Rare case of primary leiomyosarcoma of the breast treated with wide local excision and planned cosmetic breast reduction surgery

Abstract

Primary leiomyosarcoma of the breast is an extremely rare neoplasm accounting for less than 0.0006% of all breast malignancies, with fewer than 80 cases reported in the literature to date. Here, we present a case of leiomyosarcoma of the breast in a 61-year-old woman without traditional risk factors. This case was treated with lumpectomy requiring wide margins due to the high rate of local recurrence. A planned breast reduction surgery was deemed adequate postlumpectomy therapy to prevent cancer recurrence, negating the need for chemotherapy or radiation therapy. To our knowledge, this is the first case in which cosmetic breast reduction surgery will be used as postlumpectomy cancer recurrence risk mitigation for primary leiomyosarcoma of the breast. Patients with this malignancy have a relatively poor prognosis compared with other breast cancer types, with a 5-year disease-free survival of 33%–52%. As such, frequent follow-up and monitoring for postresection recurrence is essential.

A 45-Year-Old Woman with a Primary Leiomyosarcoma of the Breast Successfully Treated by Surgical Excision: A Case Report

“…Differential diagnoses include leiomyoma, spindle cell myoepithelioma, and spindle cell sarcomatoid carcinomas [ 2 ]. In contrast to leiomyosarcoma, leiomyoma does not show evidence of atypia and mitosis [ 8 ]. Malignant myoepithelioma often does not show significant atypia; however, an epithelioid cell population may be found, which is not found in leiomyosarcoma [ 7 ].…”

“…Horton et al presented a case of breast LMS in which breast reduction surgery and postlumpectomy therapy prevented cancer recurrence. Unfortunately, this type of treatment is only appropriate for patients with small tumor-to-breast ratio [ 8 ]. In comparison with the case report presented by Horton, in our patient had a huge tumor that was a contraindication to breast-conserving surgery and required mastectomy.…”

“…Tumor progression was observed despite the provided cycles of chemotherapy [ 2 ]. A recent report by Horton et al presented a case of primary LMS in a 61-year-old woman successfully treated with lumpectomy and breast reduction surgery [ 8 ].…”