Malignant Spindle Cell Tumor Breast—a Diagnostic Dilemma

Abstract

Primary malignant spindle cell tumors are rare constituting 1.0% of breast malignancies. Spindle cell lesions occurring in soft tissues can occur in breast with overlapping morphologies. It can present as benign lesion and have inconclusive cytological findings, so easily missed if not properly dealt with. Stromal sarcoma should be diagnosed only after thorough sectioning and negative staining for p63, broad spectrum, and high molecular weight keratin. We present a case of right breast lump. Cytological features revealed fibro histiocytic lesion. There were no areas of necrosis, hemorrhage, or calcification. Histopathologically, it showed partially encapsulated tumor with cells arranged in sheets, composed of oval to epithelioid cells with spindling at places with moderate pleomorphism (mitotic activity 6-7/10 hpf). Differential diagnosis of primary stromal sarcoma, metaplastic sarcoma, and phyllodes was made. Immunohistochemistry revealed vimentin positivity with focal positivity of S-100. Desmin, cytokeratin and smooth muscle actin, p63, ER, PR, and Her2-neu were negative. A final diagnosis of primary breast sarcoma of neural origin was established with the help of histopathology and immunohistochemistry. To conclude, it is of utmost importance to identify primary stromal sarcomas as they are known to spread very rapidly and have a poor prognosis.

Dermatofibrosarcoma protuberans – the use of neoadjuvant imatinib for treatment of an uncommon breast malignancy: a case report

“…Adding to this difficulty, DFSP represents only 1% of all sarcomas and rarely occurs in the breast, with very few cases having previously been reported [1, 8]. Spindle cell tumors also are exceedingly rare in the breast, comprising 1% of breast malignancies, and are often misdiagnosed, as in this patient [9]. The case presented here demonstrates the importance of histochemical and molecular testing when attempting to differentiate the more atypical neoplasms of the breast.…”

A Rare Case of High-Grade Spindle Cell Sarcoma of the Breast: A Case Report

“…This makes it difficult to plan the diagnosis and management considering that adolescent and pediatric group require to be managed with greater care as compared to adults. Moreover, the breast lesion in our patient progressed rapidly and was complicated by purulent discharge and bleeding which indicated the high-grade and complexity of spindle cell sarcoma (involvement of regional lymph nodes also highlighted the aggressive course of the lesion and differentiated our case from other cases of spindle cell sarcomas which did not report spread to lymph nodes) [4, 7, 8].…”

“…Most common type of cancer among women is breast cancer, with 2.3 million cases diagnosed annually and 684,996 deaths [ 5 , 6 ]. Spindle cell sarcomas of the breast are a type of mesenchymal tumors of the breast which are extremely rare, with an incidence of 4.6 cases per million women per year [ 4 ]. These lesions can be arduous to diagnose due to similarity with other breast lesions and mixed histological patterns [ 1 , 2 ].…”

“…Histopathology and immunohistochemical staining are essential to differentiate spindle cell lesions from other similar lesions which are included in the differential diagnoses such as myofibroblastoma, fibromatosis, pseudoangiomatous stromal hyperplasia, nodular fasciitis, inflammatory myofibroblastic tumor, PT, several primary sarcomas, and metastases [ 4 , 9 ]. Histological examination of sections from the cores revealed a malignant neoplasm arranged in fascicles with intervening epithelial elements.…”

Radiation-induced Stromal Sarcoma of Breast: A Case Report and Literature Review

“…Histologically, its differential diagnosis is cystosarcoma phyllodes and metaplastic carcinoma. It can be differentiated from the former and later by sparing the lobular component and IHC characteristics, respectively (17). Because of the rarity of this disease, the therapeutic ap-2…”