Fibromatosis (desmoid tumor) of the breast mimicking a case of ipsilateral metachronous breast cancer

Diagnosis and Management of Desmoid Fibromatosis of the Breast

Desmoid fibromatosis of the breast (also known as desmoid tumor of the breast) is a rare entity infrequently encountered by oncologists and surgeons caring for patients with breast disease. The current body of literature is highly reliant on case series and extrapolations from other sites of desmoid tumor-related disease. Much remains unclear regarding the pathological origins, natural history, and response to treatment of this condition. Traditional treatment strategies have centered on surgical resection, which may result in significantly disfiguring cosmetic and functional outcomes, frequent need for re-operation, and associated morbidity. There are limited data to support the superiority of upfront surgical resection when compared to medical therapy or watchful waiting strategies. Current treatment guidelines for desmoid tumors do not focus on the breast as a site of disease and are purposefully ambiguous due to the paucity of evidence available. We aim to review the literature concerning desmoid fibromatosis of the breast and propose an algorithm for current evidence-based management of this rare disease in the context of our experience with this pathology at a high-volume quaternary referral center.

Multimodality Imaging Assessment of Desmoid Tumors: The Great Mime in the Era of Multidisciplinary Teams

Desmoid tumors (DTs), also known as desmoid fibromatosis or aggressive fibromatosis, are rare, locally invasive, non-metastatic soft tissue tumors. Although histological results represent the gold standard diagnosis, imaging represents the fundamental tool for the diagnosis of these tumors. Although histological analysis represents the gold standard for diagnosis, imaging represents the fundamental tool for the diagnosis of these tumors. DTs represent a challenge for the radiologist, being able to mimic different pathological conditions. A proper diagnosis is required to establish an adequate therapeutic approach. Multimodality imaging, including ultrasound (US), computed tomography (CT) and Magnetic Resonance Imaging (MRI), should be preferred. Different imaging techniques can also guide minimally invasive treatments and monitor their effectiveness. The purpose of this review is to describe the state-of-the-art multidisciplinary imaging of DTs; and its role in patient management.

Imaging findings of a biopsy-proven desmoid tumor of the axilla in a young female

Desmoid tumors (fibromatoses) are rare but locally aggressive tumors that do not metastasize. They are non-encapsulated, well-differentiated lesions made of fibroblasts and collagen, which mainly appear in the mesentery and abdominal wall. Rarely, these tumors can also occur in breasts, making up approximately 0.2% of all breast neoplasms. Treatment typically includes surgical excision and/or medical management.

We describe a case of a 31-year-old female presenting with a mass in her left axilla that was biopsy proven to be a desmoid tumor. In this case report, we discuss the various imaging findings present on ultrasound, mammography, computed tomography, and magnetic resonance imaging.

Desmoid fibromatosis of the breast; a rare case report

Introduction

Desmoid tumor is an uncommon tumor with variable spectrum ranged from being a locally lesion to an aggressive and destructive one. The current case aims to report a rare condition of desmoid type fibromatosis of the breast.

Presentation of case

A 59-year-old female presented with a right breast mass for 9-months. Mammography showed a small speculated iso-hyper dense mass, just anterior to the pectoralis muscle measuring about 15 mm (M5) in longest axis. Ultrasound examination revealed an irregular mass with internal vascularity and posterior shadowing in the right breast with a single borderline lymph node (25 ∗ 14 mm of 4 mm cortex). Wide local excision with sentinel axillary lymph nodes biopsy was performed. Histopathological examination of the specimen confirmed the diagnosis of desmoid type fibromatosis of the breast.

Discussion

The etiology of this tumor is unknown, however, physical, hormonal and genetic factors have a significant role in the development of desmoid tumor.

Conclusion

Desmid type fibromatosis of the breast is an uncommon, benign, locally aggressive fibroblastic tumor with lack of metastatic potential, it may present with features of malignancy.

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Desmoid tumor is an uncommon tumor.

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The occurrence of desmoid tumor in the breast is even rarer.

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Differentiation from malignant disease is a challenging task.

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The current report discusses a case of desmoid type fibromatosis of the breast.

Breast Fibromatosis: Radiologic-Pathologic Correlation

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.

Radiologic images of an aggressive implant-associated fibromatosis of the breast and chest wall: case report and review of the literature

Fibromatosis of the breast is a rare benign disease compromising <0.2% of all primary breast tumors. Although the chest wall is a common location, occurrences of implant-associated fibromatosis of the breast are extremely rare; only 33 cases have been reported. We present a case of a 42-year-old female who underwent breast augmentation with silicone breast implants, and 2 years later developed an aggressive implant-associated fibromatosis of the breast and chest wall. On imaging studies, the tumor mimicked breast carcinoma, and despite chemotherapy, the fibromatosis rapidly enlarged and was locally invasive requiring wide surgical excision. Unlike previously reported imaging findings, magnetic resonance imaging revealed an oval circumscribed mass with fringe-like internal architecture. We provide a review of the literature and discuss the imaging features of implant-associated fibromatosis of the breast.

Fibromatosis of the breast mimicking an abscess: case report of unusual sonographic features

Fibromatosis of the breast, also known as a desmoid tumor, is extremely rare and most often appears as an aggressive lesion mimicking breast carcinoma. It lacks metastatic potential but can grow aggressively in a localized area. Ultrasonography often shows an irregular spiculated hypoechoic mass with posterior acoustic shadowing. We discuss a case of breast fibromatosis that presented as a painful palpable breast mass in a 32-year-old woman and mimicked an abscess in the sonogram. We found that this lesion displayed atypical sonographic features such as a heterogeneous echoic mass with an internal anechoic area.

Fibromatosis of the breast: a pictorial review of the imaging and histopathology findings

Fibromatosis of the breast is a rare condition that predominantly affects middle-aged women. It is locally aggressive, and exhibits a high incidence of local recurrence. The clinical presentation and radiological appearance are highly suspicious for carcinoma. Definitive diagnosis is made by diagnostic open biopsy. The aim of this review is to illustrate the main radiological and histopathological characteristics of this rare disease to increase awareness of this entity and discuss the role of magnetic resonance imaging (MRI) in its management.

Breast fibromatosis response to tamoxifen: dynamic MRI findings and review of the current treatment options

Breast fibromatosis is a rare entity responsible for 0.2% of all solid breast tumors. It has been associated with scars, pregnancy, implants, and familial adenomatous polyposis. We present an interesting case of breast fibromatosis in a 29 year old woman which encroached upon her saline implant and subsequently filled its cavity once the implant was removed. The patient was put on tamoxifen therapy and at 14 month follow-up there was a significant decrease in the size of the mass. Dynamic MRI images are offered for review and current treatment options are discussed.

Bilateral breast fibromatosis: case report and review of the literature

Fibromatosis or desmoid tumor is a benign, slow-growing fibroblastic neoplasm originating from musculoaponeurotic stromal elements. These tumors are characterized by an infiltrative and locally aggressive growth pattern, frequent recurrences, but no metastatic potential. The etiology is unknown, but these tumors have been associated with trauma and genetic disorders. Breast fibromatosis is exceedingly rare and often misdiagnosed, comprising only 0.2% of breast tumors. Clinically, it might mimic other breast lesions, such as carcinoma. Only approximately 6 case series and 100 case reports of this disorder affecting the breast are documented, and only 5 cases of bilateral breast fibromatosis have been reported. We describe the case of a 20-year-old woman who presented to our institution with firm, nontender masses palpable in both breasts. Prior ultrasound was suspicious for carcinoma, and breast core biopsies were suggestive of phyllodes tumor. An excisional biopsy was necessary to establish the diagnosis of breast fibromatosis for both masses. A review of articles published on desmoid tumors and breast fibromatosis was performed with emphasis on articles published in the last 10 years. Fibromatosis should be considered in the differential diagnosis of patients presenting with hard breast lumps suspicious of other diseases.

[Desmoid tumor of the breast in a 9 years old little girl]

Aggressive fibromatosis (desmoid tumour) of the breast is a rare tumour that accounts only for 0.2% of primary breast tumours. This is a benign mesenchymal tumour that develops from muscular fasciae and aponeuroses. It is characterized by its local evolution and its tendency to relapse without metastasizing. Wide radical resection should be attempted whenever possible. Positive margins at resection and reoperation are associated with a high risk of local recurrence. The role of radiotherapy and of medical treatments- especially anti-estrogens - remains unclear. We report here the case of desmoid tumour of the breast arising in a 9-year-old little girl.

Bigger than a breadbox; lighter than a heavy heart

Inexact measurements can have devastating effects in sciences where precision is of paramount importance. In contrast, morphological sciences rely heavily on description, comparison, and estimation to make meaningful inferences about the structure of humans and other animals. A review of the 1918 edition of Gray's Anatomy shows that the tendency to approximate was as marked nearly a century ago as it is today. Occasionally, objects of comparison may themselves become obsolete, necessitating changes in descriptive terminology.