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Kawakita Y, Anan K, Kurata K, Koga K, Saimura M, Tamiya S, Nishihara K, Mitsuyama S, Nakano T. Anaplastic lymphoma kinase-positive inflammatory myofibroblastic tumor of the breast: a case report and review of the literature. Surg Case Rep 2023; 9:152. [PMID: 37656266 PMCID: PMC10474000 DOI: 10.1186/s40792-023-01732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Few reports of inflammatory myofibroblastic tumor (IMT) of the breast have been published worldwide. Furthermore, primary anaplastic lymphoma kinase (ALK)-positive IMT of the breast is extremely rare. To date, only six patients with ALK-positive IMT have been reported in the literature. CASE PRESENTATION A 52-year-old woman underwent a medical examination, and a left breast mass was detected. She did not feel a mass in her chest. Mammography showed a focal asymmetric density at the lower outer portion of the left breast. Breast ultrasonography showed a 1.2-cm hypoechoic lesion with relatively clear boundaries and poor blood flow. Magnetic resonance imaging and computed tomography revealed a solitary heterogeneous mass in the left breast. Pathologic examination revealed a fibrosing lesion with proliferation of fibroblastic cells arranged in a storiform pattern and admixed inflammatory cells. Immunohistochemical examination showed that the tumor cells were positive for ALK. Under the preoperative diagnosis of IMT, we performed partial mastectomy with adequate margins. The postoperative diagnosis was pathologically confirmed as IMT. Immunohistochemical staining also showed overexpression of ALK-1 in the tumor. The patient had a good clinical course for 24 months postoperatively, without recurrence or metastasis. CONCLUSIONS IMT of the breast shows nonspecific imaging findings, making preoperative diagnosis difficult. Nevertheless, IMT has the characteristics of low-grade neoplasms with recurrence, invasion, and metastatic potential. Our report emphasizes the importance of determining a treatment plan as soon as possible based on an accurate diagnosis to improve the prognosis of this disease.
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Affiliation(s)
- Yasutaka Kawakita
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan.
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8555, Japan.
| | - Keisei Anan
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Kanako Kurata
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Kenichiro Koga
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Michiyo Saimura
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Kazuyoshi Nishihara
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Shoshu Mitsuyama
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Toru Nakano
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
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Armijo Sánchez A, Ramírez Muñoz B, Aguilar Gálvez I, García Vidal E, García Mejido J, Iglesias Bravo E. Tumor miofibroblástico inflamatorio tras cáncer de mama. Un reto en el diagnóstico diferencial. Revisión de la literatura. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2022.100793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Clinicopathological Features of Inflammatory Myofibroblastic Tumor in the Breast. Breast J 2022; 2022:1863123. [PMID: 36304484 PMCID: PMC9578916 DOI: 10.1155/2022/1863123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal spindle cell tumour with low malignant potential which is extremely rare in breasts. Because of the lack of typical imaging and clinical characteristics of IMT, it is easy to misdiagnose before operation. We now report a case of a 37-year-old woman presenting with a mass in her left breast. Ultrasound showed a well-circumscribed lesion in the lower outer quadrant. The patient underwent lumpectomy, and histopathology revealed a tumor which was composed of fusiform cells and inflammatory cells. Immunohistochemistry (IHC) showed tumor cells are positive for vimentin, ALK, BCL2, and SMA. The FISH test demonstrated ALK (2p23) chromosomal translocation (ALK positive). The final diagnosis of breast IMT was rendered with nonclassical morphology. Postoperative 30-month follow-up no evidence showed residual tumor or recurrence. As a very rare tumor, breast IMT could be easily misdiagnosed clinically and pathologically. Complete surgical resection of the tumor is preferred, and it has the risk of recurrence and metastasis.
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Zhou P, Chen YH, Lu JH, Jin CC, Xu XH, Gong XH. Inflammatory myofibroblastic tumor after breast prosthesis: A case report and literature review. World J Clin Cases 2022; 10:1432-1440. [PMID: 35211580 PMCID: PMC8855174 DOI: 10.12998/wjcc.v10.i4.1432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/21/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumors (IMTs) are defined as tumors composed of differentiated myofibroblastic spindle cells, usually accompanied by numerous plasma cells and lymphocytes, and classified as intermediate (occasionally metastatic) by the World Health Organization. Its pathogenesis and biological behavior have not yet been elucidated. Breast IMT is extremely rare, and prosthesis implantation combined with IMT has not been reported. This study reports a case of IMT following resection of a malignant phyllodes tumor of the left breast and implantation of a prosthesis.
CASE SUMMARY A 41-year-old female presented to our hospital with a mass in the left breast for 3 mo. The patient had undergone resection of a large mass in her left breast pathologically diagnosed as a malignant phyllodes tumor and implantation of a prosthesis five years prior. Ultrasonic examination revealed an oval mass in the left breast, and the patient underwent left breast mass resection and prosthesis removal. Light microscopy revealed the spindle cells to be diffusely proliferated, with a large number of neutrophils, lymphocytes, and plasma cell infiltration. Immunohistochemical staining revealed that the spindle cells were partially positive for smooth muscle actin, which is positive for BCL-2 and cluster of differentiation (CD) 99 but were negative for anaplastic lymphoma kinase, cytokeratin, S-100 protein, desmin, and CD34. The final diagnosis was IMT. No recurrence or metastasis was observed during the 5-year postoperative follow-up.
CONCLUSION Prosthesis implantation may be one of the causes of IMT, but further investigation is necessary to prove it.
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Affiliation(s)
- Peng Zhou
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, Guangdong Province, China
| | - Yi-Hao Chen
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, Guangdong Province, China
- Graduate School, Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China
| | - Jiang-Hao Lu
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, Guangdong Province, China
| | - Chun-Chun Jin
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, Guangdong Province, China
| | - Xiao-Hong Xu
- Graduate School, Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China
- Department of Ultrasound, Guangdong Medical University Affiliated Hospital, Zhanjiang 524001, Guangdong Province, China
| | - Xue-Hao Gong
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, Guangdong Province, China
- Graduate School, Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China
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Dani M, Pinder S, Fentiman I. Bilateral Inflammatory Pseudotumour of the Breast: A Case Report and Review of the Literature. Eur J Breast Health 2018; 14:229-233. [PMID: 30288498 DOI: 10.5152/ejbh.2018.4150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/21/2018] [Indexed: 01/14/2023]
Abstract
Inflammatory tumour (IPT) consists of spindle cells, mature plasma cells, histiocytes, lymphocytes and eosinophils. Most frequently presenting in the respiratory tract it can also affect other sites such as breast. This case was a 73-year old woman presenting with a left breast lump, clinically indeterminate (P3), proven on biopsy to be IPT. Seven years later she returned with bilateral breast lumps and underwent triple assessment followed by wide excisions which confirmed the diagnosis of IPTs. Because it can be difficult to differentiate IPT from a low-grade spindle cell metaplastic breast carcinoma (SpCMBC) wide excision to achieve clear margins should be achieved to exclude malignancy.
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Affiliation(s)
- Mohsin Dani
- Department of Research Oncology, Guy's Hospital, London, England
| | - Sarah Pinder
- Department of Research Oncology, Guy's Hospital, London, England
| | - Ian Fentiman
- Department of Research Oncology, Guy's Hospital, London, England
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Abstract
Spindle cell lesions of the breast cover a wide spectrum of diseases ranging from reactive tumor-like lesions to high-grade malignant tumors. The recognition of the benign spindle cell tumor-like lesions (nodular fasciitis; reactive spindle cell nodule after biopsy, inflammatory pseudotumor/inflammatory myofibroblastic tumor; fascicular variant of pseudoangiomatous stromal hyperplasia) and tumors (myofibroblastoma, benign fibroblastic spindle cell tumor, leiomyoma, schwannoma, spindle cell lipoma, solitary fibrous tumor, myxoma) is crucial to avoid confusion with morphologically similar but more aggressive bland-appearing spindle cell tumors, such as desmoid-type fibromatosis, low-grade (fibromatosis-like) spindle cell carcinoma, low-grade fibrosarcoma/myofibroblastic sarcoma and dermatofibrosarcoma protuberans.
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Affiliation(s)
- Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Anatomic Pathology, University of Catania, Via S. Sofia 87, Catania 95123, Italy.
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Abstract
Myofibroblastic, fibroblastic and/or myoid lesions are rare in the breast but comprise the majority of mammary mesenchymal spindle cell lesions. Whereas most have similar features to their counterparts at extramammary sites, pseudoangiomatous stromal hyperplasia is considered a breast-specific myofibroblastic proliferation on the same spectrum as myofibroblastoma. Other lesions with myofibroblastic/fibroblastic differentiation include fibromatosis and nodular fasciitis, as well as more aggressive tumors such as the rarely reported myofibrosarcoma, inflammatory myofibroblastic tumor and fibrosarcoma. Lesions with myoid differentiation include benign leiomyoma, myoid hamartoma and leiomyomatous myofibroblastoma, but primary leiomyosarcoma and rhabdomyosarcoma may also rarely arise in the breast. Furthermore, fibroepithelial lesions and metaplastic carcinomas can demonstrate myoid metaplasia. Diagnosis can be challenging, particularly on core biopsy, but benign lesions with or without recurrence potential must be distinguished from more aggressive tumors, especially metaplastic carcinoma and phyllodes tumors. This article will review lesions with myofibroblastic, fibroblastic and myoid differentiation in the breast, with special emphasis on differential diagnosis.
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Affiliation(s)
- Gregor Krings
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.
| | - Patrick McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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8
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Affiliation(s)
- Erin K. Greenleaf
- Department of Surgery College of Medicine The Pennsylvania State University Hershey, Pennsylvania
| | - Nicole C. Williams
- Department of Anatomic Pathology College of Medicine The Pennsylvania State University Hershey, Pennsylvania
| | - Anna M. Leung
- Department of Surgery College of Medicine The Pennsylvania State University Hershey, Pennsylvania
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9
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Lee JC, Wu JM, Liau JY, Huang HY, Lo CY, Jan IS, Hornick JL, Qian X. Cytopathologic features of epithelioid inflammatory myofibroblastic sarcoma with correlation of histopathology, immunohistochemistry, and molecular cytogenetic analysis. Cancer Cytopathol 2015; 123:495-504. [PMID: 26139079 DOI: 10.1002/cncy.21558] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/18/2015] [Accepted: 04/21/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Epithelioid inflammatory myofibroblastic sarcoma (E-IMS) is a recently established rare variant of inflammatory myofibroblastic tumor. It is characterized by a distinctive constellation of clinical, pathological, and molecular features, including a nearly exclusive intraabdominal location, strong male predilection, aggressive clinical course, predominance of epithelioid tumor cells, and Ran-binding protein 2 (RANBP2)-anaplastic lymphoma kinase (ALK) fusion in the majority of cases. To the authors' knowledge, the cytologic features of E-IMS have not been described to date. METHODS Cases of E-IMS that had corresponding cytology were searched. Six cytology samples (1 fine-needle aspiration sample, 2 imprint samples, and 3 effusion fluids) containing tumor cells were identified in 5 patients with E-IMS. RESULTS The cytomorphology included large monotonous epithelioid cells arranged in loose aggregates or singly, with admixed myxoid stroma, and an inflammatory background rich in neutrophils. The tumor cells had a large, round, eccentric nucleus with vesicular chromatin, prominent nucleoli, and moderate amounts of pale cytoplasm. Delicate thin-walled branching vessels traversing tumor aggregates was a prominent feature in a fine-needle aspiration sample. Immunohistochemically, ALK was positive in all 5 tumors, with a nuclear membranous staining pattern noted in 3 cases and a cytoplasmic pattern observed in the other 2 cases. ALK rearrangement was confirmed in all 5 tumors by molecular genetic studies. CONCLUSIONS The cytologic features of E-IMS recapitulate its histologic characteristics. E-IMS merits inclusion in the differential diagnosis of any intraabdominal, large epithelioid cell neoplasm. Confirmation of ALK rearrangement is advisable because patients may benefit from targeted therapies.
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Affiliation(s)
- Jen-Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jiann-Ming Wu
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jau-Yu Liau
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsuan-Ying Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Yu Lo
- Department of Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - I-Shiow Jan
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xiaohua Qian
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Kovács A, Máthé G, Mattsson J, Stenman G, Kindblom LG. ALK-Positive Inflammatory Myofibroblastic Tumor of the Nipple During Pregnancy-An Unusual Presentation of a Rare Disease. Breast J 2015; 21:297-302. [DOI: 10.1111/tbj.12404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Anikó Kovács
- Department of Pathology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Gyöngyvér Máthé
- Department of Pathology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Jan Mattsson
- Department of Surgery; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Göran Stenman
- Department of Pathology; Sahlgrenska Cancer Center; University of Gothenburg; Gothenburg Sweden
| | - Lars-Gunnar Kindblom
- Department of Musculosceletal Pathology; Royal Orthopaedic Hospital NHS Trust Foundation and Division of Cancer Studies; Medical School; Birmingham University; Birmingham UK
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11
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Inflammatory myofibroblastic tumor of the breast. Case Rep Surg 2015; 2015:705127. [PMID: 25767734 PMCID: PMC4341847 DOI: 10.1155/2015/705127] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/03/2015] [Indexed: 02/08/2023] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) of the breast represent extremely rare lesions. Due to the scarcity of reports, their natural history, recurrence, and metastatic potential remain poorly defined. We report on a case of a primary breast IMT in a postmenopausal female patient treated successfully with breast conserving surgery and review the literature pertaining to this rare entity.
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12
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Sakuma T, Matsuo K, Koike S, Tagami K. Fine needle aspiration cytology of nodular fasciitis of the breast. Diagn Cytopathol 2014; 43:222-9. [DOI: 10.1002/dc.23176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 05/09/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Takahiko Sakuma
- Department of Laboratory Medicine; Atsumi Hospital; Tahara Aichi Japan
| | | | - Shinya Koike
- Department of Surgery; Atsumi Hospital; Tahara Aichi Japan
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13
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Zhao HD, Wu T, Wang JQ, Zhang WD, He XL, Bao GQ, Li Y, Gong L, Wang Q. Primary inflammatory myofibroblastic tumor of the breast with rapid recurrence and metastasis: A case report. Oncol Lett 2012; 5:97-100. [PMID: 23255901 DOI: 10.3892/ol.2012.948] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 08/13/2012] [Indexed: 12/16/2022] Open
Abstract
Primary inflammatory myofibroblastic tumor (IMT) of the breast is extremely rare; only 19 cases have been reported in the English literature. In the present study, we present a case of IMT in a 56-year-old female patient who was admitted to our hospital due to a mass found in her right breast. Mammogram and ultrasound revealed a well-circumscribed mass and surgery was performed. Histopathologically, the lesion was composed of spindle and inflammatory cells, including plasma cells and lymphocytes. Mitotic figures were not observed. Immunohistochemically, the tumor cells were positive for SM-actin, anaplastic lymphoma kinase (ALK) and vimentin and focal positive for desmin, but negative for NSE, S-100, CD117, CD34, NF, CD21, CD35 and CD68. Thus, we made a diagnosis of IMT and advised regular follow-up. However, the patient had local recurrence and metastasis to the left groin area 3, 7 and 10 months after the initial surgery. Notably, the histopathological characteristics of the recurrent and metastatic foci were similar to those of the initial specimen, but mitotic figures were clearly observed. Thus, we conclude that IMT shows occasionally malignant biological behavior although it is a neoplasm of intermediate biological potential that frequently recurs and rarely metastasizes. We advise that clinical physicians should regularly follow up patients after focal resection for IMT.
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14
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Bukhari MH, Arshad M, Jamal S, Niazi S, Bashir S, Bakhshi IM, Shaharyar. Use of fine-needle aspiration in the evaluation of breast lumps. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:689521. [PMID: 21789264 PMCID: PMC3135154 DOI: 10.4061/2011/689521] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 01/14/2011] [Accepted: 04/14/2011] [Indexed: 12/19/2022]
Abstract
Background. A study was designed to see the role of fine needle aspiration cytology (FNAC) in palpable breast lumps. Materials and Methods. Four hundred and twenty five (425) patients came to the Department of Pathology King Edward Medical University, Lahore in four years for FNAC of their palpable breast masses from June 2006 to June 2010. FNAC diagnosis was compared with histological diagnosis to see the accuracy of fine needle aspiration cytology for neoplastic lesions. Results. There were 271/425 benign, 120/425 malignant, and 32/425 suspicious smears. Inadequate samples were repeated twice or thrice, and the degree of success was improved with consecutive repeating approaches. The frequency of inadequacy declined from 86 to 18, and 2 for first, second and third attempts, respectively. The number of repeats increased the diagnostic accuracy of aspirates which is statistically significant (P = .000). Invasive ductal carcinoma was the most commonly reported lesion with maximum incidence in the 4th, 5th, and 6th decades followed by invasive lobular carcinoma and other malignant lesions. The sensitivity, specificity, accuracy, negative predictive value, and the positive predictive value of FNAC was 98%, 100%, 98%, 100%, and 97%, respectively.
Conclusion. FNAC serves as a rapid, economical, and reliable tool for the diagnosis of palpable breast lesions because the cytopathological examination of these lesions before operation or treatment serves as an important diagnostic modality.
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15
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Borak S, Siegal GP, Reddy V, Jhala N, Jhala D. Metastatic inflammatory myofibroblastic tumor identified by EUS-FNA in mediastinal lymph nodes with ancillary FISH studies for ALK rearrangement. Diagn Cytopathol 2011; 40 Suppl 2:E118-25. [PMID: 21472870 DOI: 10.1002/dc.21663] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 01/12/2011] [Indexed: 12/28/2022]
Affiliation(s)
- Samuel Borak
- Department of Pathology, University of Alabama at Birmingham, AL, USA
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16
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Vecchio GM, Amico P, Grasso G, Vasquez E, La Greca G, Magro G. Post-traumatic inflammatory pseudotumor of the breast with atypical morphological features: A potential diagnostic pitfall. Report of a case and a critical review of the literature. Pathol Res Pract 2011; 207:322-6. [PMID: 21371828 DOI: 10.1016/j.prp.2011.01.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/28/2010] [Accepted: 01/17/2011] [Indexed: 02/06/2023]
Abstract
Although inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) may share a common morphology, they are distinct clinico-pathologic entities. Unfortunately, the terms IMT and IPT are still used interchangeably, especially when lesions occur in unusual sites, including breast. All the cases of IMT/IPT involving the breast have raised spontaneously without any apparent prior injury. We herein report the first case of a post-traumatic IPT of the breast parenchyma in a 22-year-old male. Histologically, the lesion was highly cellular and composed of spindle cells arranged in a predominant fascicular pattern. Notably, mono- or multi-nucleated large pleomorphic cells were observed. Inflammatory cells, especially plasma cells and lymphocytes, were closely admixed with the spindle cell proliferation. The overall picture was reminiscent of an "IMT with atypical features", typically seen in lung, abdomen, pelvis, and retroperitoneum of children. Immunohistochemically, the spindle-shaped and large pleomorphic cells were immunoreactive to vimentin, α-smooth muscle actin, and desmin. No immunoreactivity was obtained with ALK-1 protein. The present case contributes to widening the morphological spectrum of IPT of the breast, emphasizing the possibility that a reactive lesion may contain large pleomorphic cells that may represent a potential diagnostic pitfall. Lastly, we suggest that the diagnosis of IMT of the breast should be rendered with caution when dealing with ALK-negative spindle cell lesions in adult patients, and alternative diagnoses, including IPT, should be seriously considered.
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Affiliation(s)
- Giada Maria Vecchio
- Department G.F. Ingrassia, Division of Anatomic Pathology, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
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17
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Park SB, Kim HH, Shin HJ, Gong G. Inflammatory pseudotumor (myoblastic tumor) of the breast: a case report and review of the literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:52-55. [PMID: 19802887 DOI: 10.1002/jcu.20637] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Inflammatory pseudotumor of the breast is a very rare cause of breast mass. To our knowledge, only a few cases have been described in the English literature. In this case, the lesion appeared on mammography as a round high-density mass with ill-defined margins and on sonography as an irregular mass of complex echogenicity with ill-defined margins and an echogenic rim. The lesion was resected with no evidence of local recurrence after 3 years.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Jung-gu, Seoul, 100-380, Korea
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18
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Kim SJ, Moon WK, Kim JH, Cho N, Chang CM. Inflammatory pseudotumor of the breast: a case report with imaging findings. Korean J Radiol 2009; 10:515-8. [PMID: 19721838 PMCID: PMC2731871 DOI: 10.3348/kjr.2009.10.5.515] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 04/09/2009] [Indexed: 12/29/2022] Open
Abstract
Inflammatory pseudotumor, also known as inflammatory myofibroblastic tumor and plasma cell granuloma, is an uncommon low-grade lesion composed of spindle cells admixed with mature plasma cells and other inflammatory cells, such as histiocytes, lymphocytes, and eosinophils. Here, we describe the mammographic and ultrasonographic findings of a case of an inflammatory pseudotumor of the breast in a 60-year-old woman. With the suspicion of malignancy, core needle biopsy and surgical excision confirmed the mass as being an inflammatory pseudotumor of the breast.
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Affiliation(s)
- Seung Ja Kim
- Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
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19
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Lee BK, Youn HJ, Jung SH. Inflammatory Myofibroblastic Tumor of the Breast. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.suppl.s1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Byoung Kil Lee
- Division of Breast, Thyroid Surgery, Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Hyun Jo Youn
- Division of Breast, Thyroid Surgery, Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Hoo Jung
- Division of Breast, Thyroid Surgery, Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
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Akbulut M, Gunhan-Bilgen I, Zekioglu O, Duygulu G, Oktay A, Ozdemir N. Fine needle aspiration cytology of inflammatory myofibroblastic tumour (inflammatory pseudotumour) of the breast: a case report and review of the literature. Cytopathology 2007; 18:384-7. [DOI: 10.1111/j.1365-2303.2007.00470.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Park IK, Yoon DS, Kim YM, Park HD, Min SK. Inflammatory Myofibroblastic Tumor of the Breast. J Breast Cancer 2006. [DOI: 10.4048/jbc.2006.9.3.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Il-kyung Park
- Department of Surgery, College of Medicine, Konyang University Hospital, Daejon, Korea
| | - Dae-sung Yoon
- Department of Surgery, College of Medicine, Konyang University Hospital, Daejon, Korea
| | - Yoon-mi Kim
- Department of Pathology, College of Medicine, Konyang University Hospital, Daejon, Korea
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Khanafshar E, Phillipson J, Schammel DP, Minobe L, Cymerman J, Weidner N. Inflammatory myofibroblastic tumor of the breast. Ann Diagn Pathol 2005; 9:123-9. [PMID: 15944952 DOI: 10.1016/j.anndiagpath.2005.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Three patients developed firm, mobile, nontender masses in their breasts. Two were discovered by the patients and one after mammography. Macroscopically, the nodules were firm, circumscribed, yellow on cut sections, and composed of interlacing cytologically bland spindle cells admixed with chronic inflammatory cells, the latter predominantly of lymphocytes and plasma cells. Immunohistochemistry yielded strong smooth-muscle actin reactivity within the spindle cells; 2 lesions were negative for pankeratin, 1 was focally and weakly positive. No lesions were positive for anaplastic lymphoma kinase-1, desmin, S-100, CD34, CD21, or CD35. In each case, a diagnosis of inflammatory myofibroblastic tumor was made (aka, inflammatory pseudotumor). After conservative excision with apparently negative margins, there have been no recurrences, except in one patient who developed a recurrence after 3 months. The latter recurrence was managed successfully with a second excision. We report these patients to emphasize the diagnostic features of inflammatory myofibroblastic tumor of the breast and discuss how they can be distinguished from other spindle-cell breast lesions with which they can be confused, especially spindle-cell carcinoma.
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Affiliation(s)
- Elham Khanafshar
- Department of Pathology, University of California, San Diego 92103-8720, USA
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Ilvan S, Celik V, Paksoy M, Cetinaslan I, Calay Z. Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the breast. APMIS 2005; 113:66-9. [PMID: 15676017 DOI: 10.1111/j.1600-0463.2005.apm1130110.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Inflammatory myofibroblastic tumor of the lung has often been reported but extrapulmonary cases are rare. Here we describe a case of inflammatory myofibroblastic tumor of the breast in a 60-year-old woman. This is only the eleventh case reported in the English language literature. The patient was free of disease 85 months after surgery.
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Affiliation(s)
- Sennur Ilvan
- Department of Pathology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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