Fibromatosis of the breast: a 10-year multi-institutional experience and review of the literature

Boland, Michael R.; Nugent, Timothy; Nolan, J. J.; O’Mahony, Johnny; O’Keeffe, Sylvia; Gillham, C.; Maguire, Aoife; Geraghty, James; McCartan, Damian; Evoy, Denis; Prichard, Ruth; McDermott, Enda; Alazawi, Dhaffir; Boyle, Terence J.; Connolly, Elizabeth

doi:10.1007/s12282-020-01145-5

Cited by 15 publications

(33 citation statements)

References 30 publications

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“…The most important challenge in the diagnosis of blandappearing BSCLs is the exclusion of fibromatosis-like MBC [11][12][13][14] (Table 2). This rare tumour shows the unusual combination of spindle cell metaplasia of malignant breast epithelial cells and bland cytological features with minimal nuclear pleomorphism and scarce mitotic activity.…”

Section: Fibromatosis-like Metaplastic Breast Carcinomamentioning

confidence: 99%

“…Although fibromatosis is a locally aggressive lesion that was traditionally excised after CNB diagnosis, the current trend is to adopt a more conservative observational approach [13,15]. Surgical excision is associated with a high rate of re-excision (33-46%) and the rate of local recurrence (9-15%) is not significantly lower than in the active surveillance group (watch-and-wait approach; 12%) [13,14]. Therefore, the distinction of fibromatosis from fibromatosislike MBC, particularly on CNB, is of crucial importance.…”

Section: Fibromatosis-like Metaplastic Breast Carcinomamentioning

confidence: 99%

“…However, if the diagnosis of fibromatosis is confirmed on CNB, diagnostic biopsy/excision is discouraged to avoid leaving lesional tissue behind as multiple surgical interventions are associated with a higher recurrence rate (see above). A conservative approach or therapeutic excision (excision with margins) is recommended [13,14,104]. Myofibroblastoma, nodular fasciitis, and SFT are benign lesions which may be difficult to definitively diagnose on CNB and a B3 categorisation is also recommended [101,102].…”

Section: Diagnosis Of Bscls On Core Needle Biopsymentioning

confidence: 99%

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Spindle cell lesions of the breast: a diagnostic approach

2021

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Spindle cell lesions of the breast comprise a heterogeneous group of lesions, ranging from reactive and benign processes to aggressive malignant tumours. Despite their rarity, they attract the attention of breast pathologists due to their overlapping morphological features and diagnostic challenges, particularly on core needle biopsy (CNB) specimens. Pathologists should recognise the wide range of differential diagnoses and be familiar with the diverse morphological appearances of these lesions to make an accurate diagnosis and to suggest proper management of the patients. Clinical history, immunohistochemistry, and molecular assays are helpful in making a correct diagnosis in morphologically challenging cases. In this review, we present our approach for the diagnosis of breast spindle cell lesions, highlighting the main features of each entity and the potential pitfalls, particularly on CNB. Breast spindle cell lesions are generally classified into two main categories: bland-appearing and malignant-appearing lesions. Each category includes a distinct list of differential diagnoses and a panel of immunohistochemical markers. In bland-appearing lesions, it is important to distinguish fibromatosis-like spindle cell metaplastic breast carcinoma from other benign entities and to distinguish fibromatosis from scar tissue. The malignant-appearing category includes spindle cell metaplastic carcinoma, stroma rich malignant phyllodes tumour, other primary and metastatic malignant spindle cell tumours of the breast, including angiosarcoma and melanoma, and benign mimics such as florid granulation tissue and nodular fasciitis.

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Section: Fibromatosis-like Metaplastic Breast Carcinomamentioning

confidence: 99%

Section: Fibromatosis-like Metaplastic Breast Carcinomamentioning

confidence: 99%

Section: Diagnosis Of Bscls On Core Needle Biopsymentioning

confidence: 99%

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Spindle cell lesions of the breast: a diagnostic approach

2021

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“…The cells of fibromatosis lack cytological atypia and mitoses should be difficult to identify (Figure 7A). This lesion may recur locally but is usually managed by surveillance 34, 35 …”

Section: Entities That May Results In Overdiagnosis Of Malignancymentioning

confidence: 99%

Pitfalls in breast pathology

2022

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Accurate pathological diagnosis is the cornerstone of optimal clinical management for patients with breast disease. As non-operative diagnosis has now become the standard of care, histopathologists encounter the daily challenge of making definitive diagnoses on limited breast core needle biopsy (CNB) material. CNB samples are carefully evaluated using microscopic examination of haematoxylin and eosin (H&E)-stained slides and supportive immunohistochemistry (IHC), providing the necessary information to inform the next steps in the patient care pathway. Some entities may be difficult to distinguish on small tissue samples, and if there is uncertainty a diagnostic excision biopsy should be recommended. This review discusses (1) benign breast lesions that may mimic malignancy, (2) malignant conditions that may be misinterpreted as benign, (3) malignant conditions that may be incorrectly diagnosed as primary breast carcinoma, and (4) some IHC pitfalls. The aim of the review is to raise awareness of potential pitfalls in the interpretation of breast lesions that may lead to underdiagnosis, overdiagnosis, or incorrect classification of malignancy with potential adverse outcomes for individual patients.

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“…However, if the diagnosis of fibromatosis is confirmed on CNB, a conservative approach or therapeutic approach (excision with free margins) is recommended. 22 Desmoid fibromatosis has a propensity for local recurrence within the first three years, with reported recurrence rates in the breast ranging from 20 to 30%. Size, atypia, cellularity and number of mitoses cannot predict the likelihood of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Fibromatosis of the Breast: Report of a Case with Cytohistological Correlation

et al. 2022

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Background: Breast fibromatosis is a very rare, locally infiltrative lesion, without metastatic potential that arises from either stromal fibroblasts or myofibroblasts of the breast or from the pectoral fascia, extending into the breast, with its cytological and histological features only rarely being described. Case Presentation: A 58-year-old woman, with no past medical/surgical or family history, was diagnosed on regular mammographic and ultrasound examination with a nodular tumor density, in the upper inner part of her right breast. There were no calcifications or apparent lymph nodes in the right axilla. The woman underwent FNA and US-guided biopsy and final resection biopsy under hook marking. We reviewed the cytological findings of fibromatosis of the breast, as they presented in FNAC aspirates of a non-palpable mammographic finding and the histological findings in both preoperative core-needle biopsy and excision specimen. The final diagnosis was of fibromatosis of the breast. No further actions were taken. The woman is well, without recurrence, more than four years afterwards. Conclusion: Our case can make the pathologists more acquainted with the cytological and pathologic features of a rare tumor entity and the clinicians with a rare breast lesion, which can mimic malignancy both clinically and radiologically. The diagnosis of fibromatosis of the breast is more reliable in excision specimens. Nevertheless, cytology can be an invaluable adjunct to histology, pre-operatively, as it can exclude cancer and help in the preoperative planning.

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Fibromatosis of the breast: a 10-year multi-institutional experience and review of the literature

Cited by 15 publications

References 30 publications

Spindle cell lesions of the breast: a diagnostic approach

Spindle cell lesions of the breast: a diagnostic approach

Pitfalls in breast pathology

Fibromatosis of the Breast: Report of a Case with Cytohistological Correlation

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