 1 to 6 cm in the largest diameter, diagnosed clinically as a benign fibroadenoma without any further cytological or histopathological confirmation. Histopathological examination of the excised breast mass reveals undifferentiated, primary stromal sarcoma of the breast (PSSB), which was followed by mastectomy three weeks later with reconstructive breast surgery with a total duration of follow-up of 3 years thereafter. This is the first case of PSSB reported in Jordan. DISCUSSION/CONCLUSION PSSB is the generic term given to malignant breast tumors thought to arise from the specialized mesenchymal stroma of the breast but lacking an epithelial component with a phylloides pattern. PSSB is difficult to diagnose preoperatively due to its rarity and inadequate imaging methods to establish an exact diagnosis. The histology of the patient mass may be the leading factor for the management of these tumors. Even in very young patients, a progressively growing breast mass should alert the clinician to investigate for malignancy and verify the results by biopsy. Surgery with adequate resection margins represents the only potentially curative modality with prognostic significance. Adjuvant chemotherapy and radiotherapy are not very beneficial. The prognosis is dismal for patients with lymph node involvement and the size of the tumor has a lesser bearing on the outcome.
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Affiliation(s)
- Mohammad Al-Wiswasy
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mahmoud Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Raith Al-Saffar
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hamzeh Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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8
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Primary Stromal Breast Sarcoma with Concomitant Contralateral Carcinoma: A Rare Case from Syria. Case Rep Oncol Med 2019; 2019:6460847. [PMID: 31583145 PMCID: PMC6754894 DOI: 10.1155/2019/6460847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 07/25/2019] [Indexed: 12/04/2022] Open
Abstract
Bilateral breast cancers are rare cases encountered and are usually the same type in both sides. Only very few cases were reported to have different histological types of neoplasia involving sarcoma. Moreover, sarcomas rarely originate from the breast as a primary lesion whereas the common presentation is having angiosarcoma following radiotherapy. In this report, we present a rare case of a Syrian 43-year-old woman having two distinct primary lesions in the breasts: invasive ductal carcinoma and contralateral stromal sarcoma.
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Moon SH, Jung JH, Lee J, Kim WW, Park HY, Lee JW, Lee SJ. Complete remission of giant malignant phyllodes tumor with lung metastasis: A case report. Medicine (Baltimore) 2019; 98:e15762. [PMID: 31145295 PMCID: PMC6708932 DOI: 10.1097/md.0000000000015762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Malignant phyllodes tumors are rare breast neoplasms that are associated with a 6.2% to 25% incidence rate of distant metastasis; the lung is the most common metastatic site. To date, there is no consensus regarding the treatment of metastatic malignant phyllodes breast tumors. PATIENT CONCERN A 48-year-old woman was admitted into the breast clinic for a rapidly growing right breast tumor that was first noticed 1 month prior. DIAGNOSIS Core needle biopsy revealed a malignant phyllodes tumor. A chest computed tomography and positron emission tomography/CT showed metastatic lymph nodes that appeared to have spread to the right axilla, as well as multiple solitary pulmonary nodules in the right lung. Fine needle aspiration on the axillary lymph node confirmed metastasis. INTERVENTIONS A right mastectomy with axillary lymph node dissection was conducted and a thoracoabdominal flap and a split thickness skin graft were performed for the skin defect. Palliative chemotherapy with doxorubicin plus ifosfamide was performed. OUTCOMES An examination conducted 3 years postsurgery showed no signs of recurrence, and the patient's overall health status was satisfactory. LESSONS As standard treatment guidelines for metastatic malignant phyllodes tumors are lacking, we opted for the aforementioned aggressive treatments that resulted in complete remission of the lung metastasis. Therefore, aggressive treatment, whenever possible, is warranted.
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Affiliation(s)
| | | | | | | | | | | | - Soo Jung Lee
- Department of Hemato-Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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The Role of Adjuvant Radiotherapy for a Case of Primary Breast Sarcoma: A Plan Comparison between Three Modern Techniques and a Review of the Literature. Case Rep Med 2018; 2018:4137943. [PMID: 29849658 PMCID: PMC5932497 DOI: 10.1155/2018/4137943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/13/2018] [Accepted: 03/21/2018] [Indexed: 12/25/2022] Open
Abstract
A 65-year-old woman, affected by a malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma) of the left breast, presented to our department to receive the postoperative radiotherapy. In the absence of prospective and randomized trials and investigations on breast sarcoma irradiation in literature, due to the rarity of this pathology, the role of adjuvant radiotherapy remains unclear. To identify the best radiotherapy technique for this patient, three methods were compared: 3D conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and volumetric arc therapy (VMAT) or RapidArc® (RA). 50 Gy was prescribed to the chest wall and 66 Gy to the tumor bed. Three plans were designed, and target coverage, organs-at-risk sparing, and treatment efficiency were compared. IMRT and RA improved both target coverage and dose uniformity/homogeneity. Planning objective for the lung is always satisfied comparing the different techniques, but the volume receiving 20 Gy drops to 17% by RA compared to 3D-CRT. The heart volume receiving 30 Gy was 10% by IMRT, against 13% and 16% by RA and 3D-CRT. The monitor unit (MU) required by 3D-CRT was 527 MU, followed by RA and IMRT. Treatment time was similar with 3D-CRT and RA but doubled using IMRT. Although all three radiotherapy techniques offered a satisfactory solution, RA and IMRT offer some improvement on target coverage, dose homogeneity, and conformity for this particular case of breast sarcoma.
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El Amine Elhadj O, Nasri M, Thabet S, Ben Hassouna J, Goucha A, Rahal K, Elmay A, Gamoudi A. [Primary breast sarcomas: About 30 cases treated at Salah-Azaiez institute in Tunisia]. Cancer Radiother 2017; 21:45-50. [PMID: 28223032 DOI: 10.1016/j.canrad.2016.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/01/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify retrospectively prognostic factors of primary breast sarcoma and review its treatment modalities. MATERIALS AND METHODS This is a descriptive study on 30 cases of primary breast sarcoma. We carried out a univariate and multivariate analysis correlating clinical, pathological and therapeutic parameters with disease-free survival and overall survival. RESULTS The mean age was 46.8 years. The mean tumour size was 10cm. The 30 cases were 18 phyllodes sarcomas, eight angiosarcomas, three liposarcomas and a case of granulocytic sarcoma. Sixteen patients had adjuvant radiotherapy and only seven patients received adjuvant chemotherapy. The median follow-up was 64 months. Overall survival rates at 3 and 5 years were 49.1% and 33.7%. Disease-free survival rates at 3 and 5 years were 22.8% and 15.2% respectively. The analytical study of the following parameters: tumour size and presence or absence of node or distant metastases, showed no correlation with overall survival nor with disease-free survival. Furthermore, adjuvant radiotherapy did not improve overall survival (P=0.298; hazard ratio [HR]=1 [0.982-1.04]) nor disease-free survival (P=0.61; HR=0.942 [0.862-1.029]). By univariate analyses, we identified a correlation between overall survival, surgical margins (>1cm) (P=0005; HR=3.4 [1.217-9.919]) and tumour necrosis (P=0.028; HR=0.099 [0.014-0.682]). We did not find any independent prognostic factor by multivariate analysis. CONCLUSION The prognosis of primary breast sarcoma seems to depend essentially on optimal surgical excision (margin over 1cm). The only potential histological parameter correlated with the prognosis is the presence of tumour necrosis. The histological subtype should not be considered as a prognostic marker for overall or disease-free survival in patients with primary breast sarcoma.
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Affiliation(s)
- O El Amine Elhadj
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie.
| | - M Nasri
- Service d'oncologie médicale, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - S Thabet
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - J Ben Hassouna
- Service de chirurgie carcinologique, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - A Goucha
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - K Rahal
- Service de chirurgie carcinologique, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - A Elmay
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - A Gamoudi
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
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12
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Ramalho I, Campos S, Rebelo T, Figueiredo Dias M. A Scary Onset of a Rare and Aggressive Type of Primary Breast Sarcoma: A Case Report. Case Rep Oncol 2016; 9:796-801. [PMID: 28101028 PMCID: PMC5216215 DOI: 10.1159/000452946] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022] Open
Abstract
Primary breast sarcoma, arising from connective tissue within the breast, is extremely rare, accounting for less than 1% of all primary breast malignancies and no more than 5% of all sarcomas. The rarity of this pathology limits most studies to case reports and small retrospective studies, which has led to a lack of consensus on the clinical management. We report a clinical case of a 52-year-old woman, perimenopausal, previously healthy, with regular breast surveillance, who presented with a large (>20 cm) and rapidly expanding hypervascularized tumor of the left breast developed over 10 days, with a very thin preulcerative skin over the last 4 days. There was no systemic dissemination. The patient was submitted to total mastectomy and excision of axillary adenopathy. The tumor was diagnosed histologically as malignant phyllodes tumor associated with areas of high-grade sarcoma. Due to rapid growth and aggressive histological characteristics, adjuvant chemotherapy and radiotherapy were performed. There is a lot of evidence that tumors larger than 5 cm are associated with a poor prognosis. Despite the poor prognosis associated with this aggressive entity, the patient had no recurrence during 5 years of follow-up. We review the relevant literature about primary breast sarcomas.
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Affiliation(s)
- Inês Ramalho
- Gynecology A Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sara Campos
- Gynecology A Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa Rebelo
- Gynecology A Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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13
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Lee JY, Kim DB, Kwak BS, Kim EJ. Primary fibrosarcoma of the breast: a case report. J Breast Cancer 2011; 14:156-9. [PMID: 21847413 PMCID: PMC3148532 DOI: 10.4048/jbc.2011.14.2.156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 04/11/2011] [Indexed: 11/30/2022] Open
Abstract
A primary fibrosarcoma of the breast is a rare tumor. Here we report on a case of a primary fibrosarcoma of the breast that presented as a palpable left breast mass in a 47-year-old woman. The physical examination revealed a 3 cm sized, round mass in the left upper outer breast. The mammograms revealed a 3 cm sized, partially circumscribed and partially obscured, high density mass in the upper outer quadrant of the left breast. An ultrasonogram demonstrated a 3 cm sized, ovoid, circumscribed and hypoechoic mass with peripheral increased vascularity on Doppler imaging. Surgical excision was performed and the pathology revealed a low grade fibrosarcoma.
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Affiliation(s)
- Jin Young Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Dae Bong Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Beom Seok Kwak
- Department of Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Eo-Jin Kim
- Department of Pathology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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14
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Al-Benna S, Poggemann K, Steinau HU, Steinstraesser L. Diagnosis and management of primary breast sarcoma. Breast Cancer Res Treat 2010; 122:619-26. [DOI: 10.1007/s10549-010-0915-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 04/21/2010] [Indexed: 11/28/2022]
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15
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Affiliation(s)
- Kristin L Cox
- Virginia Clinton Kelley/FFANY Breast Fellowship, Komen Interdisciplinary Breast Fellowship, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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16
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Confavreux C, Lurkin A, Mitton N, Blondet R, Saba C, Ranchère D, Sunyach MP, Thiesse P, Biron P, Blay JY, Ray-Coquard I. Sarcomas and malignant phyllodes tumours of the breast – A retrospective study. Eur J Cancer 2006; 42:2715-21. [PMID: 17023158 DOI: 10.1016/j.ejca.2006.05.040] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 05/16/2006] [Accepted: 05/16/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although most breast cancers are adenocarcinomas of the mammary gland, primary breast sarcomas may also arise from mammary gland mesenchymal tissue. The annual incidence of primary breast sarcoma is low and has been estimated at 45 new cases per 10 million women. These tumours are at high risk of recurrence and are known to have poor prognosis. Phyllodes tumours represent a specific subset of these breast soft tissue tumours. They are composed of a connective tissue stroma and epithelial elements. Pathological presentation ranges from grade I to malignant phyllodes tumours (grade III) where the stromal component clearly exhibits a sarcoma pattern. MATERIALS AND METHODS SAPHYR (SArcoma and PHYllode Retrospective) is a retrospective study of the experience of Leon Bérard Cancer Centre (Lyon, France) from 1966 to August 2004. SAPHYR aims to describe the characteristics of primary breast sarcomas and to define potential survival factors to be evaluated in future prospective studies. RESULTS We included 70 patients. Half of them presented at least one recurrence (35/70). Median disease-free-survival (DFS) was 1.15 years. At 3 years, median overall survival had not been reached and more than 61% of the patients were alive. Quality of surgical resection was significantly (p=0.036) different whether patients were in the R0 group (72%) or not (38%). No survival difference was found between malignant phyllodes (grade III) and other primary breast sarcomas (angiosarcomas excluded). Histology revealed three significantly (p=0.0003) different prognostic groups: phyllodes grade I and II (DFS=57%), angiosarcomas (DFS=7%) and phyllodes grade III and other primary breast sarcomas (DFS=45%). DISCUSSION Phyllodes tumours and primary breast sarcomas are totally different from epithelial breast cancers and should be considered as a distinct group of rare tumours. The first goal of treatment is to achieve negative margins (R0). We propose to treat the patients according to the clinical practice guidelines in use for soft tissue sarcomas and address them to a reference centre for sarcoma. Treating rare tumours in the same place should permit us to standardise pathological data and to include patients into multicentric radiotherapy or chemotherapy protocols to improve overall survival. As further prospective studies are needed, European oncology groups must join their forces to create a prospective Rare Cancer Network.
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Affiliation(s)
- C Confavreux
- Centre Régional de Lutte contre le Cancer Léon Bérard, 28 rue Laennec, 69008 Lyon, France.
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Davis WG, Hennessy B, Babiera G, Hunt K, Valero V, Buchholz TA, Sneige N, Gilcrease MZ. Metaplastic Sarcomatoid Carcinoma of the Breast With Absent or Minimal Overt Invasive Carcinomatous Component. Am J Surg Pathol 2005; 29:1456-63. [PMID: 16224212 DOI: 10.1097/01.pas.0000176431.96326.49] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metaplastic carcinomas of the breast are a heterogeneous group of neoplasms ranging from tumors with a predominant component of overt carcinoma and focal mesenchymal differentiation to keratin-positive tumors with pure sarcomatoid morphology. We examined the clinicopathologic features of 22 patients previously diagnosed at M.D. Anderson Cancer Center with metaplastic carcinoma of the breast with pure or almost pure sarcomatoid morphology. Patients were included in the study if their tumors had sarcomatoid morphology and: 1) an invasive carcinomatous component identifiable on hematoxylin and eosin stains comprising less than 5% of the invasive tumor; or 2) associated ductal carcinoma in situ; or 3) immunohistochemical expression of keratin in the sarcomatoid areas. Patients with low-grade fibromatosis-like metaplastic tumors and those who received neoadjuvant chemotherapy were excluded. Axillary lymph node dissection or limited axillary node excision was performed in 17 patients, including 1 patient who had a sentinel lymph node biopsy. Lymph node involvement occurred in only 1 patient and consisted of a single 3.5-mm metastasis. Clinical follow-up was available for 21 patients and ranged from 4 months to 155 months (median follow-up, 35 months). Ten patients experienced local relapse, including 7 of 11 patients treated with breast-conserving surgery, and 9 developed distant metastases, most frequently to the lungs. These findings suggest that metaplastic sarcomatoid carcinomas that lack or have only a minimal overt invasive carcinomatous component have a biologic behavior similar to that of sarcomas. In addition to systemic treatment, early aggressive local therapy is recommended, as these patients have a high rate of local relapse.
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Affiliation(s)
- William G Davis
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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