Prognostic Factors in Primary Breast Sarcomas: A Series of Patients With Long-Term Follow-Up

Zelek, Laurent; Llombart-Cussac, Antonio; Terrier, Philippe; Pivot, Xavier; Guinebretière, Jean Marc; Péchoux, C. Le; Tursz, Thomas; Rochard, F.; Spielmann, M.; Cesne, Axel Le

doi:10.1200/jco.2003.06.080

Cited by 197 publications

(191 citation statements)

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“…Tumour size seems to be the most frequently reliable prognostic factor in many of these series, as in breast carcinomas and softtissue sarcomas (Oberman, 1965;Norris and Taylor, 1968;Gutman et al, 1994;Barrow et al, 1999;Zelek et al, 2003) Other reported prognostic factors are the histopathological diagnosis (Barrow et al, 1999), the infiltrative features (Norris and Taylor, 1968;Barnes and Pietruszka, 1977), the histopathologic grading (Norris and Taylor, 1968;Barnes and Pietruszka, 1977;Gutman et al, 1994;Barrow et al, 1999;Zelek et al, 2003), presence of positive margins (Berg et al, 1962;Barrow et al, 1999), and extent of surgery for local recurrence (Pollard et al, 1990;North et al, 1998). Some authors found age to be of prognostic importance (Ludgate et al, 1977).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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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 p5 cm and 50% for tumours 45 cm. Tumour size was significantly associated with OS (risk ratio ¼ 1.3 per 1 cm increase; 95% CI, 1.02 -1.7; P ¼ 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. Primary sarcomas of the breast are rare, malignant tumours arising from the mesenchymal tissue of the mammary gland (Oberman, 1965;Barnes and Pietruszka, 1977;Callery et al, 1985), with an approximate incidence of 17 new cases per million women (Moore and Kinne, 1996). At the Mayo Clinic, 27 881 malignant breast tumours were seen between 1940 and 1999 (C Adem, personal unpublished data) and 18 breast sarcomas were diagnosed accounting for 0.0006% of breast malignancies.Breast sarcomas should be distinguished from metaplastic carcinomas (Adem et al, 2002). When facing a spindle cell neoplasm in an epithelial organ such as the breast one should be careful in rendering the diagnosis of sarcoma. In this setting, immunohistochemistry using the right antibodies is of major input. Berg et al defined stromal sarcomas of the breast in 1962 as a group of mesenchymal malignant tumours with fibrous, myxoid and adipose components, excluding malignant cystosarcoma phyllodes, lymphomas and angiosarcomas (Berg et al, 1962). However, series in the literature have included many different entities under the rubric of sarcomas such as cystosarcoma phyllodes, lymphosarcoma and carcinosarcoma (Botham et al, 1958;Donegan, 1967;Fawcett, 1967;Kennedy and Biggart, 1967;Rissanen and Holsti, 1968;Gogas et al, 1976;Ludgate et al, 1977;Khanna et al, 1981;Christensen et al, 1988;Terrier et al, 1989;Pitts et al, 1991;Ciatto et al, 1992;Luna Vega et al, 1992;McGregor et al,...

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Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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“…With small tumors, recurrence is usually local and distant metastases are infrequent. However, tumors larger than 5 cm are associated with distant metastases, independent of local recurrence [8].…”

Section: Discussionmentioning

confidence: 99%

“…However in present case the diagnosis could be made pre-operatively on NCB with help of IHC. Differential diagnosis of this rare tumor include: benign hemangioma, cystosarcoma phyllodes, stromal sarcoma, metaplastic carcinoma, fibrosarcoma, liposarcoma, squamous cell carcinoma with sarcomatoid features, myoepithelioma, fibromatosis, and reactive spindle cell proliferative lesion [2,8]. Surgical resection with mastectomy is the usual treatment.…”

Section: Discussionmentioning

confidence: 99%

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Primary Angiosarcoma of Breast: A Case Report

Raju

Mahajan

Rehmani

et al. 2014

Indian J Surg Oncol

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Primary breast sarcomas are rare entities. These malignant tumors originate from mesenchymal glandular breast tissue and account for <1 % of all breast cancer cases. Angiosarcomas are rare malignant tumors that arise from endothelial cells lining vascular channels. Most angiosarcomas are secondary to radiotherapy treatments for breast cancer or to an arm lymphoedema subsequent to a modified radical mastectomy. Primary angiosarcomas are rare and account for 0.04 % of all malignant breast tumors. Keywords Breast . Primary angiosarcoma Case reportA 22 year old female presented with 4 months history of awareness of painless progressive lump in left breast. There was no history of previous breast surgery or irradiation. On examination there was a large lump occupying all quadrants of left breast with skin nodules and plaques and pinkish blue discoloration (Fig. 1a). Examination of axilla was unremarkable. Trucut biopsy from the lump was suggestive of vascular channels dissecting the stroma. Vascular channels were lined by plump endothelial cells with extensive haemorrhage and focal mitotic activity. Morphology suggested possibility of angiosarcoma. Immunohistochemistry (IHC) was positive for CD 31 and CD 34. Based on these findings provisional diagnosis of angiosarcoma of left breast was kept. Chest radiograph, ultrasonography of abdomen and F-18 bone scan were negative for metastatic disease. Patient underwent total mastectomy with level I axillary lymph node dissection with latissimus dorsi myocutaneous flap reconsruction. On gross examination tumour was well circumscribed measuring 17× 14×7 cm. Histopathologic examination (HPE) showed large gaping vascular channels lined by endothelial cells, focally arranged as lobular aggregates with atypical mitosis (5-6 per 10 high power fields) and focally congested vascular channels (Fig. 1b). All margins were free of tumour. All 7 nodes resected were negative for malignancy. IHC was negative for cytokeratin and positive for CD 31 (Fig.1c) and CD 34. IHC was negative for estrogen and progesterone receptors. More than 75 % of bulk of tumour was formed by well differentiated pattern but there were significant foci showing solid areas with marked pleomorphism and mitotic activity. So, diagnosis of primary intermediate grade angiosarcoma of breast was made. Patient received 50 Gy radiation therapy to chest wall (2 Gy per fraction over 5 weeks) followed by three cycles of adriamycin and ifosfamide based chemotherapy. Following third cycle of chemotherapy she complained of bone pains. F-18 bone scan was done and it was suggestive of multiple bone metastasis while contrast enhanced computed tomogram of chest, abdomen and pelvis was negative for metastasis. DiscussionPrimary breast angiosarcoma is more frequent in young women (20 to 50 years) with no previous cancer history or other known risk factors [1,2]. Between 6 and 12 % of primary breast angiosarcomas are diagnosed during pregnancy or shortly after, suggesting hormonal involvement. However, cases reported to display ...

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“…In fact, PTs range from benign to malignant lesions. The ductal component is usually benign, whereas malignancy develops in the mesenchymal portion of phyllodes tumour, which can contain liposarcomatous, leiomyosarcomatous, chondrosarcomatous, osteosarcomatous and/or angiosarcomatous constituents, singly or variably admixed [3,4]. Malignant PT most commonly metastasizes to the lungs and to the bones [4].…”

Section: Introductionmentioning

confidence: 99%

Angiosarcomatoid Dermo-Hypodermic Lung and Cardiac Metastases from Malignant Breast Phyllodes Tumour

Bella¹,

Ferrara²

2016

J Med Diagn Meth

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Prognostic Factors in Primary Breast Sarcomas: A Series of Patients With Long-Term Follow-Up

Abstract: PBSs have the same clinical history and prognostic factors as sarcomas arising at other sites. Therefore, it is legitimate to use a similar treatment strategy for PBS as for other sarcomas.

Cited by 197 publications

References 24 publications

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

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

Primary Angiosarcoma of Breast: A Case Report

Angiosarcomatoid Dermo-Hypodermic Lung and Cardiac Metastases from Malignant Breast Phyllodes Tumour

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