Necrotizing Fasciitis Following Modified Radical Mastectomy

Abstract

stromal component comprised loose-spindled cells with no cytologic atypia or mitotic activity. The majority of the stromal cells contained homogenously eosinophilic hyaline intracytoplasmic inclusions. Immunohistochemically the spindled stromal cells were positive for smooth muscle actin, vimentin, and desmin, and negative for S100 protein. The inclusion bodies were highlighted by smooth muscle actin (Fig. 2).This case was diagnosed as a benign Phyllodes tumor with intracytoplasmic inclusion bodies identical to infantile digital fibromatosis (IDF) based on the morphology of the stromal and epithelial components. The clinical, mammographic, and ultrasonographic findings supported the diagnosis. The stromal cells in this tumor are similar to the stromal cells in IDF having fibroblastic and myofibroblastic morphology. The stromal cells were positive for smooth muscle actin, vimentin, and desmin in this tumor as described in IDF. As in IDF the inclusion bodies in our case highlighted the hollow pattern with smooth muscle actin. The presence of intracytoplasmic inclusion bodies in stromal cells with morphologic, immunohistochemical pattern similar to that of IDF in a case of benign phyllodes tumor is rare with two cases described so far. This is the only case where the inclusion bodies were found in FNAC, NCB, and resection specimen.A 59-year-old woman was treated for an adenocarcinoma of her left breast for which an ablation and sentinel node procedure was performed. Since the sentinel node was positive for adenocarcinoma an axillairy node dissection on the left side was performed. A wound drain was placed during this procedure (a) (b) Figure 2. Phyllodes tumor in excised specimen (H&E) (a). Inclusions highlighted with smooth muscle actin (b).

Primary Necrotizing Fasciitis of the Breast: A Case Report and Review of the Literature

“…1,2 Shah et al 1 reported a case in a 50-year-old, black, type II diabetic and Keune et al 2 in a 47-year-old Caucasian. NF of the breast has also been reported in the literature in postmastectomy wounds, 3–5 associated with ulceration of the breast 6,7 and following core needle biopsy. 8…”

“…Consistent with NF in other regions of the body, NF of the breast is most commonly type I; 1–3,6,7 however, type II NF has also been described. 4,5,8 Type II diabetes has been implicated in two 1,5 out of the eight other case reports of NF of the breast and at least two of these patients were also obese; 3,5 however, one patient had no identified risk factors. 2…”

Necrotizing Fasciitis of the Breast Requiring Emergent Radical Mastectomy

“…Type II NF, as in the case of our patient, is most common in young, previously healthy, and immunocompetent adults, and is more likely to occur without a clear precipitating factor . Among the 16 reported cases of breast NF, common risk factors include DM , history of an invasive breast procedure, and a history of breast cancer . Notably, however, no clear precipitating factor was identified in six reported cases .…”

Necrotizing Fasciitis of the Breast Requiring a Life-Saving Mastectomy: A Case Report and Literature Review

“…Necrotizing fasciitis of the breast can be idiopathic [1,13] or secondary to other causes, i.e, following a needle core biopsy [14,15], elective total or partial mastectomy [7,[16][17][18][19], human bites [15], penetrating injury [20], anticoagulation therapy [21][22][23], topical belladonna application [24], in patients with puerperal sepsis [25], and breast tumors with mammary infarcts in pregnant patients [26,27]. Our literature search revealed that trauma, small trivial wounds, or even minor scratches can cause necrotizing fasciitis [28].…”