1/161. Myofibroblastoma of the breast with diverse histological features.We report two cases of myofibroblastoma with unusual pathological features, in a 66-year-old woman and a 49-year-old man. Both tumours were unilateral, grossly nodular and well circumscribed, but not encapsulated. The lesions were made up of bipolar spindle cells arranged in fascicular clusters separated by bands of hialinized collagen; one included several islands of mature cartilage next to fat cells. The other contained atypical mononucleated and multinucleated giant cells. No mitotic figures were observed. Immunohistochemically, both tumours showed strong and diffuse cytoplasmic staining for vimentin and CD 34 and focal positivity for alpha-smooth muscle actin, and both were negative for cytokeratins, CD 68, Ham 5, 6, Mac 387, and S-100 protein. desmin was positive in one case. Ultrastructural study revealed populations composed of fibroblastic cells without signs of myofibroblastic differentiation in one case; the second featured abundant undifferentiated mesenchymal cells with myofibroblastic differentiation. Both patients remain disease-free 38 and 36 months after lumpectomy.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
2/161. Spindle cell lipoma of the breast.Spindle cell lesions, which commonly arise in the soft tissues, may present in the breast and be difficult to distinguish from primary mammary spindle cell tumors. We present the case of a 28 year old woman with a 1.5 cm circumscribed spindle cell lipoma lying deep within the tissue of the right breast. Thin, uniform spindle cells were associated with collagen bundles, mature adipocytes and entrapped normal mammary ducts, lobules, vessels and nerves, appearances which simulated an aggressively infiltrating tumor. The spindle cells proved immunoreactive to CD34 and vimentin but non-reactive for cytokeratin, S100, desmin, smooth muscle actin and factor viii. Although surgical resection was incomplete, the patient is alive and without evidence of tumor recurrence 12 months postoperatively. In our case, a conservative approach to management was justified and supported by the patient's subsequent clinical course. This case exemplifies the diagnostic challenge of spindle cell lesions arising in breast tissue and the value of immunoperoxidase stains.- - - - - - - - - - ranking = 5keywords = spindle cell, spindle (Clic here for more details about this article) |
3/161. Fine needle aspiration of primary pleomorphic liposarcoma of the breast. A case report.BACKGROUND: Primary liposarcoma of the breast is an extremely rare lesion. Only two cases describing the aspiration biopsy findings have been reported in the literature. We report the cytologic findings in an additional case, stressing the cytologic clues necessary to distinguish this neoplasm from a primary adenocarcinoma. CASE: A 53-year-old female presented to the emergency room with bleeding from a 20-cm, ulcerating mass in the right breast. Four months earlier she had been seen at another institution, where a diagnosis of poorly differentiated carcinoma was made by aspiration biopsy. Computed tomography had been negative for metastatic disease, and the patient refused further evaluation. Aspiration biopsy of the breast mass was repeated at our institution and interpreted as consistent with a poorly differentiated carcinoma. Histologic, immunophenotypic and ultrastructural evaluation of the mastectomy specimen revealed a pleomorphic liposarcoma. CONCLUSION: With increasing utilization of fine needle aspiration to evaluate breast lesions, it can be anticipated that unusual entities, including liposarcomas, will be encountered increasingly in breast aspirates. Therefore, it is important to consider liposarcoma in the differential diagnosis of aspirates showing isolated spindle and polygonal cells with vacuolated cytoplasm, nuclear scalloping and pleomorphism to avoid a misdiagnosis of carcinoma.- - - - - - - - - - ranking = 0.25694848817306keywords = spindle (Clic here for more details about this article) |
4/161. Chondrolipomatous tumor of the breast with myoid differentiation.Benign human breast lesions containing chondroid tissue are uncommon. Their classification and nomenclature are confusing. We report a case of a voluminous, well circumscribed painless breast mass in a 47-year-old woman. The mass had been present for nine years and measured 17 x 8 x 6 cm. Histologically it was composed of breast parenchymal elements, fat mature cartilage and fibrous tissue with small fascicles of eosinophilic spindle-shaped cells intensely stained with actin and desmin antibodies. A careful review of the literature showed only one similar case reported by Metcalf and Ellis in 1985 and called "choristoma". We discuss this terminology and the other breast lesions containing cartilage.- - - - - - - - - - ranking = 0.25694848817306keywords = spindle (Clic here for more details about this article) |
5/161. Metaplastic carcinoma of the breast arising within complex sclerosing lesion: a report of five cases.AIMS: This study presents a series of five cases in which metaplastic carcinoma, predominantly low-grade adenosquamous carcinoma, of the breast is seen arising within a background of a complex sclerosing lesion. This association has been recognized previously but has not been documented in detail. This study describes the characteristics of the components present in each case and discusses the existing literature. This observation adds further evidence to support an association between some types of invasive breast carcinoma and sclerosing lesions of the breast. methods AND RESULTS: Four of these cases were received as referral cases for opinion. The fifth was received as part of the routine surgical workload within our own institution. Two patients presented following mammographic screening and three symptomatically; their mean age was 62 years (range 49-68). The mean lesion size was 16 mm (range 7-24). All five lesions showed features of a complex sclerosing lesion/radial scar in the form of central sclerosis with elastosis and radiating benign entrapped tubules. One had associated benign papillary structures and two had focal benign squamous metaplasia. Four cases showed coexisting but distinct areas of low-grade adenosquamous carcinoma with glandular and squamous epithelial differentiation in a spindle cell background. One case had associated undifferentiated spindle cell carcinoma. Detailed immunophenotypic characteristics of two cases are presented. CONCLUSIONS: This series illustrates a postulated but previously unconfirmed association between an unusual form of metaplastic breast carcinoma (adenosquamous carcinoma) and complex sclerosing lesions. The mechanisms of induction of breast carcinoma are poorly understood but these observations further emphasize the potential for sclerosing lesion of the breast to be associated with, and possibly give rise to, invasive carcinoma of different types. The precise nature of the interaction between the pathological processes remains unclear.- - - - - - - - - - ranking = 2keywords = spindle cell, spindle (Clic here for more details about this article) |
6/161. A case of amelanotic spindle-cell melanoma presenting as metastases to breast and axillary lymph node: diagnosis by FNA cytology.Metastatic neoplasms to the breast are relatively rare. Spindle-cell lesions of the breast are also uncommon. Here we present a case of fine-needle aspiration (FNA) of an amelanotic, spindle-cell melanoma metastatic to the breast and axillary lymph node. The patient was a 47-yr-old female who presented with a right breast mass, left axillary adenopathy, and a pigmented skin lesion on the back. FNA of the right breast and left axilla showed malignant, nonpigmented spindle cells that were weakly positive for HMB-45 on immunocytochemistry. The skin biopsy showed a pigmented malignant melanoma with epithelioid features, and also weak positivity for HMB-45. Although malignant melanoma is one of the more common tumors to metastasize to the breast, this is the first known case that showed exclusive spindle-cell morphology. history and physical examination were crucial in making the correct FNA diagnosis. The cytologic differential diagnosis of spindle-cell tumors of breast and the discordant morphology between the primary and metastatic melanotic lesions observed in this case are discussed.- - - - - - - - - - ranking = 2.7986394172114keywords = spindle cell, spindle (Clic here for more details about this article) |
7/161. Myofibroblastoma of the breast: genetic link with spindle cell lipoma.Mammary myofibroblastoma is a rare tumour, mainly occurring in male patients. This paper describes two cases of mammary myofibroblastoma, with typical histological features, including the presence of fat cells and mast cells. Immunohistochemically, the spindle cells stained positively for desmin and CD34. Cytogenetically, both tumours showed partial monosomy 13q and in case 1, there was, in addition, partial monosomy 16q. Rearrangements affecting 13q and 16q occur typically in spindle cell lipomas. In addition to histological similarities, the hitherto unreported chromosomal changes in mammary myofibroblastoma, which are similar to the chromosomal aberrations in spindle cell lipoma, strongly suggest a link between these two tumours and are not in favour of myofibroblastoma being a primary solitary fibrous tumour of the breast.- - - - - - - - - - ranking = 7keywords = spindle cell, spindle (Clic here for more details about this article) |
8/161. fibroadenoma mimicking papillary carcinoma on ThinPrep of fine-needle aspiration of the breast.OBJECTIVE: To compare and contrast benign and malignant lesions of the breast that have similar appearances on fine-needle aspiration cytology and that constitute diagnostic pitfalls. DESIGN: The cytology files (dated November 1995 through May 1998) of the Beth israel Deaconess Medical Center were searched to identify cases of breast fine-needle aspiration biopsies that were highly cellular and composed of bland-appearing spindle/columnar cells and that could represent either epithelial or stromal cells; these cases were reported as indeterminate (atypical/suspicious) and had subsequent excisional biopsies taken. RESULTS: Four such cases were found. Two were fibroadenomas and 2 were papillary carcinomas. Their appearances were strikingly similar on aspiration cytology. All cases were prepared with the ThinPrep method. On microscopic examination, all 4 cases were hypercellular and had many single cells and clusters of columnar/elongate cells. Immunocytochemistry proved these cells to be of epithelial origin. At least occasional bipolar stromal cells were seen in the background. The only appreciable difference between the benign and malignant cases was more significant nuclear atypia, which was barely discernible, in the malignant cases. Immunocytochemistry for smooth muscle actin was helpful in 2 cases that had sufficient material. CONCLUSIONS: Some cases of fibroadenomas and papillary carcinomas can be very difficult, if not impossible, to distinguish on fine-needle aspiration cytology. Immunocytochemistry may be helpful if sufficient material is available. To avoid false-negative or false-positive diagnosis on cytology, it is best to report such cases as atypical or suspicious with final diagnosis pending excisional biopsy.- - - - - - - - - - ranking = 0.25694848817306keywords = spindle (Clic here for more details about this article) |
9/161. Lipomatous myofibroblastoma: a potential diagnostic pitfall in the spectrum of the spindle cell lesions of the breast.We report on two cases of myofibroblastoma (MFB) of the breast comprised predominantly of a mature fatty component, representing approximately three quarters of the entire tumour area. Both tumours consisted of a well-circumscribed lipomatous tumour mass containing dispersed nodular or irregularly shaped spindled cellular areas. The fatty component was represented exclusively by mature adipocytes, uniform in size and shape, lacking nuclear pleomorphism. The cellular areas contained spindly to oval cells with morphological and immunophenotypical features typical of MFB. The two components were so intimately admixed that a finger-like infiltrating growth pattern was apparent. The cases reported here as "lipomatous MFB" aim to clarify further the morphological spectrum of MFB of the breast. Lipomatous MFB may potentially mimic other benign or aggressive tumour-like lesions or even bland-looking malignant spindle cell tumours such as fibromatosis, nodular fasciitis, spindle cell lipoma, spindle cell liposarcoma, spindle cell variant of metaplastic carcinoma, spindle cell malignant myoepithelioma, and low-grade fibrosarcoma/malignant fibrous histiocytoma. The histogenesis of the present bimorphic mesenchymal tumours could be explained as the result of a dual, myofibroblastic and lipomatous, differentiation from a common pluripotential mesenchymal precursor cell, probably represented by the vimentin /CD34 fibroblast of the mammary stroma.- - - - - - - - - - ranking = 9.2569484881731keywords = spindle cell, spindle (Clic here for more details about this article) |
10/161. Atypical hemangioma of the breast: a diagnostic pitfall in breast fine-needle aspiration.We report on the fine-needle aspiration (FNA) cytology of atypical hemangioma of the breast in a 52-yr-old female. The patient presented with a 2-cm palpable left breast mass. An FNA of the mass was performed following a mammogram, corresponding to the palpable breast mass. The FNA demonstrated the presence of numerous atypical single spindle cells scattered throughout a hemorrhagic background. An unequivocal diagnosis of malignancy was not rendered in this case. However, the degree of cytologic atypia suggested a malignant process, and a recommendation for an excisional biopsy was made. Atypical hemangioma should therefore be included in the differential diagnosis of angiosarcoma and other benign and malignant spindle-cell lesions of the breast encountered on cytologic samples.- - - - - - - - - - ranking = 1.2569484881731keywords = spindle cell, spindle (Clic here for more details about this article) |
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