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Azam R, Mrkonjic M, Gupta A, Gladdy R, Covelli AM. Mesenchymal Tumors of the Breast: Fibroblastic/Myofibroblastic Lesions and Other Lesions. Curr Oncol 2023; 30:4437-4482. [PMID: 37232796 DOI: 10.3390/curroncol30050338] [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: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 05/27/2023] Open
Abstract
Mesenchymal breast tumors are a rare and diverse group of tumors that present some of the most challenging cases for multidisciplinary breast cancer teams. As a result of overlapping morphologies and a lack of large-scale studies on these tumors, practices are often heterogeneous and slow to evolve. Herein, we present a non-systematic review that focuses on progress, or lack thereof, in the field of mesenchymal breast tumors. We focus on tumors originating from fibroblastic/myofibroblastic cells and tumors originating from less common cellular origins (smooth muscle, neural tissue, adipose tissue, vascular tissue, etc.).
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Affiliation(s)
- Riordan Azam
- Postgraduate Medical Education, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Miralem Mrkonjic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 1X5, Canada
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Abha Gupta
- Department of Medical Oncology, University of Toronto, Toronto, ON M5G 1X8, Canada
- The Hospital for Sick Children and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Rebecca Gladdy
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Andrea M Covelli
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
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Brandão RG, Elias S, Nazário ACP, Assunção MDCGA, Papa CCE, Facina G. Leiomyoma of the breast parenchyma: a case report and review of the literature. SAO PAULO MED J 2018; 136:177-181. [PMID: 28977094 PMCID: PMC9879555 DOI: 10.1590/1516-3180.2016.0253040117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Benign tumors are often seen in breast screening examinations. However, the differential diagnosis is not always simple because of radiological similarity between the different benign lesions. CASE REPORT We present a rare case report of leiomyoma of the breast parenchyma in a 68-year-old asymptomatic patient. The mammographic and ultrasonographic findings were similar to those observed in benign lesions. CONCLUSION The histopathological diagnosis requires careful differentiation from lesions that have smooth muscle proliferation, especially leiomyosarcoma. The most commonly performed treatment is resection of the lesion with free margins. Although breast leiomyoma is rare, it should be considered among the differential diagnoses for breast nodules of benign appearance. Resection with safety margins proved to be the only treatment needed.
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Affiliation(s)
- Rodrigo Gregório Brandão
- Medical Doctor and Doctoral Student, Discipline of Mastology, Department of Gynecology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Simone Elias
- Medical Doctor, Doctorate in Medicine and Assistant Professor, Discipline of Mastology, Department of Gynecology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Afonso Celso Pinto Nazário
- Medical Doctor, Doctorate in Medicine and Full Professor of the Department of Gynecology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | | | | | - Gil Facina
- Medical Doctor, Doctorate in Medicine, Full Professor and Head of the Discipline of Mastology, Department of Gynecology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
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Abstract
Myofibroblastic, fibroblastic and/or myoid lesions are rare in the breast but comprise the majority of mammary mesenchymal spindle cell lesions. Whereas most have similar features to their counterparts at extramammary sites, pseudoangiomatous stromal hyperplasia is considered a breast-specific myofibroblastic proliferation on the same spectrum as myofibroblastoma. Other lesions with myofibroblastic/fibroblastic differentiation include fibromatosis and nodular fasciitis, as well as more aggressive tumors such as the rarely reported myofibrosarcoma, inflammatory myofibroblastic tumor and fibrosarcoma. Lesions with myoid differentiation include benign leiomyoma, myoid hamartoma and leiomyomatous myofibroblastoma, but primary leiomyosarcoma and rhabdomyosarcoma may also rarely arise in the breast. Furthermore, fibroepithelial lesions and metaplastic carcinomas can demonstrate myoid metaplasia. Diagnosis can be challenging, particularly on core biopsy, but benign lesions with or without recurrence potential must be distinguished from more aggressive tumors, especially metaplastic carcinoma and phyllodes tumors. This article will review lesions with myofibroblastic, fibroblastic and myoid differentiation in the breast, with special emphasis on differential diagnosis.
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Affiliation(s)
- Gregor Krings
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.
| | - Patrick McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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Long-Standing Nodule of the Nipple. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Brugués A, Alós L, Fuertes de Vega I. Long-Standing Nodule of the Nipple. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:501-2. [PMID: 25701893 DOI: 10.1016/j.ad.2014.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- A Brugués
- Servicio de Dermatología, Hospital Clínic, Barcelona, España.
| | - L Alós
- Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, España
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Spyropoulou G, Pavlidis L, Trakatelli M, Athanasiou E, Pazarli E, Sotiriadis D, Demiri E. Rare benign tumours of the nipple. J Eur Acad Dermatol Venereol 2014; 29:7-13. [DOI: 10.1111/jdv.12623] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 06/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- G.A. Spyropoulou
- Department of Plastic and Reconstructive Surgery; Aristotle University of Thessaloniki; Papageorgiou General Hospital; Thessaloniki Greece
| | - L. Pavlidis
- Department of Plastic and Reconstructive Surgery; Aristotle University of Thessaloniki; Papageorgiou General Hospital; Thessaloniki Greece
| | - M. Trakatelli
- Department of Dermatology; Aristotle University of Thessaloniki; Papageorgiou General Hospital; Thessaloniki Greece
| | - E. Athanasiou
- Department of molecular and gene therapy; Hematology Clinic; Papanikolaou General Hospital; Thessaloniki Greece
| | - E. Pazarli
- Department of Pathology; Papageorgiou General Hospital; Thessaloniki Greece
| | - D. Sotiriadis
- Department of Dermatology; Aristotle University of Thessaloniki; Papageorgiou General Hospital; Thessaloniki Greece
| | - E. Demiri
- Department of Plastic and Reconstructive Surgery; Aristotle University of Thessaloniki; Papageorgiou General Hospital; Thessaloniki Greece
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Pavlidis L, Vakirlis E, Spyropoulou GA, Pramateftakis MG, Dionyssiou D, Demiri E. A 35-year-old woman presenting with an unusual post-traumatic leiomyoma of the nipple: a case report. J Med Case Rep 2013; 7:49. [PMID: 23421917 PMCID: PMC3599736 DOI: 10.1186/1752-1947-7-49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/15/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Leiomyoma of the mammary papilla is one of the most uncommon nipple tumors with only 50 cases reported in the literature until now. To the best of our knowledge we present the first report of a nipple leiomyoma that originated from a traumatic abrasion caused by breastfeeding. Case presentation A 35-year-old healthy Caucasian female with a cauliflower-like tender and pink nodular mass that was approximately 10mm in diameter presented to our out-patients department. The patient suggested that the mass originated from a traumatic abrasion caused by breastfeeding three years ago and it has been slowly growing ever since. An excision biopsy was performed. The histological and immunohistochemical examination confirmed the diagnosis of leiomyoma. There were no postoperative complications or any sign of local recurrence four years postoperatively. Conclusions Leiomyoma of the mammary papilla is a rare benign neoplasm that usually appears as a solid tender nodule. Differential diagnosis comprises breast carcinoma, leiomyosarcoma and myoid hamartoma. The recommended treatment is complete excision of the tumor with histologically confirmed tumor-free margins otherwise recurrence is possible. A detailed history of the patient’s disease can reveal the original etiology. This is an original case report that will have particular interest to plastic surgeons, dermatologists, and pathologists. The pathogenetic mechanism was trauma of the nipple. According to our review of the literature this particular information has never been reported and we think that it may advance our knowledge of this very infrequent tumor.
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Affiliation(s)
- Leonidas Pavlidis
- Plastic Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital Thessaloniki, Thessaloniki, Greece.
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Two cases of male nipple leiomyoma: idiopathic leiomyoma and gynecomastia-associated leiomyoma. Am J Dermatopathol 2012; 34:287-91. [PMID: 22207446 DOI: 10.1097/dad.0b013e31822a3075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe 2 cases of male nipple leiomyoma. A 70-year-old man had a painful subcutaneous tumor on his left nipple of 6 months duration. Histopathology disclosed dermal spindle cells with oval-shaped nuclei forming interlacing bundles with irregular pattern. Glandular elements were absent. The spindle cells were positive to α-smooth muscle actin, desmin, and vimentin. Estrogen receptor (ER) and progesterone receptor (PrR) were negative. We diagnosed this case as male leiomyoma of the nipple. Another patient was a 61-year-old man with gynecomastia induced by spironolactone of 6 months duration. He also had a painful nodule on his left nipple and histopathology disclosed spindle-shaped tumor cells as in the previous patient. The tumor was accompanied by glandular elements in the deep dermis and subcutaneous tissue, which showed apocrine secretion and were positive for α-smooth muscle actin, ER, and PrR. These glandular elements were interpreted as mammary gland. But ER and PrR stain did not show positive results for leiomyoma in the upper dermis. To the best of our knowledge, this is the first report of male idiopathic and gynecomastia-induced leiomyoma with ER and PrR staining.
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Cho HJ, Kim SH, Kang BJ, Kim H, Song BJ, Lee AW. Leiomyoma of the nipple diagnosed by MRI. Acta Radiol Short Rep 2012; 1:10.1258_arsr.2012.120025. [PMID: 23986851 PMCID: PMC3738360 DOI: 10.1258/arsr.2012.120025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 09/13/2012] [Indexed: 11/28/2022] Open
Abstract
Leiomyoma of the nipple is a rare, benign, non-epithelial tumor that is thought to arise from smooth muscle fibers in the subareolar tissue of the breast. We report an unusual case of leiomyoma of the nipple in a 32-year-old woman in whom the diagnosis was made by ultrasound-guided core needle biopsy. She came to our hospital complaining of a recently enlarged nipple with discharge and erosion in the region of the left nipple-areolar complex. This mass was evaluated by mammography, ultrasonography, and magnetic resonance imaging (MRI). To the best of our knowledge, this is the first case of a leiomyoma of the nipple examined by MRI. MRI showed an oval mass with circumscribed margins that appeared as an intermediate signal intensity on both T1- and T2-weighted images. A dynamic MRI study showed a rim-enhancing oval mass with delayed persistent enhancement. Ultrasound-guided core needle biopsy revealed spindle cell proliferation consistent with leiomyoma of the nipple.
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Kim JH, Kim HJ, Lee KG, Yi SM, Kim IH, Ro KW. Reactive hypertrophy of the nipples in a patient with atopic dermatitis. Clin Exp Dermatol 2011; 37:303-5. [PMID: 22007792 DOI: 10.1111/j.1365-2230.2011.04176.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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[Hyperkeratotic lesion of the nipple revealing cutaneous leiomyoma]. Ann Dermatol Venereol 2008; 135:571-4. [PMID: 18789291 DOI: 10.1016/j.annder.2008.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 02/14/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Leiomyoma of the nipple and areola is a rare benign neoplasm. We report the case of a patient with leiomyoma of the nipple presenting as a hyperkeratotic plaque. OBSERVATION A 23-year-old patient presented with a five year history of a papillomatous, hyperkeratotic, painful plaque originating in her right nipple. Histological examination of a punch biopsy showed hyperkeratosis of the epidermis with dilatation of the lymphatic vessels within the dermis. Surgical excision revealed a proliferation of smooth muscle fibres, leading to diagnosis of leiomyoma. DISCUSSION The clinical and histological features were initially consistent with idiopathic naevoid hyperkeratosis of areola. However, associated pain is uncommon in idiopathic lesions. This unusual feature led us to surgical excision enabling the diagnosis of leiomyoma. A hyperkeratotic lesion of the nipple may be associated with benign or malignant neoplasms, hamartoma or chronic dermatoses, or it may be idiopathic. In the present case, the hyperkeratotic lesion revealed subareolar leiomyoma. This is an uncommon clinical presentation not previously seen in medical observations, since leiomyoma usually presents as a firm, painful lump in the subareolar region.
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Mandal S, Dhingra K, Khurana N. Parenchymal leiomyoma of breast, mimicking cystosarcoma phylloides. ANZ J Surg 2008; 78:108-9. [DOI: 10.1111/j.1445-2197.2007.04376.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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