3. M
i
Epithelial
x
Myoepithelial e
d
Epithelial Mesenchymal
Mixed
4. M
i
Epithelial
x
Myoepithelial e
d
Epithelial Mesenchymal
Mixed
5. Osnovne činjenice
• Bilo koji tumor mekih tkiva se može
pojaviti i u dojci;
• U poredjenju sa carcinomom dojke,
tumori mekih tkiva u dojci su veoma
retki;
• Veċa je verovatnoċa da jedan tumor sa
izgledom sarcoma je u stvari
metaplastični karcinom ili loše
differentivani phylloides tumor.
7. Metaplastic Carcinoma of the Breast
with Neuroectodermal Stromal Component
Tibor Tot, Juan Jose Badani De La Parra,
and Leif Bergkvist.
Pathology Research International 2011
29. Asymptomatic
Selected from screening
58 year
Right breast, upper lat
Fettily replaced breast
6x4mm circular lesion
Found also on ultrasound
Radiologic dg.:
Susp mucinous cancer
37. Mariscal A. et al.
Breast hemangioma
mimicking carcinoma.
Breast 2002 11:357-8.
Gopal SV et al.
Breast hemangioma
simulating an
inflammatory carcinoma
Breast J 2005 11:498-9
38. Galindo LM. et al.
Atypical hemangioma of
the breast: a diagnostic
pitfall in breast
fine-needle aspiration.
Diagn Cytopathol 2001 24:215-8.
39. Honda SA, et al.
Hemangioma of the
breast with atypical
histological features.
further analysis of
histological subtypes
confirming their benign
character.
Am J Surg Pathol 1992 16:553-60.
70. Maligni tumori mekih tkiva
• Nespecifični za dojku
• ”Specifični” : Malignant Stromal Spindle
Cell Tumors – MSSCTs
Tavassoli, Eusebi, Tumors of the Mammary Gland
AFIP Atlas of Tumor pathology, Series 4, 2009
71. Sarcomi dojke
• Veoma retki, < 1% od svih malignih
tumora
• Dr J Lamovec: 6/5382 malignih tumora u
Ljubljani za 1 godina
• Dalarna 2005-2011 oktobra, 1/1493
malignih slucajeva
74. Vim SMA Ker CD34
MSSCT fibroblastic + - - +/-
MSSCT myofibroblastic + + - +
Monophasic + - + -
sarcomatoid carcinoma
Myoepithelial carcinoma + + -/+ -
Based on Tavassoli, Eusebi AFIP 4, page 291
75. The only difference resides in 25% of
axillary metastases in SC and virtually
never in sarcomas.
76. Treatment of MSSCTs
• Mastectomy (recurrences rare)
• Breast conserving surgery (recurrences in
up to 2/3 of cases)
• Survival ?
• Metastases to the lungs, liver, GI tract,
adrenals, brain, bones, pleura and
retroperitoneum.
77. MSSCT with predominant
fibroblastic differentiation
• Fibrosarcoma
• Malignant fibrous histiocytoma
• Vimentin only
• Diagnosis by exclusion
84. Leiomyosarcoma of the breast
• Positive for vimentin, actin& desmin
• Nearly 50% of cases around nipple
• Circumscribed margins
• Mitotic count no same impact as uterus
• Moderately aggressive neoplasms
• Complete excision the ONLY treatment
95. Angiosarcoma
• Definition: Malignant tumors composed of
neoplastic elements with morphological
properties of normal endothelial cells.
• Synonym: hemangiosarcoma;
hemangioblastoma; lymphangiosarcoma
96. Angiosarcoma
• Primary (de novo) in breast parenchyma.
• Secondary in the skin and soft tissues of the
arm following ipsilateral radical mastectomy and
subsequent lymphedema (Stewart - Treves
syndrome).
• Secondary in the skin and chest wall following
radical mastectomy and local radiotherapy.
• Secondary in the skin or breast parenchyma or
both following conservative treatment and
radiotherapy.
97. Angiosarcoma - grade 1
Interanastomosing channels filled with red
blood cells.
Hyperchromatic nuclei
Dissection of interlobular and intralobular
stroma
Glands entrapped
Mitoses and necrosis absent
Donnel et al. Am J Surg Pathol 5:629-642,1981
100. Angiosarcoma grade 3
Interastomosing vascular channels.
Solid areas (more than 50%)
Mitoses and necrosis present
Donnel et al. Am J Surg Pathol 5:629-642,1981
101.
102.
103. Angiosarcoma grade 2
Features of grade I in 75% of tumour.
Rest solid areas.
Endothelial tufting
Mitoses numerous
Donnel et al. Am J Surg Pathol 5:629-642,1981
116. First report 1986
Vuitch MI, Rosen PP, Erlandson RA. Pseudoangiomatous
hyperplasia of the mammary stroma.
Human Pathol 1986;17:185-91
117. ”prelymphatic” system linked to the main
lymph vessels in the breast
Hartveit F. Attenuated cells in breast stroma: the missing
lymphatic system of the breast.
Histopathology 1990;16:533-43
118. Tumor with myofibroblastic differentiation
Powell CM, Cranor LM, Rosen PP. Pseudoangiomatous
stromal hyperplasia (PASH). A mammary stromal tumor
with myofibroblastic differentiation.
Am J Surg Pathol 1995; 19:270-7.
119. Clinical manifestations:
1. Tumor forming (unilateral, firm, rubbery mass)
0,4 % of consecutive breast specimens
Polger MR et al. Pseudoangoiomatous stromal hypeplasia: mammographic
and sonographic appearance. AJR 1996 166:349-52.
2. Incidental /microscopical
23 % of consecutive breast specimens
Ibrahim RE et al. Pseudoangoiomatous hypeplasia of the mammary stroma;
some observations regarding its clinicoapathologic spectrum.
Cancer 1989 63 1154 -60
3. Massive bilateral (peau d’orange)
(1 case in Rosen’s Breast Pathology)
120. Clinical manifestations:
Massive (bilateral) (peau d’orange)
- 1 case in Rosen’s Breast Pathology
- 1 case:
Mansouri D et al. Pseudoangiomatous stromal hyperplaia of mammary
stroma: a case with gigantomastia. Ann Pathol 2004; 24:179-82
+1
121. Tumor forming PASH: 1 male case
Seidman JD et al. Rapid growth of pseudoangiomatous hyperplasia
of mammary stroma in axillary gynecomastia in an immunosuppressed man.
Arch Pathol Lab Med 1993:117:736-8
PASH:
frequent incidental finding in gynecomastia
(23 – 47 %)
Milanesi MF et al. Pseudoangiomatous hyperplasia of mammary stroma
associated with gynecomastia J Clin Pathol 1998:51 204-6
Badve S, Soane JP. Pseudoangiomatous stromal hyperplasia of male breast.
Histopathology 1995 26:463-6
124. Radiologic appearance
A single case of round well-circumscribed tumor,
3.6 cm 8.2cm in 12 months
Taira N et al. Nodular pseudoangiomatous stromal hyperplasia of mammary
troma in a case showing rapid tumor growth. Breast Cancer 2005; 12:331-6
125. Most of the women are premenopausal,
If postmenopausal HRT
15 –55 (36) ys.
126. Puthi S et al.
Tamoxifen in the management of
pseudoangiomatous stromal hyperplasia.
Breast J 2001: 7:434-9
