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.
Similar content being viewed by others
References
Al-Nafussi A (1999) Spindle cell tumors of the breast: practical approach to diagnosis. Histopathology 35(1):1–13
Al-Benna S, Poggemann K, Steinau HU, Steinstraesser L (2010) Diagnosis and management of primary breast sarcoma. Breast Cancer Res Treat 122(3):619–626
Pencavel T, Allan CP, Thomas JM, Hayes AJ (2011) Treatment for breast sarcoma: a large, singlecentre series. Eur J Surg Oncol 37(8):703–708
Bousquet G et al (2007) Outcome and prognostic factors in breast sarcoma: a multicenter study from the rare cancer network. RadiotherOncol 85(3):355–361
Koker MM, Kleer CG (2004) p63 expression in breast cancer: a highly sensitive and specific marker of metaplastic carcinoma. Am J Surg Pathol 28:1506–1512
Carter MR, Hornick JL, Lester S, Fletcher CD (2006) Spindle cell (sarcomatoid) carcinoma of the breast: a clinicopathologic and immunohistochemical analysis of 29 cases. Am J SurgPathol 30:300–309
Schnitt SJ, Collins LC. Spindle cell lesions. In: Biopsy interpretat- ion of the breast. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins 2008; 20(5): 323–343
Nizri E, Merimsky O, Lahat G (2014) Optimal management of sarcomas of the breast: an update. Expert Rev Anticancer Ther 14(6):705–710
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Presentations at meetings—Poster presentation in one
Rights and permissions
About this article
Cite this article
Arora, S., Rana, D., Pujani, M. et al. Malignant Spindle Cell Tumor Breast—a Diagnostic Dilemma. Indian J Surg Oncol 9, 387–390 (2018). https://doi.org/10.1007/s13193-018-0750-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-018-0750-x