Sarcoma of breast

Surgery for Malignant Mesenchymal Tumors of the Breast: A Series of 31 Cases

Thirty-one cases of malignant mesenchymal tumors of the breast were analyzed with the purpose of identifying the most suitable type of surgery to be recommended. All the cases considered underwent pathologic review. Even young women were affected, and menopausal status did not seem to influence the development of mesenchymal tumors. Mammography was of little use for diagnosis. All cases underwent surgery and 26 had an adequate follow-up. In 8 cases a relapse occurred with a mean free interval of 6 months. Total mastectomy was sufficient to provide local control, whereas axillary dissection turned out to be not worthwhile. Postoperative radiotherapy did not improve distant results. Relapses mainly consisted of lung metastases. Fifteen patients were alive, free of disease, at a time ranging from 9 months to 13 years after surgery.

Histopathology, Collateral Lesions and Morphological Precursors in Six Cases of Sarcoma of the Female Breast

A personal case of osteoclast-like giant cell sarcoma of the mammary gland is reported together with five other breast sarcomas observed during sixteen years at this Institute. Clinical and pathological findings are discussed. The frequent association of sarcomas with previous and/or simultaneous fibroadenomas in the same breast is emphasized.

Primary breast sarcoma: clinicopathologic series from the Mayo Clinic and review of the literature

Primary sarcomas of the breast are extremely rare, with less than 0.1% of all malignant tumours of the breast. Mayo Clinic Surgical Pathology database was searched for all breast sarcoma from 1910 to 2000. Pathology reports and slides were reviewed and tumour types were determined. Metaplastic carcinomas and phyllodes tumours were excluded. There were 25 women ranging in age 24-81 years (mean 45 years). All but one patient presented with a palpable lump. Mastectomy was performed in 19 patients and lumpectomy in five patients. Histopathological diagnoses were fibrosarcoma (six), angiosarcoma (six), pleomorphic sarcoma (six), leiomyosarcoma (two), myxofibrosarcoma (three), hemangiopericytoma (one) and osteosarcoma (one). Tumour size ranged from 0.3 to 12 cm (mean 5.7). Low-grade lesions were observed in 10 cases and high-grade in 15. Overall, mean follow-up was 10.5 years. Local recurrence was observed in 11 patients and ranged from 2 to 36 months (mean 15 m), while distant metastasis was observed in 10 patients (40%) affecting lungs, bones, liver, spleen, and skin. Of the 25 patients, 12 have died of disease and six of other causes. Five-year overall (OS) and cause-specific survival (CSS) were 66 and 70%, respectively. OS and DFS at 5 years were 91% for tumours < or =5 cm and 50% for tumours >5 cm. Tumour size was significantly associated with OS (risk ratio=1.3 per 1 cm increase; 95% CI, 1.02-1.7; P=0.036). There was no significant difference in OS or CSS between low- and high-grade lesions. In this series, tumour size was a more valuable prognostic factor than tumour grade.

P53 expression is a factor for prognostic assessment in breast sarcoma

The present study was undertaken with the aim of evaluating the clinical and anatomopathological findings, emphasizing expression of the protein p53 as possible prognostic markers, in patients with breast sarcoma. p53 immunohistochemical expression was determined in archival paraffin embedded tissue blocks of 30 breast sarcoma patients, (19 fibrosarcomas, nine malignant fibrohistiocytomas and two liposarcomas) treated at the Hospital do Cancer AC Camargo, São Paulo, Brazil from 1955 to 1990. Immunopositivity was present in 50% of the cases. The survival of the patients was compared with the above parameters. Median follow up time was 113 months. The 5 years specific survival rates were 55.1% for patients with a positive expression of p53 contrariwise to 92.3% of specific survival found in p53 negative patients (p = 0.04). Positive expression of p53 was found in 3/4 (75%) of the patients with local recurrence and in 7/9 (77%) of patients with metastatic disease. No significant correlation between survival and clinicopathologic features (age, menopausal status, tumor size, stage and histological type), was found. A slight positive correlation between high grade and poor outcome was observed, 89% of the metastatic cases being classified as high grade (p = 0.02, by one sided Fisher's exact test). When we have compared, independently, survival probability curves between p53 positive/negative expression and each category of clinicopathologic features a worse prognosis was observed when p53 was positive in patients older than 50 years (p = 0.01), in tumors larger than 5 cm (p = 0.02), within the malignant fibrous histiocytoma subtype (p = 0.01) and in tumors classified as high grade (p = 0.07). In conclusion p53 expression seems to be a useful prognostic marker for this type of tumor.

Primary soft tissue sarcoma of the breast

Primary soft tissue sarcoma (STS) of the breast is a rare and heterogeneous disease. The rarity of this tumor limits most studies to small retrospective case reviews and case reports. The optimal treatment of primary STS of the breast can best be determined through multidisciplinary discussions prior to the initiation of therapy. Whether chemotherapy is indicated is primarily determined by tumor size. There is evidence that tumors larger than 5 cm are associated with an elevated risk of systemic failure and a poor prognosis. Negative surgical margins are more important for local recurrence and overall survival than is the extent of surgical resection. Thus, neoadjuvant chemotherapy should be considered in order to shrink the tumor and help obtain negative surgical margins. After surgical resection, patients with chemosensitive tumors should undergo additional adjuvant chemotherapy to treat micrometastatic disease. Patients with tumors less than 5 cm that are easily resectable should undergo complete resection to the extent required to provide negative surgical margins. Radiation therapy should be used to improve local control in cases in which the tumor is larger than 5 cm and in cases with positive surgical margins. The appropriate treatment of primary STS of the breast requires a multidisciplinary approach necessitating experienced surgeons, pathologists, radiotherapists, and medical oncologists.

Immunocytochemical investigation of intermediate filament proteins and epithelial membrane antigen in spindle cell tumours of the breast

Seven consecutive cases of primary spindle celled tumours of the breast have been studied immunohistologically using antisera to the intermediate filament proteins (IFP) vimentin, cytokeratin, and desmin, and with an antibody to epithelial membrane antigen. Representative paraffin sections were examined using a peroxidase-antiperoxidase method. In three cases, very occasional foci of epithelial differentiation were apparent by conventional microscopy, and in one case, adjacent ductal carcinoma in situ was present. The remaining three cases were composed of spindle cell elements entirely, with no evidence of epithelial differentiation morphologically. Immunoreactivity of spindle cell elements for vimentin was found in all seven cases, and for cytokeratin in six cases. One case showed immunoreactivity for vimentin, cytokeratin, and desmin, and one case only for vimentin. Epithelial membrane antigen was not identified in the spindle cell elements of any tumour, but was present in the invasive epithelial component of three cases and the in situ component of one case. We conclude that many spindle cell tumours of breast show immunohistological evidence of epithelial differentiation and can be regarded as spindle cell carcinomas. However, in some cases IFP expression may be complex and histogenesis cannot be determined. This technique can aid histological diagnosis in some cases.

A classical osteogenic sarcoma of the breast: histology, immunohistochemistry and ultrastructure

A classical osteogenic sarcoma of the breast is described and the results of light microscopy, including immunohistochemistry for epithelial and mesenchymal markers, and of electron microscopy are presented. No epithelial features were detected by any of the methods used, the tumour being considered a true osteogenic sarcoma. The tumour appears to have arisen de novo, and not from a pre-existing fibroadenoma.

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

We treated a fifty six-year-old woman with leiomyosarcoma of the breast. Light microscopy showed typical findings of leiomyosarcoma and electron microscopy confirmed the smooth muscle origin of the tumor. The patient is well without evidence of metastases or local recurrence of the tumor fifty-five months after radical mastectomy.

Cystosarcoma phyllodes of the mammary gland--Müller's tumor. For the 180th birthday of Johannes Müller

For the last 150 years, cystosarcoma phyllodes of the mammary gland has had 62 different synonyms. At the present time, the most logical name for it seems to be tumor phyllodes. The result of the histological analysis of every single tumor should contain information about the degree of its maturity. The classical description of cystosarcoma phyllodes given by Johannes Müller (1838) is still considered the basis for understanding the clinical and histogenetical aspects of this neoplasm.

Stromal sarcoma of breast: a light and electron microscopic study

A case of stromal sarcoma of the breast was studied by light and electron microscopy. The tumor comprised of uniform, plump spindle cells with neither epithelial nor "metaplastic" mesenchymal elements. Ultrastructurally most of the tumor cells appeared immature containing abundant free ribosomes, variable amounts of microfilaments and profiles of rough endoplasmic reticulum, with scant intercellular collagen and elastic fibers. The cells often showed prominent nesting as well as a variety of cell junctions, including desmosomes. We believe this tumor is a poorly differentiated, precursor mesenchymal sarcoma which belongs in the category of "stromal sarcoma of breast," a term coined by Berg et al. in 1962. To our knowledge, this represents the first published electron microscopic study on this tumor. Despite a high mitotic figure count in the tumor, the patient has survived a simple mastectomy with no evidence of metastasis 30 months later.

Sarcomas of the breast: a clinicopathologic analysis of ten cases

The clinical and pathologic features of ten mammary sarcomas are discussed. Tumor size, contour, degree of cellular atypia, and mitotic activity were specifically evaluated to determine if they are important indiced of clinical behavior. Results indicate that infiltrating margins, 2-3+ stromal atypia, and eight or more mitoses per 10 HPF are characteristics of neoplasms associated with a poor prognosis. Tumor size was an unreliable criterion. A classification of breast sarcomas is presented with an appeal to avoid use of the term "stromal sarcoma" as a specific pathologic diagnosis. Since a diagnosis based upon cell of origin and correlated with the above morphologic features is fundamental to an intelligent therapeutic approach to this rare group of neoplasms, future reports dealing with this subject should include these details.

Metastatic cystosarcoma phyllodes: a light and electron microscopic study

Two cases of metastatic cystosarcoma phyllodes, one in lung and the other in axillary lymph nodes, were studied with the light and the electron microscopes. The malignant element of these tumors appears to be a poorly differentiated mesenchymal cell. No evidence supporting the presence of epithelial cells was found. The tumor metastatic to the axilla exhibited intracellular virus-like particles similar to those described in adenocarcinoma of breast and other sarcomas.

The unique association of mammary stromal sarcoma with intraductal carcinoma

The unique combination of clinically unsuspected stromal sarcoma and noninfiltrating intraductal mammary carcinoma is presented. This association has not been previously documented. The clinicopathologic features of cystosarcoma phyllodes and mammary stromal sarcoma are reviewed to provide background perspectives to illuminate the unusual aspects of this case.

A composite malignant tumour of the elderly female breast

A composite malignant tumour arising in the breast of an elderly woman is described. The cystic tumour containing areas of squamous metaplasia, bone formation, adenocarcinoma, and osteosarcoma was surrounded by the typical changes of mammary dysplasia (fibroadenosis). The classification and acceptance of such tumours is highly debatable. There is no one acceptable classification of breast sarcomas and hence the prognosis of such neoplasms, particularly those containing heterologous tissues, is poorly defined. Evidence is presented in support of such composite tumours as being definite entities which arise from the closely associated epithelial and mesenchymal components of the breast simultaneously.