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Zeng YF, Dai YZ, Chen M. Mammary-type myofibroblastoma with infarction and atypical mitosis-a potential diagnostic pitfall: A case report. World J Clin Cases 2022; 10:5343-5351. [PMID: 35812659 PMCID: PMC9210889 DOI: 10.12998/wjcc.v10.i16.5343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/04/2021] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mammary-type myofibroblastoma (MTMF) is a rare benign extramammary soft tissue tumor with myofibroblastic differentiation. Although 160 cases of MTMF have been reported in the literature since 2001, no cases of infarction or atypical mitosis have been reported so far. Herein, we report an unusual case of MTMF in the pelvic cavity, which mimicked some malignant features, including infarction, atypical mitosis, infiltrative growth, and prominent cytologic atypia, making it difficult to ascertain whether the tumor was benign.
CASE SUMMARY A 49-year-old man complained of pain and discomfort in the right buttock for more than 4 mo and did not receive any treatment. Nuclear magnetic resonance imaging (MRI) showed a 13-cm-sized mass in his right pelvic cavity. Histologically significant differences were atypical mitosis figures and multiple necrotic foci in the tumor. In addition, smooth muscle and skeletal muscle were invaded within and at the edge of the tumor. These morphologic features are often reminiscent of malignant tumors and therefore pose a diagnostic challenge to pathologists. The tumor cells were strongly positive for both cluster of differentiation 34 and desmin, and the loss of retinoblastoma 1 shown by immunohistochemical and fluorescence in situ hybridization results confirmed the pathological diagnosis of MTMF. Currently, the patient is alive and in good condition without tumor recurrence or metastasis after 2.5 years of follow-up by telephone and MRI.
CONCLUSION The two pseudo-malignant characteristics of infarction and atypical mitosis broaden the morphological lineage of MTMF, a rare mesenchymal tumor.
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Affiliation(s)
- Yuan-Feng Zeng
- Department of Pathology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, Jiangxi Province, China
| | - Yan-Zhi Dai
- Department of Pathology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, Jiangxi Province, China
| | - Min Chen
- Department of Pathology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, Jiangxi Province, China
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Zeng Y, Wang Q, Jiang X, Yao H, Wang X, Tang X. Diagnostic challenges of intra-operative frozen consultation for mammary epithelioid myofibroblastoma. Int J Surg Pathol 2022; 30:634-641. [PMID: 35175153 DOI: 10.1177/10668969221076547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Myofibroblastoma (MFB) of the breast is a rare benign neoplasm that exhibits several morphologic variants and presents diagnostic challenges for pathologists, especially in recognizing intra-operative frozen sections. In order to raise awareness of this tumor and avoid misdiagnosis, we describe a case of a 38-year-old female patient diagnosed as epithelioid MFB. This painless tumor was well-circumscribed, found in the left breast and was physically examined over a period of six months. Histologically, this tumor was predominantly composed of epithelioid cells, which arranged as single cells, small clusters or nests. Tumor stroma was collagenized with spindle cells, adipose and focal myxoid areas. This case was misinterpreted as invasive carcinoma in the frozen section. The immunohistochemical profile demonstrated positivity for Vimentin, desmin, SMA, calponin, CD34, ER, PR and AR, whereas pan-keratin, keratin 7, keratin 34βE12, keratin 5/6, EMA, p63 and S100 were negative. RB1 was abnormally negative, confirming the diagnosis of epithelioid MFB. Making a correct diagnosis is primarily dependent on awareness by the pathologist of this unusual variant of MFB and careful integration of clinicopathologic findings to avoid potential diagnostic pitfalls.
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Affiliation(s)
- Ying Zeng
- Department of Pathology, Chongqing General Hospital, China
| | - Qianhui Wang
- Department of Pathology, Chongqing General Hospital, China
| | - Xin Jiang
- Department of Pathology, Chongqing General Hospital, China
| | - Hui Yao
- Department of Pathology, Chongqing General Hospital, China
| | - Xue Wang
- Department of Pathology, Chongqing General Hospital, China
| | - Xuefeng Tang
- Department of Pathology, Chongqing General Hospital, China
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A Rare Case of Epithelioid Myofibroblastoma of Breast Mimicking Lobular Carcinoma on Trucut Biopsy: a Diagnostic Pitfall and Literature Review. Indian J Surg Oncol 2021; 12:201-204. [PMID: 33994748 DOI: 10.1007/s13193-021-01294-9] [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: 06/24/2020] [Accepted: 02/24/2021] [Indexed: 10/22/2022] Open
Abstract
Epithelioid myofibroblastoma of the breast is a rare benign stromal tumor occurring in the postmenopausal females and elderly males. We report one such case in a 65-year-old female who underwent trucut biopsy from a well-defined right breast lump, which was misinterpreted as invasive lobular carcinoma on histology. Tumor showed mild to moderately pleomorphic tumor cells arranged in single file pattern, loosely dispersed and focally in sheets with inconspicuous nucleoli embedded in a fibrotic and hyalinized stroma. Immunohistochemistry for E-cadherin was negative further substantiating the morphological diagnosis. However, mastectomy specimen revealed it to be a case of epithelioid myofibroblastoma with the help of a large panel of immunohistochemical stains. In this report, we emphasize on the challenges of establishing this rare diagnosis mimicking lobular carcinoma, a diagnostic pitfall on trucut biopsy.
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Khattab RA, Rowe JJ, Booth CN, Sneige N, Fong N, Pantanowitz L, Oshilaja O, Brainard JA, Downs-Kelly EP, Dawson A, Sturgis CD. Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses. Diagn Cytopathol 2019; 47:1100-1118. [PMID: 31343114 DOI: 10.1002/dc.24288] [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: 05/06/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 11/06/2022]
Abstract
The Uniform Approach to Breast Fine Needle Aspiration Biopsy was put forward by a learned group of breast physicians in 1997. This landmark manuscript focused predominantly on diagnosis and reporting of mammary epithelial lesions. Today, most American practitioners turn initially to core biopsy rather than aspiration biopsy for the first line diagnosis of solid breast lesions; however, recent efforts from the International Academy of Cytology have produced a system called the Standardized Reporting of Breast Fine Needle Aspiration Biopsy Cytology (colloquially labeled in 2017 as the "Yokohama System"), suggesting a new interest in breast fine needle aspiration (FNA), especially in resource limited settings or clinical practice settings with experienced breast cytopathologists. Fibroepithelial lesions of the breast comprise a heterogeneous group of biphasic tumors with epithelial and stromal elements. Mesenchymal lesions of the breast include a variety of neoplasms of fibroblastic, myofibroblastic, endothelial, neural, adipocytic, muscular, and osteo-cartilaginous derivations. The cytology of mesenchymal breast lesions is infrequently described in the literature and is mainly limited to case reports and small series. This illustrated review highlights the cytologic features of fibroepithelial and mesenchymal mammary proliferations and discusses differential diagnoses and histomorphologic correlates.
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Affiliation(s)
- Ruba A Khattab
- Department of Pathology, University Hospitals of Case Western Reserve University, Cleveland, Ohio
| | - J Jordi Rowe
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Nour Sneige
- Department of Pathology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas
| | - Nancy Fong
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Andrea Dawson
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
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Khatib Y, Pandey V, Khade AL, Pandey R. Myofibroblastoma of the Breast: A Rare Cause of Breast Lump in a Postmenopausal Woman. J Midlife Health 2018; 9:47-49. [PMID: 29628731 PMCID: PMC5879850 DOI: 10.4103/jmh.jmh_59_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A breast mass in a postmenopausal age woman is treated with a high index of clinical suspicion for malignancy. Myofibroblastoma (MFB) of the breast is a very rare benign stromal tumor, predominantly occurring in menopausal women and older men. Owing to its rarity, nonspecific radiology, cytomorphology, and many variants, it can be confused with other malignant and benign breast lesions and hence can be a source of diagnostic pitfall. We present a case of an MFB of the breast in a 55-year-old female, which was detected on a routine screening mammography. Fine-needle aspiration cytology was inconclusive. Final diagnosis was made by histopathology and immunohistochemistry examination. We report this case as the likelihood of encountering MFB has increased in recent years due to routine mammographic screening, and this lesion should be kept in the differential diagnosis of spindle-cell lesions of the breast.
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Affiliation(s)
- Yasmeen Khatib
- Department of Pathology, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra, India
| | - Vinita Pandey
- Department of Pathology, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra, India
| | - Archana L Khade
- Department of Pathology, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra, India
| | - Rahul Pandey
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Abstract
Breast tumors with lipomatous or liposarcomatous components are infrequently encountered, but can be a source of diagnostic difficulty if the context of the fatty differentiation is not recognized. Among the true adipocytic tumors, lipoma is the most common lipomatous tumor arising in the breast. Several mammary spindle cell tumors may show adipocytic differentiation, including fibroepithelial tumors and myofibroblastoma. Liposarcomatous components most often arise in malignant phyllodes tumors, as opposed to primary liposarcomas of the breast which are believed to be uncommon. This article will review the spectrum fat-containing tumors of the breast with an emphasis on differential diagnosis and insights from recent molecular studies.
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Affiliation(s)
- J Jordi Rowe
- Department of Pathology Cleveland Clinic, Cleveland, OH, USA.
| | - Alison L Cheah
- Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW 2113, Australia.
| | - Benjamin C Calhoun
- Department of Pathology Cleveland Clinic, 9500 Euclid Avenue, Mail Code L25, Cleveland, OH 44195, USA.
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