Primary breast sarcoma: Clinical and retrospective analysis of cases from Jerez General Hospital, Spain

Abstract

e21526 Background: Primary sarcomas of the breast (PBS) are a heterogeneous group of tumors from stromal breast, infrequent (0.1% of BC). Diagnosis and treatment is unclear. We analyzed all cases of PBS from BC diagnosed at our institution from 2004 to 2008. Methods: Histopathological specimens of PBS were reviewed (excluded phylloides, metaplastic and sarcomatoids carcinomas). A single-independent pathologist revised biopsies to confirm histology features (H&E) and inmunohistochemistry (IHC) setting: p53, ki67, vimentine, oestrogen and cerbB2 receptors, CD31/34, cito-keratins (CK) and histology grade. We revised image methods (mammography, ultrasound or IRM/TC) and surgery make. We analysed diseases outcomes (disease free survival, DFS) by histology high risk factors (tumor size, histology, and proliferation index). Heterogeneous chemotherapy/radiotherapy schedules was evaluated . Statistical analysis with G-Stat 2.0 was performed. Results: Seven cases of PBS (1 male/6 female) were reviewed, from 790 BC diagnosed (0.8%): 2 angiosarcomas (AS), 1 malignant fibrous histiocytoma, 2 undifferentiated, one osteoclastic and other spindle-cell sarcoma. Mean age was 63 years, 3 image-techniques used in 71.4% patients (pts), lumpectomy was performed in 71.4%. IHC: vimentine + and CK- in all cases, CD31/CD34+ in AS. P53 and Ki67 were not significantly associated with DFS (p=0.33 and p=0.88 respectively), tumor size (mean 7.4 cm) neither (T-Student test, p=0.80). Adjuvant therapy was radiation 57.14% pts; and chemotherapy (doxorubicin 4/liposomal doxorubicin 2 pts) in recurrence. Three pts have died with distant metastases (DFS mean: 11.7 months; Kaplan-Meier method). Contralateral low grade AS in one woman, and lung adenocarcinoma in the man, had been diagnosed 2 years later. Conclusions: PBS are rare and difficult diagnosis tumors. There are few series published, without prospective studies to evaluate an adequate therapy, diagnosis and valuable prognostic factors. Our incidence was high, but the independent pathology analysis confirmed all histopathological diagnosis. This review included novel IHC and IRM images, considered necessary for diagnosis and personalized treatment. No significant financial relationships to disclose.