Primary fibrosarcoma of the breast: a case report

Jin-Young Lee, Dae-Bong Kim, Beom Seok Kwak,* **

Department of Radiology, Dongguk University Il-San Hospital, Dongguk University

*Departement of Surgery, Dongguk University Il-San Hospital, Dongguk University
**Department of Pathology, Dongguk University Il-San Hospital, Dongguk University

Address for reprints: Dae-Bong Kim

Department of Radiology, Dongguk University International Hospital, Dongguk
University, 814 Siksa-dong, Ilsandong-gu, Goyang-si, 410-773, Korea
E-mail: dbkim@duih.org
Phone: 031-961-7837, 031-961-7825
Fax: 031-961-8281

Primary fibrosarcoma of the breast: a case report

Abstract

A primary fibrosarcoma of the breast is extremely rare. We report a case of

primary fibrosarcoma of the breast that presented as a palpable left breast mass an
a 47-year-old woman. A physical examination revealed a about 3 cm sized, round
mass in the left upper outer breast. Mammograms revealed a 3cm sized, partially
circumscribed and partially obscured, and high density mass in the upper outer
quadrant of the left breast. A sonogram demonstrated a 3cm sized, ovoid,
circumscribed, and hypoechoic mass with increased vascularity in the periphery at
Doppler imaging. A surgical excision was performed , and The pathology revealed a
fibrosarcoma.
Keywords: Breast
Mammography
Ultrasonography
Primary fibrosarcoma

Introduction

Primary sarcomas of the breast are malignant tumors arising from the
mesenchymal tissue of the breast[1]. Although primary carcinoma arising from
breast tissue is relatively common, but primary sarcomas of the breast are
extremely rare and constitute less than 0.1% of malignant breast neoplasm[2].

Fibrosarcoma of the breast is the subtype of the breast sarcoma, and is also quite
rare[3]. A few cases about fibrosarcomas arising in the irradiated breast or postoperative scar have been reported[4]. But primary fibrosarcoma of the breast in
female is exceedingly rare[1]. We report the mammographic and sonographic
findings of a pathologically proven primary fibrosarcoma of the breast in a 47-yearold woman with no history of previous breast lesion.

Case report

A 47-year-old woman presented with a chief complaint of a painless palpable

mass in the left breast. The patient noticed the breast mass incidentally 10 days prior
to hospital visit. She had no history of breast abnormalities, previous breast surgery
or radiation therapy. A physical examination revealed a about 3 cm sized, round
mass in the left upper outer breast. There was no overlying skin abnormality. No
axillary or supraclavicular lymph nodes were palpable.
Mammography showed a 3 cm, ovoid, partially obscured, partially circumscribed
high-density mass in ther upper outer portion of the left breast. Calcifications were
not observed within the mass (Fig. 1A, B). Breast sonography demonstrated a 2.5cm
sized, ovoid, circumscribed, homogeneous hypoechoic solid mass with posterior
acoustic enhancement at the 2 oclock direction of the left breast (Fig. 1C). Color
Doppler study showed vascularity in the peripheral portion of the mass (Fig. 1D). We
classified the mass as Breast Imaging Reporting and Data System(BI-RADS)
category 4b. Next, we performed US-guided core needle biopsy and histological
examination of the biopsy specimen revealed the presence of cellular spindle cell
proliferative neoplasm with intermittent mitosis. These findings was not efficacious in

the differentiation between spindle cell mesenchymal neoplasm from fibroepithelial

neoplasm, and could not provide a diagnosis. Therefore, surgical excision was
performed, and the gross specimen showed a well defined round mass without
necrosis. Histological examination showed a high celluar, spindle cell tumor,
displaying mild to moderate celluar atypia, and mitoses(up to 9~10 per high-power
field) (Fig. 1E). The results of immunohistochemical staining were SMA (-) and S-100
(-), indicating a fibrous tumor (Fig. 1F). The final diagnosis was a low-grade
fibrosarcoma.

Discussion

Breast sarcoma is rare, accounting for less than 0.1% of malignant neoplasm of
the breast[2]. Primary fibrosarcomas of the breast are type of malignant stromal
sarcoma. Fibrosarcoma is composed of immature mesenchymal elements
surrounded by collageneous substances [3]. Because of the rarity of this tumor, the
overall incidence of primary fibrosarcoma of the breast has not been established.
Pollard et al. reviewed 25 cases of primary breast sarcoma that diagnosed
pathologically at London hospital during the 80-year period of the study. Among the
25 cases, 4 cases were fibrosarcoma [5].
Fibrosarcomas may occur at any age, but they occur commonly in woman
between 40 and 50 years old. There are no clinical features that distinguish
fibrosarcomas from other breast neoplasms. They grow rapidly and local tumor
recurrence after local excision is common [6]. Metastasis of the tumor is primarily
hematogenous, particularly to lung and bone. Lymphatic metastasis is rare [3].
Imaging features of fibrosarcoma of the breast have not been well established yet.

Elson et al. reviewed mammographic findings of 5 cases with fibrosarcoma of the

breast. In this study, the tumors were dense masses with largely indistinct margin,
ranging from 1.5 cm to 7.0 cm on mammography, and one of them contained
calcified structure. These findings were nonspecific and cannot differentiate the mass
from other breast tumors [3]. In our case, the mass appeared an ovoid, partially
obscured, partially circumscribed high-density mass on mammography. On
ultrasonography, it appeared an ovoid, circumscribed, homogeneous hypoechoic
solid mass with posterior acoustic enhancement.
The main treatment of primary breast sarcoma, including fibrosarcoma, is surgical
excision[7]. The aim of surgery is for excellent local control, and the surgery include
simple mastectomy and local excision with negative surgical margin[8]. Our patient
was treated by surgical excision, and since then neither distant metastases nor local
recurrence have developed.
We have presented a rare case of primary fibrosarcoma of the breast with
mammography and ultrasonography finding. Due to its rarity, more data and
research is required.

References

1. 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 Jul 19;91(2):237-41.
2. O'Donnell ME, McCavert M, Carson J, Mullan FJ, Whiteside MW, Garstin WI.
Non-epithelial malignancies and metastatic tumours of the breast. Ulster Med
J. 2009 May;78(2):105-12.
3. Elson BC, Ikeda DM, Andersson I, Wattsgrd C. Fibrosarcoma of the breast:
mammographic findings in five cases. AJR Am J Roentgenol. 1992
May;158(5):993-5.
4. Iwasaki K, Nagamitsu S, Tsuneyoshi M. Postirradiation fibrosarcoma
following radical mastectomy. Jpn J Surg. 1978 Mar;8(1):73-7.
5. Pollard SG, Marks PV, Temple LN, Thompson HH. Breast sarcoma. A
clinicopathologic review of 25 cases. Cancer. 1990 Sep 1;66(5):941-4.
6. Deodhar SD, Khope S, Kinare SG. Fibrosarcoma of the breast (a case
report). J Postgrad Med. 1983 Apr;29(2):122B, 123-4.
7. Trent JC, Benjamin RS, Valero V. Primary soft tissue sarcoma of the breast.
Curr Treat Options Oncol. 2001 Apr;2(2):169-76.
8. Teo T, Wee SB. Clinically 'benign' breast lumps: sarcoma in hiding?--Case
reports and literature review. Ann Acad Med Singapore. 2004 Mar;33(2):2704.

Figure Legends

Fig.1.A&B Mammography showed a 3 cm, ovoid, partially obscured, partially

circumscribed high-density mass in ther upper outer portion of the left
breast. Calcifications were not observed within the mass.
C. Breast sonography demonstrated a 2.5cm sized, ovoid, circumscribed,
homogeneous hypoechoic solid mass with posterior acoustic enhancement
at the 2 oclock direction of the left breast.
D. Doppler study showed vascularity in the peripheral portion of the mass.
Fig.1.E. The tumor consists of cellular spindle cells with elongated nuclei arranged in
interwoven bundles. The mitotic activity is increased. (Hematoxylin & Eosin
stain. original magnification X400).
F. The tumor is negative for smooth muscle actin. (Immunohistochemistry.
Original magnification X400).

Fig.1
A.

B.

C.

D.

Fig.1.
E.

F.