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| Year : 1983 | Volume
: 29
| Issue : 2 | Page : 122-4 |
Fibrosarcoma of the breast (a case report).
Deodhar SD, Khope SS, Kinare SG
How to cite this article:
Deodhar S D, Khope S S, Kinare S G. Fibrosarcoma of the breast (a case report). J Postgrad Med 1983;29:122 |
While carcinoma of the breast is a common condition, fibrosarcoma is quite rare. We had under our care recently at the King Edward VII Memorial Hospital, Bombay, a case of fibrosarcoma of the breast. The rarity of this condition prompts us to present this report.
K.T., a 50 year old female was admitted in November, 1981 with the complaint of a lump in the right breast of 6 months' duration. She had been in menopause for 5 years. In 1978, a benign lump had been removed from the same breast. On examination, a uniformly firm lump, 5 cm x 4 cm in size, irregular in shape and well circumscribed was found in the upper lateral quadrant of the right breast. While the lump was adherent to the scar of the previous operation, it was free from the deeper tissue. The axillary lymph nodes were not palpable. The left breast and the axilla did not show any abnormality. A careful examination of the patient did not show any other abnormality.
The smears prepared from the fine needle aspiration of the lump were difficult to interpret. The X-ray survey of the skeleton and lung was normal. 99mTc scintiscan of the liver was also normal. Biochemical investigations did not reveal any significant abnormality. In view of possible malignancy, a wide excision of the lump with a 4 cm margin of the surrounding tissue was carried out. The resultant skin defect was covered with a free split skin graft. The post-operative course was uneventful.
Pathology
The specimen showed a nodular tumour well circumscribed but non-encapsulated. At the margin were seen small knobs protruding and pushing their way into the surrounding fat. The cut surface was grey, homogenous, firm, and gave a gritty sensation suggesting fibrous tissue, with possible cartilage or bone; there were no areas of necrosis or haemorrhage.
H & E sections [Figs. 1]& [Figs. 2] showed a very cellular tumour, uniform in appearance, characterized by large spindle shaped cells, displaying varying degrees of pleomorphism, vesicular type of nuclei, mostly eccentric, with coarse chromatin and a few mitotic figures. There were collagenous fibres arranged in interwining whorled bundles and scattered blood vessels; a few areas showed chondroid but no osteoid differentiation. The fat surrounding the tumour showed strands of normal breast tissue. The histological diagnosis was fibrosarcoma of the breast with chondroid differentiation. Sections taken from the periphery of the tumour showed total excision.
The efforts to explain the etiology of breast sarcomas in general have given rise to a number of theories over the years. The histogenesis is still not settled. The concept most generally held is that these tumours arise through metaplasia and malignant change in the stromal cells, considered to be totipotential, being able to differentiate in various directions under proper environmental stimulus. Another theory is displacement of pleuripotential embryonic cells during development, much like teratoma.
Sarcomas of the breast constitute between 0.2 and 3% of all breast malignancies.[1], [4] These neoplasms are heterogenous group of mesenchymal tumours and may contain varying amounts of bone cartilage and osteoid tissue.[1], [2], [5]
Fibrosarcomas are amongst the rare tumours of the breast. They may occur at any age, but are commonly seen between 40 and 50 years. There are no characteristic features that clinically distinguish them from other breast tumours. The tumours grow rapidly and local recurrence after excision is common. Metastases are commonly seen in the lung but may occur in the brain, kidney and the bone; lymphatic spread is rare.
The histological features of fibrosarcoma have been well documented by Berg et al[3] The prognosis rests upon the number of mitotic figures per HPF and the behaviour of the tumour with surrounding breast tissue as well as cellular atypia and the tumour size. The tumours having less than 5 mitotic figures/HPF have a better prognosis than those with 8-10 mitotic figures/HPF and infiltration in the surrounding tissue. The presence of bone and/or cartilage is also a sign of poor prognosis.[5]
Our thanks are due to Dr. C. K. Deshpande, Dean, Seth G.S. Medical College and K.E.M. Hospital, Bombay, for allowing us to publish this case report.
| 1. | Aird Ian: "Companion to Surgical Studies". Second Edition, E. and S. Livingstone Ltd., Edinburg, London, 1958, pp. 617-618.  |
| 2. | Barnes, L. and Pietruszka, M.: Sarcomas of the breast. A clinicopathological analysis of ten cases. Cancer, 40: 1577-1585, 1977. |
| 3. | Berg, J. W., DeCrosse, J. J., Fracchia, A. A. and Farrow, J.: Stromal sarcomas of the breast. A unified approach to connective tissue sarcomas other than cystosarcoma phyllodes, Cancer, 15: 418-424, 1962. |
| 4. | Oberman, H. A.: Sarcomas of the breast. Cancer, 18: 1233-1243, 1955. |
| 5. | Smith, B. H. and Taylor, H. B.: The occurrance of bone and cartilage in the mammary tumours. Amer. J. Clan. Path., 51: 610-618, 1969. |
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