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Mesenchymal Tumors of the Breast

  • Helenice Gobbi
  • Cristiana Buzelin Nunes
Chapter
First Online:

Abstract

Mesenchymal breast lesions include a variety of benign and malignant neoplasms, as well as reactive and tumor-like lesions made up of mesenchymal cells. They frequently pose diagnostic challenges to surgical pathologists. This chapter provides a diagnostic approach to benign and malignant mesenchymal lesions of the breast, with emphasis on those that enter the differential diagnosis with spindle cell metaplastic carcinoma and malignant phyllodes tumor. Close clinicopathological correlation is recommended in the evaluation of both spindle cell/fibrous and vascular lesions of the breast.

Keywords

Breast Mesenchymal tumor Sarcoma Spindle cell metaplastic carcinoma Pseudoangiomatous stromal hyperplasia Nodular fasciitis Myofibroblastoma Fibromatosis Angiosarcoma; Atypical vascular lesion 
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References

  1. 1.
    Cheah AL, Billings SD, Rowe JJ. Mesenchymal tumours of the breast and their mimics: a review with approach to diagnosis. Pathology. 2016;48:406–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Torous VF, Schnitt SJ, Collins LC. Benign breast lesions that mimic malignancy. Pathology. 2017;49:181–96.CrossRefPubMedGoogle Scholar
  3. 3.
    Schnitt SJ, Collins LC. Reactive, inflammatory, and nonproliferative lesions. In: Schnitt SJ, Collins LC, editors. Biopsy interpretation of the breast. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. p. 25–57.Google Scholar
  4. 4.
    Lim SZ, Ong KW, Tan BK, Selvarajan S, Tan PH. Sarcoma of the breast: an update on a rare entity. J Clin Pathol. 2016;69:373–81.CrossRefPubMedGoogle Scholar
  5. 5.
    Adem C, Reynolds C, Ingle JN, Nascimento AG. Primary breast sarcoma: clinicopathologic series from the Mayo Clinic and review of the literature. Br J Cancer. 2004;91:237–41.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Voutsadakis IA, Zaman K, Leyvraz S. Breast sarcomas: current and future perspectives. Breast. 2011;20:199–204.CrossRefPubMedGoogle Scholar
  7. 7.
    Pandey M, Mathew A, Abraham EK, Rajan B. Primary sarcoma of the breast. J Surg Oncol. 2004;87:121–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Schnitt SJ, Collins LC. Spindle cell lesions. In: Schnitt SJ, Collins LC, editors. Biopsy interpretation of the breast. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. p. 363–86.Google Scholar
  9. 9.
    Rakha EA, Aleskandarany MA, Lee AH, Ellis IO. An approach to the diagnosis of spindle cell lesions of the breast. Histopathology. 2016;68:33–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Reis-Filho JS, Lakhani SR, Gobbi H, Sneige N. Metaplastic carcinoma. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 48–52.Google Scholar
  11. 11.
    Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68:5–21.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Thornton K. Sarcomas of the breast with a spotlight on angiosarcoma and cystosarcoma phyllodes. Surg Oncol Clin N Am. 2016;25:713–20.CrossRefPubMedGoogle Scholar
  13. 13.
    Gobbi H, Tse G, Page DL, Olson SJ, Jensen RA, Simpson JF. Reactive spindle cell nodules of the breast after core biopsy or fine-needle aspiration. Am J Clin Pathol. 2000;113:288–94.CrossRefPubMedGoogle Scholar
  14. 14.
    Powell CM, Cranor ML, Rosen PP. Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation. Am J Surg Pathol. 1995;19:270–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Michal M, Badve S, Shin SJ. Pseudoangiomatous stromal hyperplasia. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 129–30.Google Scholar
  16. 16.
    Gobbi H, Fletcher C. Nodular fasciitis. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 126.Google Scholar
  17. 17.
    Montgomery EA, Meis JM. Nodular fasciitis. Its morphologic spectrum and immunohistochemical profile. Am J Surg Pathol. 1991;15:942–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Gobbi H, Simpson JF, Borowsky A, Jensen RA, Page DL. Metaplastic breast tumors with a dominant fibromatosis-like phenotype have a high risk of local recurrence. Cancer. 1999;85:2170–82.CrossRefPubMedGoogle Scholar
  19. 19.
    Fletcher CDM. Inflammatory myofibroblastic tumour. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 133.Google Scholar
  20. 20.
    Gobbi H, Atkinson JB, Kardos TF, Simpson JF, Page DL. Inflammatory myofibroblastic tumor of the breast: report of a case with giant vacuolated cells. Breast. 1999;8:135–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Wargotz ES, Weiss SW, Norris HJ. Myofibroblastoma of the breast. Sixteen cases of a distinctive benign mesenchymal tumor. Am J Surg Pathol. 1987;11:493–502.CrossRefPubMedGoogle Scholar
  22. 22.
    Fukunaga M, Ushigome S. Myofibroblastoma of the breast with diverse differentiations. Arch Pathol Lab Med. 1997;121:599–603.PubMedGoogle Scholar
  23. 23.
    Magro G, Fletcher CDM, Eusebi V. Myofibroblastoma. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 130–1.Google Scholar
  24. 24.
    Rosen PP, Ernsberger D. Mammary fibromatosis. A benign spindle-cell tumor with significant risk for local recurrence. Cancer. 1989;63:1363–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Lee A, Gobbi H. Desmoid-type fibromatosis. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 131–2.Google Scholar
  26. 26.
    Abraham SC, Reynolds C, Lee JH, Montgomery EA, Baisden BL, Krasinskas AM, Wu TT. Fibromatosis of the breast and mutations involving the APC/beta-catenin pathway. Hum Pathol. 2002;33:39–46.CrossRefPubMedGoogle Scholar
  27. 27.
    Gobbi H, Tan PH. Lipoma. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 123–4.Google Scholar
  28. 28.
    Schnitt SJ, Collins LC. Other mesenchymal lesions. In: Schnitt SJ, Collins LC, editors. Biopsy interpretation of the breast. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. p. 408–18.Google Scholar
  29. 29.
    Tan PH, Tse G, Lee A, Simpson JF, Hanby AM. Fibroepithelial tumours. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 142–7.Google Scholar
  30. 30.
    Daya D, Trus T, D'Souza TJ, Minuk T, Yemen B. Hamartoma of the breast, an underrecognized breast lesion. A clinicopathologic and radiographic study of 25 cases. Am J Clin Pathol. 1995;103:685–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Tse GM, Law BK, Ma TK, Chan AB, Pang LM, Chu WC, Cheung HS. Hamartoma of the breast: a clinicopathological review. J Clin Pathol. 2002;55:951–4.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Fox SB, Lee A. Granular cell tumor and benign peripheral nerve-sheath tumours. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 134–5.Google Scholar
  33. 33.
    Fanburg-Smith JC, Meis-Kindblom JM, Fante R, Kindblom LG. Malignant granular cell tumor of soft tissue: diagnostic criteria and clinicopathologic correlation. Am J Surg Pathol. 1998;22:779–94.CrossRefPubMedGoogle Scholar
  34. 34.
    Donnell RM, Rosen PP, Lieberman PH, Kaufman RJ, Kay S, Braun DW Jr, Kinne DW. Angiosarcoma and other vascular tumors of the breast. Am J Surg Pathol. 1981;5:629–42.CrossRefPubMedGoogle Scholar
  35. 35.
    Ginter PS, McIntire PJ, Shin SJ. Vascular tumours of the breast: a comprehensive review with focus on diagnostic challenges encountered in the core biopsy setting. Pathology. 2017;49:197–214.CrossRefPubMedGoogle Scholar
  36. 36.
    MacGrogan G, Skalova A, Shin SJ. Benign vascular lesions. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 127–8.Google Scholar
  37. 37.
    Schnitt SJ, Collins LC. Vascular lesions. In: Schnitt SJ, Collins LC, editors. Biopsy interpretation of the breast. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. p. 387–407.Google Scholar
  38. 38.
    Rosen PP. Vascular tumors of the breast. III. Angiomatosis. Am J Surg Pathol. 1985;9:652–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Fineberg S, Rosen PP. Cutaneous angiosarcoma and atypical vascular lesions of the skin and breast after radiation therapy for breast carcinoma. Am J Clin Pathol. 1994;102:757–63.CrossRefPubMedGoogle Scholar
  40. 40.
    Fraga-Guedes C, Gobbi H, Mastropasqua MG, Rocha RM, Botteri E, Toesca A, Viale G. Clinicopathological and immunohistochemical study of 30 cases of post-radiation atypical vascular lesion of the breast. Breast Cancer Res Treat. 2014;146:347–54.CrossRefPubMedGoogle Scholar
  41. 41.
    Fraga-Guedes C, André S, Mastropasqua MG, Botteri E, Toesca A, Rocha RM, et al. Angiosarcoma and atypical vascular lesions of the breast: diagnostic and prognostic role of MYC gene amplification and protein expression. Breast Cancer Res Treat. 2015;151:131–40.CrossRefPubMedGoogle Scholar
  42. 42.
    Fletcher CDM, MacGrogan G, Fox SB. Angiosarcoma. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 135–6.Google Scholar
  43. 43.
    Fraga-Guedes C, Gobbi H, Mastropasqua MG, Botteri E, Luini A, Viale G. Primary and secondary angiosarcomas of the breast: a single institution experience. Breast Cancer Res Treat. 2012;132:1081–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Scow JS, Reynolds CA, Degnim AC, Petersen IA, Jakub JW, Boughey JC. Primary and secondary angiosarcoma of the breast: the Mayo Clinic experience. J Surg Oncol. 2010;101:401–7.PubMedGoogle Scholar
  45. 45.
    Fletcher CDM, Eusebi V. Liposarcoma. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 137.Google Scholar
  46. 46.
    Fletcher CDM, Eusebi V. Osteosarcoma. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC Press; 2012. p. 138–9.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Helenice Gobbi
    • 1
  • Cristiana Buzelin Nunes
    • 2
  1. 1.Department of Surgery, Institute of Health SciencesFederal University of Triangulo MineiroUberabaBrazil
  2. 2.Department of Anatomic Pathology, Faculty of MedicineFederal University of Minas GeraisBelo HorizonteBrazil

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