1
|
Zhang N, Sun L, Chen X, Song H, Wang W, Sun H. Meta-analysis of contrast-enhanced ultrasound in differential diagnosis of breast adenosis and breast cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39206962 DOI: 10.1002/jcu.23803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
This systematic review and meta-analysis study aimed to determine the total capacity of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of breast lesions and breast cancer. For collecting papers, four groups of keywords were searched in five databases. The required information was extracted from the selected papers. In addition to the descriptive findings, a meta-analysis was also conducted. Thirty-three of thirty-six studies (91.67%) on the differential diagnosis of various degrees and types of breast lesions showed that CEUS has proper performance. The pooled values related to the sensitivity and specificity of CEUS were computed by 88.00 and 76.17.
Collapse
Affiliation(s)
- Na Zhang
- Department of Electrodiagnosis, Jilin Province FAW General Hospital, Changchun, China
| | - Limin Sun
- Department of Electrodiagnosis, Jilin Province FAW General Hospital, Changchun, China
| | - Xing Chen
- Department of Cardiology, Jilin Province FAW General Hospital, Changchun, China
| | - Hanxing Song
- Department of Electrodiagnosis, Jilin Province FAW General Hospital, Changchun, China
| | - Wenyu Wang
- Thoracic Surgery Department, Jilin Province FAW General Hospital, Changchun, China
| | - Hui Sun
- Department of Electrodiagnosis, Jilin Province FAW General Hospital, Changchun, China
| |
Collapse
|
2
|
Singla V, Gulati M, Singh T, Bal A, Tandup C. The conundrum of breast cancer mimics. Curr Probl Diagn Radiol 2024; 53:517-526. [PMID: 38494382 DOI: 10.1067/j.cpradiol.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/03/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
The BIRADS lexicon ensures a standard reporting terminology in breast imaging and serves as a means of smooth communication between the radiologist and the referring physician. BIRADS assessment categories 4 and 5 warrant a biopsy to rule out underlying malignancy. However, a substantial number of cases in these categories sometimes turn out to be benign on biopsy. These benign mimics encompass inflammatory, sclerosing, neoplastic and a few other miscellaneous conditions. Awareness of these various mimics of breast cancer can equip the radiologist to handle these apparent cases of radiologic-pathological (rad-path) discordance better, guide overall patient management, avoiding inadvertent excisional biopsies and help alleviate patient anxiety and confusion.
Collapse
Affiliation(s)
- Veenu Singla
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Malvika Gulati
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Singh
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Cherring Tandup
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
3
|
Su HZ, Huang M, Li ZY, Tu JH, Hong LC, Zhang ZB, Zhang XD. Ultrasound characteristics of breast fibromatosis mimicking carcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:144-151. [PMID: 37991026 DOI: 10.1002/jcu.23613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To explore the value of ultrasound (US) characteristics in diagnosing breast fibromatosis (BF) and evaluate their differences from breast carcinoma. METHODS A total of 121 patients with BF (n = 24, 29 lesions) or invasive ductal carcinoma (IDC) (n = 97, 102 lesions) of the breast were included. Their clinical and US findings were recorded and analyzed. RESULTS The mean age of BF was younger than that of IDC (28.75 ± 5.55 vs. 50.19 ± 9.87, p < 0.001). The mean size of the BF was smaller than that of IDC (2.09 ± 0.91 vs. 2.71 ± 1.20, p = 0.011). Compared to IDC, BF had more frequency of posterior echo attenuation (p < 0.001), less frequency of peripheral hyperechoic halo (p = 0.002), calcification (p = 0.001), US reported axillary lymph node positive (p = 0.025), and grade 2-3 vascularity (p < 0.001). The Breast Imaging Reporting and Data System categorized BF at a lower level than IDC (p < 0.001). After adjusting for age, the peripheral hyperechoic halo, posterior echo feature, and vascularity could independently identify the differences between these two entities. CONCLUSION Some differences were observed between BF and IDC in terms of patient age, lesion size, and US characteristics.
Collapse
Affiliation(s)
- Huan-Zhong Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Mei Huang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zhi-Yong Li
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jin-Hua Tu
- Department of Pathology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Long-Cheng Hong
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zuo-Bing Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiao-Dong Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| |
Collapse
|
4
|
Deshwal A, Walton T, Varzgalis M, McGowan K, O'Dowd G. Imaging modalities used in mammary fibromatosis. Radiol Case Rep 2023; 18:1949-1953. [PMID: 36970238 PMCID: PMC10030809 DOI: 10.1016/j.radcr.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/08/2023] [Indexed: 03/19/2023] Open
Abstract
Mammary fibromatosis is a rare neoplastic proliferation of fibroblastic cells. Usually seen in abdominal and extra-abdominal sites, it is rarely seen in the breast. Patients with mammary fibromatosis usually present with a firm palpable mass with or without dimpling and skin retraction-often mimicking breast carcinoma. Here, we present a case of mammary fibromatosis in a 49-year-old woman who presented with a palpable lump in her right breast. Mammography tomosynthesis revealed architectural distortion which was seen on ultrasonography as a hypoechoic area. The patient underwent a wire-guided excision where the histology of this specimen showed irregular spindle cell proliferation with hemosiderin deposition, confirming mammary fibromatosis. Further re-excision of margins revealed no evidence of residual fibromatosis, and the patient underwent subsequent surveillance mammograms to ensure there was no recurrence.
Collapse
|
5
|
Jones LI, Klimczak K, Geach R. Breast MRI: an illustration of benign findings. Br J Radiol 2023; 96:20220280. [PMID: 36488196 PMCID: PMC9975519 DOI: 10.1259/bjr.20220280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022] Open
Abstract
Despite its unparalleled sensitivity for aggressive breast cancer, breast MRI continually excites criticism for a specificity that lags behind that of modern mammographic techniques. Radiologists reporting breast MRI need to recognise the range of benign appearances on breast MRI to avoid unnecessary biopsy. This review summarises the reported diagnostic accuracy of breast MRI with particular attention to the technique's specificity, provides a referenced reporting strategy and discusses factors that compromise diagnostic confidence. We then present a pictorial review of benign findings on breast MRI. Enhancing radiological skills to discriminate malignant from benign findings will minimise false positive biopsies, enabling optimal use of multiparametric breast MRI for the benefit of screening clients and breast cancer patients.
Collapse
Affiliation(s)
- Lyn Isobel Jones
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Katherine Klimczak
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Rebecca Geach
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
| |
Collapse
|
6
|
Russell DH, Montgomery EA, Susnik B. Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management. Adv Anat Pathol 2022; 29:309-323. [PMID: 35838633 DOI: 10.1097/pap.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Spindle cell proliferations of the breast are a heterogeneous group of lesions ranging from benign or reactive lesions to aggressive malignant neoplasms. Diagnosis on core biopsy can be particularly challenging as lesions displaying different lineages associated with variable outcomes share overlapping morphologies (scar vs. fibromatosis-like metaplastic carcinoma) whereas individual entities can exhibit a large variety of appearances (myofibroblastoma). In this review, lesions are grouped into lineage, when possible, including those showing fibroblastic/myofibroblastic differentiation, ranging from entities that require no additional management, such as scar and nodular fasciitis, to those with unpredictable clinical outcomes such as fibromatosis and solitary fibrous tumor or locally aggressive behavior such as dermatofibrosarcoma protuberans. The review of low-grade vascular lesions includes atypical vascular lesion and low-grade angiosarcoma. Also discussed are various adipocytic lesions ranging from lipoma to liposarcoma, and rare smooth muscle and neural entities more commonly encountered in locations outside the breast, such as leiomyoma, neurofibroma, schwannoma, or granular cell tumor. Optimal histological evaluation of these entities merges clinical and radiologic data with morphology and ancillary testing. We present our approach to immunohistochemical and other ancillary testing and highlight issues in pathology correlation with imaging. Recent updates in the management of breast spindle cell lesions are addressed. In a well-sampled lesion with radiographic concordance, the core biopsy diagnosis reliably guides management and we advocate the inclusion of management recommendations in the pathology report. Precise characterization using up to date guidelines is important to identify a subset of patients who may safely avoid unnecessary surgical procedures. A multidisciplinary approach with close collaboration with our clinical colleagues is emphasized.
Collapse
Affiliation(s)
- Daniel H Russell
- Departments of Pathology University of Miami Hospital and Jackson Health Systems, Miami, FL
| | | | | |
Collapse
|
7
|
Bouab M, Harit A, Boufettal H, Mahdaoui S, Samouh N. Desmoid fibromatosis of the breast occurring after breast reduction surgery mimicking a carcinoma: A rare case report. Ann Med Surg (Lond) 2022; 77:103526. [PMID: 35638040 PMCID: PMC9142379 DOI: 10.1016/j.amsu.2022.103526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Maryem Bouab
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Amjad Harit
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Houssine Boufettal
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Sakher Mahdaoui
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Naima Samouh
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| |
Collapse
|
8
|
Winkler N, Peterson M, Factor R. Breast Fibromatosis: Radiologic-Pathologic Correlation. JOURNAL OF BREAST IMAGING 2021; 3:597-602. [PMID: 38424943 DOI: 10.1093/jbi/wbab051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 03/02/2024]
Abstract
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.
Collapse
Affiliation(s)
- Nicole Winkler
- University of Utah Health/Huntsman Cancer Institute, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | - Michael Peterson
- University of Utah School of Medicine, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | - Rachel Factor
- University of Utah Health/Huntsman Cancer Institute, Department of Pathology, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Rakha EA, Brogi E, Castellano I, Quinn C. Spindle cell lesions of the breast: a diagnostic approach. Virchows Arch 2021; 480:127-145. [PMID: 34322734 PMCID: PMC8983634 DOI: 10.1007/s00428-021-03162-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/27/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022]
Abstract
Spindle cell lesions of the breast comprise a heterogeneous group of lesions, ranging from reactive and benign processes to aggressive malignant tumours. Despite their rarity, they attract the attention of breast pathologists due to their overlapping morphological features and diagnostic challenges, particularly on core needle biopsy (CNB) specimens. Pathologists should recognise the wide range of differential diagnoses and be familiar with the diverse morphological appearances of these lesions to make an accurate diagnosis and to suggest proper management of the patients. Clinical history, immunohistochemistry, and molecular assays are helpful in making a correct diagnosis in morphologically challenging cases. In this review, we present our approach for the diagnosis of breast spindle cell lesions, highlighting the main features of each entity and the potential pitfalls, particularly on CNB. Breast spindle cell lesions are generally classified into two main categories: bland-appearing and malignant-appearing lesions. Each category includes a distinct list of differential diagnoses and a panel of immunohistochemical markers. In bland-appearing lesions, it is important to distinguish fibromatosis-like spindle cell metaplastic breast carcinoma from other benign entities and to distinguish fibromatosis from scar tissue. The malignant-appearing category includes spindle cell metaplastic carcinoma, stroma rich malignant phyllodes tumour, other primary and metastatic malignant spindle cell tumours of the breast, including angiosarcoma and melanoma, and benign mimics such as florid granulation tissue and nodular fasciitis.
Collapse
Affiliation(s)
- Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
| | - Edi Brogi
- Department of Pathology At Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Cecily Quinn
- Histopathology, BreastCheck, Irish National Breast Screening Programme and St. Vincent's University Hospital, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| |
Collapse
|
10
|
Wei L, Jiang G, Bai L, Li T, Ma X, Jiang L, Wang J, Li S. Inflammatory Myofibroblastoma of the Breast: A Case Report. Front Oncol 2021; 11:646336. [PMID: 34141609 PMCID: PMC8204013 DOI: 10.3389/fonc.2021.646336] [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: 12/26/2020] [Accepted: 04/19/2021] [Indexed: 12/31/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare tumor with low-grade malignant risk mainly occurring in soft tissues and lungs, and it is extremely rare in the breast. Meanwhile, imaging findings of the tumor often present with non-specific features that lead to misdiagnosis and delayed treatment. Here, we report a case of inflammatory myofibroblastic tumor in the breast with the imaging findings of mammography, magnetic resonance imaging (MRI), and pathologic findings to improve the understanding of the disease. The patient was treated by surgical operation, and was followed up for 44 months, no local recurrence and distant metastasis.
Collapse
Affiliation(s)
- Ling Wei
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| | - Guoyuan Jiang
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| | - Lala Bai
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| | - Tingchao Li
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| | - Xuejin Ma
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| | - Lin Jiang
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| | - Jie Wang
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| | - Shiguang Li
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| |
Collapse
|
11
|
Lin S, Cao Y, Chen L, Chen M, Zhang S, Jia X. Contrast-enhanced ultrasound of breast fibromatosis: a case report. J Int Med Res 2021; 49:3000605211010619. [PMID: 33978517 PMCID: PMC8120548 DOI: 10.1177/03000605211010619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We herein present a rare case of breast fibromatosis, the contrast-enhanced ultrasonography (CEUS) findings of which we believe have never been described. The high similarity between the clinical and imaging manifestations of breast cancer makes its differential diagnosis difficult. In this report, we describe the CEUS findings of a less common type of fibromatosis, discuss the potential value of CEUS to differentiate it from malignant breast lesions, and briefly review the literature.
Collapse
Affiliation(s)
- Shanhong Lin
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Yong Cao
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Libin Chen
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Mei Chen
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Shengmin Zhang
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Xiupeng Jia
- Ningbo Clinical Pathological Diagnosis Center, Ningbo, China
| |
Collapse
|
12
|
Mei J, Hu Y, Jiang X, Zhong W, Tan C, Gu R, Liu F, Yang Y, Wang H, Shen S, Gong C. Ultrasound-Guided Vacuum-assisted Biopsy Versus Surgical Resection in Patients With Breast Desmoid Tumor. J Surg Res 2021; 261:400-406. [PMID: 33493893 DOI: 10.1016/j.jss.2020.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent studies suggest that desmoid tumors can be managed more conservatively rather than undergoing wide surgical resection (SR). Ultrasound-guided vacuum-assisted biopsy (UGVAB) is a minimally invasive technique. This retrospective study aimed to compare the outcome in patients with breast desmoid tumor (BDT) who received UGVAB alone versus SR. MATERIALS AND METHODS The pathology database was searched for patients diagnosed with BDT ≤ 3 cm from 2007 to 2019. All patients underwent breast ultrasound examination and were then performed UGVAB alone or local SR. The Kaplan-Meier method with a log-rank test was used as a univariate analysis to compare the relapse-free survival (RFS) rates between UGVAB and SR groups. Cox regression analysis was used for multivariate analysis. RESULTS A total of 39 patients were included. The median follow-up was 41 mo (range, 5-110 mo). The incidence of tumor recurrence was 23.1% (9/39). The 3-y cumulative RFS was 83.1% and 95.8% in the UGVAB and SR group, respectively, which was not significantly different between the two groups (P = 0.131, log-rank test). Multivariate analysis also revealed that treatment strategy (UGVAB versus SR) was not associated with an increased risk of relapse events (P = 0.274). CONCLUSIONS Small desmoid tumors (≤3 cm) after UGVAB alone did not have a significantly compromised RFS compared with those who underwent SR. UGVAB may be an alternative and relatively conservative method for the diagnosis and local control of BDT with a smaller size. A prospective, randomized study with large sample size is needed to confirm this observation.
Collapse
Affiliation(s)
- Jingsi Mei
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yue Hu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiaofang Jiang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenjing Zhong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Cui Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ran Gu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Fengtao Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hongli Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shiyu Shen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Chang Gong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China; Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), 510005 Guangzhou, China.
| |
Collapse
|
13
|
Liu H, Zeng H, Zhang H, Wang H, Cheng Z, Hu Y, Wu Z. Breast fibromatosis: Imaging and clinical findings. Breast J 2020; 26:2217-2222. [PMID: 32754995 DOI: 10.1111/tbj.14008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
Breast fibromatosis is a rare histologically benign tumor with local aggressive potential, and imaging and clinical findings of breast fibromatosis require attention. We retrospectively evaluated the images of 20 patients with histologically proven breast fibromatosis on mammography, magnetic resonance imaging (MRI), and ultrasonography. The lesions were assessed concerning the location, fascia involvement, imaging characteristics, and follow-up outcomes. Altogether, there were 22 lesions: 10 lesions involved the superficial fascia system including four lesions additionally involving the deep fascia and pectoralis major, and 12 lesions were inside the glandular parenchyma with two lesions originated from the prior surgery site. The detection rates of mammography, ultrasound, and MRI for breast fibromatosis were 33.3% (3/9), 90% (18/20), and 100% (3/3), respectively. We found that fascia involvement may be a characteristic of breast fibromatosis. The lesion located inside glandular parenchyma is prone to be underestimated, whereas combined MR with ultrasound is recommended for the diagnosis. The complete excision with negative margins is important for a good prognosis.
Collapse
Affiliation(s)
- Haiqing Liu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hong Zeng
- Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hanchen Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hongli Wang
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ziliang Cheng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yue Hu
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhuo Wu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
14
|
Complicaciones infrecuentes de las prótesis de mama. RADIOLOGIA 2020; 62:266-279. [DOI: 10.1016/j.rx.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/10/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
|
15
|
Sánchez Rubio N, Lannegrand Menéndez B, Duque Muñoz M, Montes Fernández M, Ciudad Fernández M. Uncommon complications of breast prostheses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Lorenzen J, Cramer M, Buck N, Friedrichs K, Graubner K, Lühr CS, Lindner C, Niendorf A. Desmoid Type Fibromatosis of the Breast: Ten-Year Institutional Results of Imaging, Histopathology, and Surgery. Breast Care (Basel) 2020; 16:77-84. [PMID: 33708054 DOI: 10.1159/000507842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 04/14/2020] [Indexed: 11/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | - Nina Buck
- Radiologische Allianz, Hamburg, Germany
| | | | - Kirsten Graubner
- Department of Gynecology and Obstetrics, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
| | | | - Christoph Lindner
- Department of Gynecology and Obstetrics, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
| | | |
Collapse
|
17
|
Lewin AA, Moy L. Unknown Case #2: Part 2. JOURNAL OF BREAST IMAGING 2019; 1:264-266. [PMID: 38424749 DOI: 10.1093/jbi/wbz004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 03/02/2024]
Affiliation(s)
- Alana A Lewin
- New York University School of Medicine, Department of Radiology, Center for Biomedical Imaging, New York, NY
| | - Linda Moy
- New York University School of Medicine, Department of Radiology, Center for Biomedical Imaging, New York, NY
| |
Collapse
|
18
|
Ghanta S, Allen A, Vinyard AH, Berger R, Aoun J, Rosenkrantz Spoont J, Avisar E. Breast fibromatosis: Making the case for primary vs secondary subtypes. Breast J 2019; 26:697-701. [PMID: 31429159 DOI: 10.1111/tbj.13506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023]
Abstract
Fibromatosis of the breast is a rare condition that can be locally aggressive. The mainstay of treatment remains wide local excision, with varied adjuvant therapy as needed. The authors describe their experience in the treatment of a series of patients and propose the classification of primary and secondary breast fibromatosis. A single-institution retrospective analysis of patients treated for breast fibromatosis from 2003 to 2017 was completed. Demographic data, pertinent past medical history, and treatment modalities were reviewed. Primary breast fibromatosis was defined as arising in the absence of previous surgery or radiation therapy to the ipsilateral breast. Secondary breast fibromatosis was defined as arising in the setting of previous surgery or radiation therapy to the ipsilateral breast. A total of 16 patients were included with the median age 40 (28-64) years. The average size of the lesion was 6.37 cm (range of 1.5-15 cm). Mean follow-up time was 65 months. Surgical excision was completed in 14 patients, with two recurrences. There were no recurrences in patients with surgical margins >1 cm. Two patients were treated nonsurgically. There were seven patients with primary fibromatosis of the breast and nine patients with secondary fibromatosis of the breast. Fibromatosis of the breast is difficult to diagnose prior to surgical excision. We advocate for the multi-disciplinary treatment of this disease process with an aggressive surgical approach to achieve margins >1 cm.
Collapse
Affiliation(s)
- Swapna Ghanta
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Ahkeel Allen
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Alicia Huff Vinyard
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Rachel Berger
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Jessica Aoun
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | | | - Eli Avisar
- University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| |
Collapse
|
19
|
Murata H, Imai K, Nakagawa K, Nishigaki Y. Multimodal radiological imaging of collagenous fibroma arising from the subacromial region in a patient with osteosarcoma: A case report. Mol Clin Oncol 2019; 10:366-370. [PMID: 30847175 DOI: 10.3892/mco.2019.1798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 12/07/2018] [Indexed: 11/05/2022] Open
Abstract
Collagenous fibroma arising from the subacromial region is extremely rare. It is important to distinguish collagenous fibroma from other fibrous tumors including desmoid tumors, to differentiate between the prognoses and management strategies, including surgical treatment. The present case report describes the case of a 42-year-old man with a collagenous fibroma of the subacromial region. He received a follow-up examination following treatment for osteosarcoma. Positron emission tomography (PET) scans used to assess for metastatic lesions indicated uptake in his left shoulder. The maximum standardized uptake value was 2.4. Magnetic resonance imaging demonstrated iso-intensity to muscle on T1-weighted images and iso-intensity with slightly high intensity on T2-weighted images. Post-contrast fat-suppressed magnetic resonance images indicated slightly heterogeneous enhancement of the lesion. There were no notable results from X-rays, bone scintigraphy and thallium-201 scintigraphy. Histological examination revealed collagenous fibroma. To the best of our knowledge, the present case is only the second incidence of collagenous fibroma arising from the subacromial region, and the first description of thallium-201 scintigraphy and PET scans in collagenous fibroma. The multimodal radiological data of this case may be useful for assisting in the differentiation of fibrous tumor types, including collagenous fibroma.
Collapse
Affiliation(s)
- Hiroaki Murata
- Department of Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Kan Imai
- Department of Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Kazuya Nakagawa
- Department of Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Yasunori Nishigaki
- Department of Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| |
Collapse
|
20
|
Steadman L, Crook S. Fibromatosis arising from the pectoralis major muscle mimicking breast cancer. Radiol Case Rep 2018; 13:1174-1178. [PMID: 30233754 PMCID: PMC6140422 DOI: 10.1016/j.radcr.2018.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/12/2018] [Accepted: 08/15/2018] [Indexed: 12/27/2022] Open
Abstract
Fibromatoses are soft tissue tumors composed of fibroblasts which commonly appear in the muscular aponeurosis of the abdomen. Mammary fibromatoses occur in only 0.2% of breast neoplasms and have been reported in association with prior breast augmentation and Gardner's syndrome. Multiple imaging modalities have been used to characterize the appearance of breast fibromatosis; however, it remains a tissue diagnosis given the variability both within and across modalities. We present the case of a 25-year-old female with a history of palpable breast mass who was evaluated with ultrasound, diagnostic mammography, MRI, and CT. Ultrasound-guided biopsy revealed fibromatosis, and MRI ultimately revealed that the mass was arising from the pectoralis major muscle and extensively involved the chest wall.
Collapse
Affiliation(s)
- Laryn Steadman
- Indiana University School of Medicine, 550 N. University Blvd., Room 0663, Indianapolis, IN 46202, USA
| | - Susan Crook
- Indiana University School of Medicine, 550 N. University Blvd., Room 0663, Indianapolis, IN 46202, USA
| |
Collapse
|
21
|
Silva S, Lage P, Cabral F, Alves R, Catarino A, Félix A, André S. Bilateral breast fibromatosis after silicone prosthetics in a patient with classic familial adenomatous polyposis: A case report. Oncol Lett 2018; 16:1449-1454. [PMID: 30008823 PMCID: PMC6036415 DOI: 10.3892/ol.2018.8853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 03/16/2018] [Indexed: 11/07/2022] Open
Abstract
Breast fibromatosis is a benign fibroblastic proliferation accounting for less than 0.2% of breast tumors. It presents sporadically or as a manifestation of familial adenomatous polyposis (FAP). Fibromatosis in FAP may develop in patients with adenomatous polyposis coli (APC) gene mutations at any location through the gene. Notably, there is an increased risk if mutation is downstream codon 1400. The present case report described a 33-year-old woman with recurrent bilateral breast fibromatosis after breast implants in a context of classic FAP. APC mutation (codon-935) was detected at the age of 16. In the same year, a thyroidectomy for a cribriform-morular papillary thyroid carcinoma (pT1) was performed. Seven years later, a prophylactic total colectomy with >100 adenomas without invasive carcinoma was performed and the patient was kept under surveillance. At the age of 30 years old, she underwent breast silicone implantation for cosmetic reasons. One year later, bilateral breast tumors were diagnosed in core biopsy as fibromatosis (nuclear β-catenin+, estrogen receptors-). After no success with medical treatment with tamoxifen, bilateral mastectomy was performed. The patient relapsed one year later and a fibromatosis lesion in the right thoracic wall was excised again. The patient demonstrated no signs of relapse 24 months after the surgery. This rare case illustrates that the increased risk of developing fibromatosis in patients with FAP, even in the classic form, should be considered before deciding to place breast implants.
Collapse
Affiliation(s)
- Sara Silva
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Pedro Lage
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Francisco Cabral
- Department of Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Rui Alves
- Department of Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Ana Catarino
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.,Department of Pathology, Serviço de Anatomia Patológica do Hospital da Luz, 1500-650 Lisbon, Portugal
| | - Ana Félix
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.,Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Saudade André
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.,Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| |
Collapse
|
22
|
Whorms DS, Fishman MDC, Slanetz PJ. Mesenchymal Lesions of the Breast: What Radiologists Need to Know. AJR Am J Roentgenol 2018; 211:224-233. [PMID: 29792741 DOI: 10.2214/ajr.17.19020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Mesenchymal breast tumors originate from the various components of mammary stroma. The aim of this review is to discuss the clinical presentation, imaging appearance, and management of mesenchymal breast lesions. CONCLUSION Although many mesenchymal tumors exhibit characteristic findings on imaging, others show nonspecific characteristics and require tissue biopsy for diagnosis. An awareness of the clinical and imaging presentation is essential in guiding the differential diagnosis and patient management.
Collapse
Affiliation(s)
- Debra S Whorms
- 1 Harvard Medical School, 25 Shattuck St, Boston, MA 02215
| | - Michael D C Fishman
- 1 Harvard Medical School, 25 Shattuck St, Boston, MA 02215
- 2 Department of Radiology, Division of Breast Imaging, Beth Israel Deaconess Medical Center, Boston, MA
- 3 Present address: Department of Radiology, Division of Breast Imaging, Boston Medical Center, Boston, MA
| | - Priscilla J Slanetz
- 1 Harvard Medical School, 25 Shattuck St, Boston, MA 02215
- 2 Department of Radiology, Division of Breast Imaging, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
23
|
Abdelwahab K, Hamdy O, Zaky M, Megahed N, Elbalka S, Elmetwally M, Denewer A. Breast fibromatosis, an unusual breast disease. J Surg Case Rep 2018; 2017:rjx248. [PMID: 29302307 PMCID: PMC5739041 DOI: 10.1093/jscr/rjx248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/27/2017] [Accepted: 12/01/2017] [Indexed: 01/11/2023] Open
Abstract
Fibromatosis is a benign tumor that rarely affects the breast and is an unusual site for its occurrence. Whilst the definite etiology of breast fibromatosis is unclear, it may present itself following surgical trauma or silicone implant. Wide local excision with adequate safety margins is considered the standard of care. We review three cases of breast fibromatosis who were presented to and operated in the Oncology center, Mansoura universty (between April 2014 and August 2016). Two of these cases underwent wide local excision and primary closure of the defect whilst the other one was reshaped by mini latismuss dorsi flap.
Collapse
Affiliation(s)
- Khaled Abdelwahab
- Surgical Oncology Unit, Mansoura Oncology Center, Mansoura Universty, Mansoura, Egypt
| | - Omar Hamdy
- Surgical Oncology Unit, Mansoura Oncology Center, Mansoura Universty, Mansoura, Egypt
| | - Mona Zaky
- Diagnostic and Interventional Radiology Department, Mansoura Universty Hospital, Mansoura Universty, Mansoura, Egypt
| | - Nirmeen Megahed
- Pathology Department, Faculty of Medicine, Mansoura Universty, Mansoura, Egypt
| | - Saleh Elbalka
- Surgical Oncology Unit, Mansoura Oncology Center, Mansoura Universty, Mansoura, Egypt
| | - Mohamed Elmetwally
- Surgical Oncology Unit, Mansoura Oncology Center, Mansoura Universty, Mansoura, Egypt
| | - Adel Denewer
- Surgical Oncology Unit, Mansoura Oncology Center, Mansoura Universty, Mansoura, Egypt
| |
Collapse
|
24
|
Fibromatosis of the breast mimicking cancer: A case report. Radiol Case Rep 2017; 13:1-5. [PMID: 29487630 PMCID: PMC5826686 DOI: 10.1016/j.radcr.2017.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 12/29/2022] Open
Abstract
Breast fibromatosis, also referred to as desmoid tumor or aggressive fibromatosis, is a very rare, locally aggressive disease that does not metastasize. Bilateral lesions are extremely rare and are found in only 4% of patients with breast fibromatosis. Tumor recurrence following surgery occurs in 18%-29% of patients, most often within the first 2 years after surgery. In this report, we discuss a case of breast fibromatosis, mimicking a breast carcinoma both clinically and radiologically, that presented clinically with dimpling of the skin of the left breast in a 31-year-old woman. The patient relapsed a few months after surgery, with a multicentric and bilateral disease.
Collapse
|
25
|
Kuba MG, Lester SC, Giess CS, Bertagnolli MM, Wieczorek TJ, Brock JE. Fibromatosis of the Breast: Diagnostic Accuracy of Core Needle Biopsy. Am J Clin Pathol 2017; 148:243-250. [PMID: 28821190 DOI: 10.1093/ajcp/aqx065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | - Catherine S Giess
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Monica M Bertagnolli
- Division of Surgical Oncology, Department of Surgery, Dana Farber-Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Tad J Wieczorek
- Department of Pathology, Brigham and Women's Faulkner Hospital, Boston, MA
| | | |
Collapse
|
26
|
|
27
|
Raj SD, Sweetwood K, Kapoor MM, Raj KM, Nagi C, Sepulveda KA, Sedgwick EL. Spindle cell lesions of the breast: Multimodality imaging and clinical differentiation of pathologically similar neoplasms. Eur J Radiol 2017; 90:60-72. [DOI: 10.1016/j.ejrad.2017.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 01/11/2017] [Accepted: 02/13/2017] [Indexed: 01/13/2023]
|
28
|
Braschi-Amirfarzan M, Keraliya AR, Krajewski KM, Tirumani SH, Shinagare AB, Hornick JL, Baldini EH, George S, Ramaiya NH, Jagannathan JP. Role of Imaging in Management of Desmoid-type Fibromatosis: A Primer for Radiologists. Radiographics 2016; 36:767-82. [DOI: 10.1148/rg.2016150153] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
29
|
Ünal B, Erdoğan G, Karaveli FŞ. Step by step approach to rare breast lesions containing spindle cells. SPRINGERPLUS 2015; 4:678. [PMID: 26558181 PMCID: PMC4635171 DOI: 10.1186/s40064-015-1480-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/28/2015] [Indexed: 12/18/2022]
Abstract
Differential diagnosis of spindle cell lesions of breast is challenging for certain reasons. The most important reason is the presence of cytological atypia and mitosis in all three conditions: reactive, benign, and malignant. Patients diagnosed with benign and malignant tumor/tumor-like lesions that had spindle cell components following the histopathological examination were included in the study. The patients’ medical records were accessed to obtain the clinical history, follow-up notes, and radiological findings. Following histopathological, immunohistochemical, and clinical evaluations, the patients were diagnosed as follows: pseudoangiomatous stromal hyperplasia (PASH), bilateral desmoid-type fibromatosis (FM), adenomyoepithelioma (AME), myofibroblastoma (MFB), malignant phyllodes tumor (MF), high-grade AS, post-chemotherapy osteosarcoma (OS) + Paget’s disease, and metaplastic carcinoma (MC). An algorithmic approach should be used in the diagnosis; cellular structure, presence and grade of atypia, growth pattern, mitotic activity, immunohistochemical staining, and clinical and radiological features should be evaluated together. Detection of some molecular changes can be useful in differential diagnosis.
Collapse
Affiliation(s)
- Betül Ünal
- Department of Pathology, Faculty of Medicine, Akdeniz University, 07070 Antalya, Turkey
| | - Gülgün Erdoğan
- Department of Pathology, Faculty of Medicine, Akdeniz University, 07070 Antalya, Turkey
| | - Fatma Şeyda Karaveli
- Department of Pathology, Faculty of Medicine, Akdeniz University, 07070 Antalya, Turkey
| |
Collapse
|
30
|
[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]. ACTA ACUST UNITED AC 2015; 44:1030-48. [PMID: 26530177 DOI: 10.1016/j.jgyn.2015.09.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning rare benign breast tumors: Abrikossoff (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma. METHODS Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and international databases. RESULTS For erosive adenomatosis of the nipple, surgical excision is recommended to exclude Paget's disease or cancer (grade C). When surgery is performed for breast desmoid tumor or syringomatous adenoma, free margins are recommended (grade C). Without clinico-radio-histologic discordance, surgical abstention may be proposed for Abrikossoff tumor (granular cell tumor), cytosteatonecrosis, galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma (grade C).
Collapse
|
31
|
Superficial desmoid tumors: MRI and ultrasound imaging characteristics. Eur J Radiol 2015; 84:2194-201. [PMID: 26358371 DOI: 10.1016/j.ejrad.2015.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/06/2015] [Accepted: 08/19/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe the imaging characteristics of superficial desmoid tumors using magnetic resonance imaging (MRI) and high-resolution sonography (HRUS). METHODS We retrospectively examined 18 patients (12 females and 6 males) with histologically proven superficial desmoids. Fourteen patients received MRI examinations, while 12 patients were examined with HRUS. The lesions were assessed with regard to location, muscular fascia involvement, and spread into the subcutaneous fatty tissue septa, adjacent muscle, and bone. In addition, size, shape, signal intensity/echogenicity relative to muscle, amount of collagen components, Doppler vascularity on HRUS and the degree of contrast enhancement in MRI were evaluated. RESULTS Altogether there were 20 subcutaneous lesions: six involved the chest wall and the breasts, five the hip, four each the shoulder and the flank, and one the abdominal wall. All but three lesions showed a stellar-type configuration with multiple irregular sun-burst-like extensions along the fascial planes and septa of the subcutaneous fat tissue. The extensions spread away from the main tumor focus, and in nine lesions, these extensions reached the cutis. The remaining three lesions had a spindle shape and also presented extensions along the fascial planes. Another imaging feature in all lesions was the presence of variable amounts of collagen components, with typical low signal on MRI and/or fibrillar hyperechoic appearance in HRUS. CONCLUSION The distinctive imaging features of collagen components associated with sun-burst-like extensions in our sample of superficial desmoids are valuable diagnostic clues in the challenging non-invasive differential diagnosis of these tumors.
Collapse
|
32
|
|