Document Type : Case Reports
Authors
1 Cancer Molecular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
Background: Breast sarcoma is a rare, but aggressive tumor. There are few case reports in the literature and several aspects of this disease are still not completely comprehended. Therefore, reporting new cases can help to enrich the literature.
Case Presentation: We report a case with a breast mass and pus secretion from her right breast, misdiagnosed as having an abscess and mistreated by antibiotics. The patient was referred for an ultrasound examination and mammography, and a needle biopsy was performed that suggested an aggressive tumor. By the pathologist’s suggestion, a total mastectomy of the right breast was performed with the excision of sentinel nodes. A pathological examination revealed high-grade undifferentiated pleomorphic sarcoma (UPS) without vascular or lymph node invasion as the final diagnosis. The patient underwent postoperative chemotherapy and is currently in good condition.
Conclusion: This case emphasizes considering this rare tumor when approaching a breast mass. Performing surgery with adequate resection margin can improve the patient’s prognosis. Some cases reporting lung and brain metastasis suggest breast UPS is a more aggressive tumor than other breast sarcomas. Total mastectomy with negative margins and free-of-tumor lymph nodes may be the key to improved prognosis in such patients.
Keywords
Main Subjects
- Al-Benna S, Poggemann K, Steinau H-U, Steinstraesser L. Diagnosis and management of primary breast sarcoma. Breast Cancer Res Treat. 2010;122(3):619-26. [DOI:10.1007/s10549-010-0915-y] [PMID]
- Lim SZ, Ong KW, Tan BKT, Selvarajan S, Tan PH. Sarcoma of the breast: an update on a rare entity. J Clin Pathol. 2016;69(5):373-81. [DOI:10.1136/jclinpath-2015-203545] [PMID]
- Eilber FC, Kattan MW. Sarcoma nomogram: validation and a model to evaluate impact of therapy. J Am Coll Surg. 2007;205(4 Suppl):S90-S5. [DOI:10.1016/j.jamcollsurg.2007.06.335] [PMID]
- Winchester D, Lehman J, Tello T, Chimato N, Hocker T, Kim S, et al. Undifferentiated pleomorphic sarcoma: Factors predictive of adverse outcomes. J Am Acad Dermatol. 2018;79(5):853-9. [DOI:10.1016/j.jaad.2018.05.022] [PMID]
- Chen S, Huang W, Luo P, Cai W, Yang L, Sun Z, et al. Undifferentiated pleomorphic sarcoma: long-term follow-up from a large institution. Cancer Manag Res. 2019;11:10001. [DOI:10.2147/CMAR.S226896] [PMID]
- Jeong YJ, Oh HK, Bong JG. Undifferentiated pleomorphic sarcoma of the male breast causing diagnostic challenges. J Breast Cancer. 2011;14(3):241-6. [DOI:10.4048/jbc.2011.14.3.241] [PMID]
- Kong J, Shahait AD, Kim S, Choi L. Radiation-induced undifferentiated pleomorphic sarcoma of the breast. BMJ Case Rep. 2020;13(2):e232616. [DOI:10.1136/bcr-2019-232616] [PMID]
- Rai MP, Mannelli VK, Kandola S, Marinas EB. Pleomorphic sarcoma of the breast. BMJ Case Rep. 2017;2017:bcr-2017-223106. [DOI:10.1136/bcr-2017-223106] [PMID]
- Noh JM, Huh SJ, Choi DH, Park W, Nam SJ. Two cases of post-radiation sarcoma after breast cancer treatment. J Breast Cancer. 2012;15(3):364-70. [DOI:10.4048/jbc.2012.15.3.364] [PMID]
- Komaei I, Guccione F, Sarra F, Palmeri E, Ieni A, Cardia R, et al. Radiation-induced undifferentiated pleomorphic sarcoma of the breast: a rare but serious complication following breast-conserving therapy. A case report and literature review. G Chir. 2019;40(6):544-50.
- Quadros CA, Vasconcelos A, Andrade R, Ramos RS, Studart E, Nascimento G, et al. Good outcome after neoadjuvant chemotherapy and extended surgical resection for a large radiation-induced high-grade breast sarcoma. Int Semin Surg Oncol. 2006;3:18. [DOI:10.1186/1477-7800-3-18] [PMID]
- Early AP, Moon W. Breast cancer and secondary cancer recurrences after autologous tissue reconstruction. Clin Breast Cancer. 2021;21(1):e96-e101. [DOI:10.1016/j.clbc.2020.07.015] [PMID]
- Zhang C, Wathuge G. Primary breast sarcoma: a rare and challenging diagnostic entity. Diagn Histopathol. 2023;29(3):173-5. [DOI:10.1016/j.mpdhp.2022.12.006]
- Cozzolino M, Oliviero C, D'Andrea B, Guglielmi G, Califano G, Caivano R, et al. The role of adjuvant radiotherapy for a case of primary breast sarcoma: a plan comparison between three modern techniques and a review of the literature. Case Rep Med. 2018;2018:4137943. [DOI:10.1155/2018/4137943] [PMID]
- Chakrabarti I, Ghosh N, Giri A. Cytologic diagnosis of undifferentiated high grade pleomorphic sarcoma of breast presenting with brain metastasis. J Neurosci Rural Pract. 2013;4(2):188-90. [DOI:10.4103/0976-3147.112763] [PMID]
- Gambichler T, Horny K, Mentzel T, Stricker I, Tannapfel A, Scheel CH, et al. Undifferentiated pleomorphic sarcoma of the breast with neoplastic fever: case report and genomic characterization. J Cancer Res Clin Oncol. 2023;149(4):1465-71. [DOI:10.1007/s00432-022-04000-6] [PMID] []
- Yamazaki H, Shimizu S, Yoshida T, Suganuma N, Yamanaka T, Yamashita T, et al. A case of undifferentiated pleomorphic sarcoma of the breast with lung and bone metastases. Int J Surg Case Rep. 2018;51:143-6. [DOI:10.1016/j.ijscr.2018.07.049] [PMID]
- Sang N-V, Duc NM, My T-TT, Ly T-T, Bang LV, Thong PM. A rare case report of breast sarcoma. Radiol Case Rep. 2021;16(5):1047-50. [DOI:10.1016/j.radcr.2021.02.035] [PMID]
- Balbi G, Di Martino L, Pitruzzella G, Pitruzzella D, Grauso F, Napolitano A, et al. Undifferentiated pleomorphic sarcoma with osteoclast-like giant cells of the female breast. World J Surg Oncol. 2013;11:21. [DOI:10.1186/1477-7819-11-21] [PMID]
- Bansal A, Kaur M, Dalal V. Pleomorphic sarcoma of breast: a report of two cases and review of literature. Acta Med Iran. 2017;55(4):272-6.
- Srinivasamurthy BC, Kulandaivelu AR, Saha K, Saha A. Primary undifferentiated pleomorphic sarcoma of the breast in a young female: a case report. World J Surg Oncol. 2016;14(1):186. [DOI:10.1186/s12957-016-0947-9] [PMID]
- Cubas Farinha N, Teixeira W, Roque D, Livraghi S. Large mirror brain metastases from primary undifferentiated sarcoma of the breast: case report and review of the literature. CNS Oncol. 2022;11(2):CNS85. [DOI:10.2217/cns-2022-0001] [PMID]
- Lee AH. Use of immunohistochemistry in the diagnosis of problematic breast lesions. J Clin Pathol. 2013;66(6):471-7. [DOI:10.1136/jclinpath-2012-201109] [PMID]
- Bonacho T, Rodrigues F, Liberal J. Immunohistochemistry for diagnosis and prognosis of breast cancer: a review. Biotech Histochem. 2020;95(2):71-91. [DOI:10.1080/10520295.2019.1651901] [PMID]
- Yamashita N, Tokunaga E, Kitao H, Hisamatsu Y, Taketani K, Akiyoshi S, et al. Vimentin as a poor prognostic factor for triple-negative breast cancer. J Cancer Res Clin Oncol. 2013;139(5):739-46. [DOI:10.1007/s00432-013-1376-6] [PMID]
- Tanaka K, Tokunaga E, Inoue Y, Yamashita N, Saeki H, Okano S, et al. Impact of expression of vimentin and Axl in breast cancer. Clin Breast Cancer. 2016;16(6):520-6. e2. [DOI:10.1016/j.clbc.2016.06.015] [PMID]
- Hemalatha A, Suresh T, Kumar MH. Expression of vimentin in breast carcinoma, its correlation with Ki67 and other histopathological parameters. Indian J Cancer. 2013;50(3):189-94. [DOI:10.4103/0019-509X.118724] [PMID]
Wang J, Wang W-L, Sun H, Huo L, Wu Y, Chen H, et al. Expression of TRPS1 in phyllodes tumor and sarcoma of the breast. Hum Pathol. 2022;121:73-80. [DOI:10.1016/j.humpath.2022.01.002] [PMID]
)