Spindle cell lesions of the breast: a diagnostic approach

Rakha, Emad A.; Castellano, Isabella; Quinn, Cecily

doi:10.1007/s00428-021-03162-x

Cited by 37 publications

(46 citation statements)

References 100 publications

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“…Owing to the considerable confusion regarding the diagnosis of this particular case even after the previously mentioned biopsy reports, we looked at other reports of this disease around the world. Common features from all of the reports we have noted include the rarity of the disease, a challenging diagnosis owing to overlapping morphology with other tumors, a high propensity of local recurrence, and tumors themselves being locally aggressive [6][7][8][9]. We note that in our case there were similar features; the tumor had been excised twice and grew back in the course of a few months each time.…”

Section: Discussionsupporting

confidence: 56%

Spindle Cell Carcinoma in the Breast: A Case Report

Ayyaz¹

2022

Cureus

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We aim to report on a patient presenting with a rare breast tumor. The tumor was recurrent with the patient having undergone wide local excision twice previously and the diagnosis was inconclusive both times. Under our care, the patient underwent a modified radical mastectomy with a level III dissection and a transverse rectus abdominis myocutaneous (TRAM) flap for reconstruction. The entire procedure was performed in front of a live audience comprising medical students, junior doctors, and consultants, managed with audiovisual feedback enabling a real-time discussion. The final histopathological report showed a spindle-cell tumor of the breast but also mentioned that a Phyllodes tumor could not be ruled out.

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Section: Discussionsupporting

confidence: 56%

Spindle Cell Carcinoma in the Breast: A Case Report

Ayyaz¹

2022

Cureus

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“…Breast spindle cell lesions are generally classified into two main categories: bland-appearing and malignant-appearing. 19 Pathologically, fibromatosis must be differentiated from scar/reactive changes due to prior surgery or trauma, myofibroblastoma, nodular fasciitis, phyllodes tumor and spindle-cell (fibromatosis-like metaplastic) carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Fibromatosis of the Breast: Report of a Case with Cytohistological Correlation

et al. 2022

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Background: Breast fibromatosis is a very rare, locally infiltrative lesion, without metastatic potential that arises from either stromal fibroblasts or myofibroblasts of the breast or from the pectoral fascia, extending into the breast, with its cytological and histological features only rarely being described. Case Presentation: A 58-year-old woman, with no past medical/surgical or family history, was diagnosed on regular mammographic and ultrasound examination with a nodular tumor density, in the upper inner part of her right breast. There were no calcifications or apparent lymph nodes in the right axilla. The woman underwent FNA and US-guided biopsy and final resection biopsy under hook marking. We reviewed the cytological findings of fibromatosis of the breast, as they presented in FNAC aspirates of a non-palpable mammographic finding and the histological findings in both preoperative core-needle biopsy and excision specimen. The final diagnosis was of fibromatosis of the breast. No further actions were taken. The woman is well, without recurrence, more than four years afterwards. Conclusion: Our case can make the pathologists more acquainted with the cytological and pathologic features of a rare tumor entity and the clinicians with a rare breast lesion, which can mimic malignancy both clinically and radiologically. The diagnosis of fibromatosis of the breast is more reliable in excision specimens. Nevertheless, cytology can be an invaluable adjunct to histology, pre-operatively, as it can exclude cancer and help in the preoperative planning.

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“…In all likelihood, there are probably too few cases of SFT primary to the breast to specifically characterize clinical behavior, and as would be expected, some cases have reportedly metastasized 6. Morphologically, SFT is a circumscribed cellular tumor comprised of bland spindle to oval cells with scant cytoplasm arranged in short fascicles with interspersed prominent intercellular collagen bundles with architecture that varies from organized and storiform to haphazard 53. The so-called “patternless” pattern and staghorn-shaped “hemangiopericytoma-like” blood vessels, although nonspecific, are hallmarks of SFT.…”

Section: Fibroblastic/myofibroblastic Tumorsmentioning

confidence: 99%

“…121,123 FLMC appears to have minimal risk of lymph node or distant metastasis, and as such, patients can avoid sentinel node biopsy or chemotherapy. Interestingly, FLMC does not share copy number aberrations with high-grade metaplastic carcinoma, and has a low level of genomic instability,124 which may explain the somewhat unique biology125 and curious associations with sclerosing and papillary lesions 53. Fibromatosis-like metaplastic breast carcinoma is a potentially treacherous lesion diagnostically, as it may appear deceptively banal and as such, mimic benignity.…”

Section: Miscellaneousmentioning

confidence: 99%

Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management

Russell

Montgomery²,

Susnik³

2022

Advances in Anatomic Pathology

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Spindle cell proliferations of the breast are a heterogeneous group of lesions ranging from benign or reactive lesions to aggressive malignant neoplasms. Diagnosis on core biopsy can be particularly challenging as lesions displaying different lineages associated with variable outcomes share overlapping morphologies (scar vs. fibromatosis-like metaplastic carcinoma) whereas individual entities can exhibit a large variety of appearances (myofibroblastoma). In this review, lesions are grouped into lineage, when possible, including those showing fibroblastic/myofibroblastic differentiation, ranging from entities that require no additional management, such as scar and nodular fasciitis, to those with unpredictable clinical outcomes such as fibromatosis and solitary fibrous tumor or locally aggressive behavior such as dermatofibrosarcoma protuberans. The review of low-grade vascular lesions includes atypical vascular lesion and low-grade angiosarcoma. Also discussed are various adipocytic lesions ranging from lipoma to liposarcoma, and rare smooth muscle and neural entities more commonly encountered in locations outside the breast, such as leiomyoma, neurofibroma, schwannoma, or granular cell tumor. Optimal histological evaluation of these entities merges clinical and radiologic data with morphology and ancillary testing. We present our approach to immunohistochemical and other ancillary testing and highlight issues in pathology correlation with imaging. Recent updates in the management of breast spindle cell lesions are addressed. In a well-sampled lesion with radiographic concordance, the core biopsy diagnosis reliably guides management and we advocate the inclusion of management recommendations in the pathology report. Precise characterization using up to date guidelines is important to identify a subset of patients who may safely avoid unnecessary surgical procedures. A multidisciplinary approach with close collaboration with our clinical colleagues is emphasized.

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Spindle cell lesions of the breast: a diagnostic approach

Cited by 37 publications

References 100 publications

Spindle Cell Carcinoma in the Breast: A Case Report

Spindle Cell Carcinoma in the Breast: A Case Report

Fibromatosis of the Breast: Report of a Case with Cytohistological Correlation

Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management

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