Breast Sarcomas: Rare but Challenging Entity for Diagnosis
DOI:
https://doi.org/10.21276/apalm.2910Keywords:
Breast sarcoma, mesenchymal tumor, immunohistochemistry, undifferentiated pleomorphic sarcomaAbstract
Background: Breast sarcomas are extremely rare, can be primary or secondary, pose a high risk of recurrence with an overall poor prognosis. Primary breast sarcomas constitute < 1% of all primary breast malignancies and less than 5% of all sarcomas. Sarcomas arising in phyllodes tumors account for < 6 % of all phyllodes tumors. The most common subtype of both primary and secondary sarcoma is angiosarcoma.
Methods: This was a retrospective study of patients diagnosed as sarcoma of breast (excluding malignant phyllodes and metaplastic carcinoma) during the period from January 2016 to July 2019. The demographic and clinical features were noted from the medical records. The details of gross specimens (grossed in strict accordance with CAP protocols) were noted. The haematoxylin and eosin-stained slides along with immunohistochemistry (IHC) (pan cytokeratin, calponin, vimentin, SMA, CD117, Ki 67, desmin, CD10, CK5/6, EMA, p63, CD34, CD56, myogenin, CD99, p16, S100, BCL2, CD31, caldesmon and CD68) were reviewed and categorized according to WHO (2019) criteria.
Result: The median age of patients was fifty years. There were fourteen breast sarcomas including one arising in phyllodes tumor during the study period. These included undifferentiated pleomorphic sarcoma (4), liposarcoma (2), myxofibrosarcoma (2), angiosarcoma (2), one each of leiomyosarcoma, rhabdomyosarcoma, fibrosarcoma and stromal sarcoma. Despite using a wide panel of IHC markers, 4/14 (28.57%) sarcomas were classified as undifferentiated pleomorphic sarcoma.
Conclusion: Primary breast sarcomas are rare tumors and pose diagnostic challenge. It is important to categorize these entities in view of the differing biologic behavior and molecular profiles. Morphology along with IHC is important for diagnosis, treatment and prognosis.
References
Vergel JC, Osorio AM, Garcia Mora M, GarcÃaAngulo Ó, GuzmánAbisaab L, Cervera-Bonilla S, et al. Breast Sarcomas: Experience of a Reference Center in Colombia. Cureus. 2019;11:5078.
Cahan WG, Wooddard HQ, Higinbotham NL, Stewart FW, Coley BL. Sarcoma arising in irradiated bone: report of 11 cases. Cancer. 1948;1:3-29.
Kumar S, Sharma J, Ralli M, Singh G, Kalyan S, Sen R. Primary Stromal Sarcoma of Breast: A Rare Entity. Iran J Pathol.2016;11:469-73.
Narla SL, Stephen P, Kurian A, Annapurneswari S. Well-differentiated liposarcoma of the breast arising in a background of malignant phyllodestumor in a pregnant woman: A rare case report and review of literature. Indian J PatholMicrobiol. 2018;61:577-9.
Shruti S, Gupta P, Malik A, Bhatnagar A, Siraj F. Cluster of Differentiation 10 Positive Stromal Sarcoma of Breast: A Diagnostic Challenge.
Cureus. 2019;11:5143.
Bansal A, Kaur M, Dalal V. Pleomorphic Sarcoma of Breast: A Report of Two Cases and Review of Literature. Acta Med Iran. 2017;55:272-6.
Srinivasamurthy BC, Kulandaivelu AR, Saha K, Saha A. Primary undifferentiated pleomorphic sarcoma of the breast in a young female: a case report. World J SurgOncol. 2016;14:186.
Allison KH, Brogi E, Ellis IO, Fox SB, Morris EA, Sahin A, et al., editors. WHO classification of tumors. Breast Tumors. Lyon: International Agency for Research on Cancer; 2019.
Lim SZ, Selvarajan S, Thike AA, Nasir ND, Tan BK, Ong KW, et al. Breast sarcomas and malignant phyllodes tumours: comparison of clinicopathological features, treatment strategies, prognostic factors and outcomes. Breast Cancer Res Treat. 2016;159:229-44.
Narla SL, Stephen P, Kurian A, Annapurneswari S. Well-differentiated liposarcoma of the breast arising in a background of malignant phyllodestumor in a pregnant woman: A rare case report and review of literature. Indian J PatholMicrobiol. 2018;61:577-9.
Kaur M. Primary Breast Sarcoma. Bangladesh Journal of Medical Science. 2020;19:579-81.
Lim SZ, Ong KW, Tan BK, Selvarajan S, Tan PH. Sarcoma of the breast: an update on a rare entity. J ClinPathol. 2016;69:373-81.
Nayak M, Patra S, Mishra P, Sahoo N, Sasmal PK, Mishra TS. Malignant phyllodestumor with heterologous differentiation: Clinicopathological spectrum of nine cases in a tertiary care institute in Eastern India. Indian J PatholMicrobiol 2017;60:371-6.
Wang Y, Zhang Y, Chen G, Liu F, Liu C, Xu T, et al. Huge borderline phyllodes breast tumor with repeated recurrences and progression toward more malignant phenotype: a case report and literature review. Onco Targets Ther. 2018;11:7787–93.
Zhang Y, Wan D, Gao F. Primary low-grade fibromyxoid sarcoma of the breast: a rare case report with immunohistochemical and fluorescence in situ hybridization detection. Hum Pathol. 2018;79:208-11.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Rashmi Khemani, Sudha S Murthy, Naidu C K, Daphne Fonseca, Suseela K, Vishal Rao B, Mohan Krishna Pasam, Raju KVVN, Subramanyeshwar Rao T, Krishnam Raju A
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).