Myofibroblastoma (MFB) is a rare mesenchymal tumor arising in breast's soft tissue with a great variety of microscopic features that can be mistaken with a wide variety of biphasic lesions. The authors report a rare case of myofibroblastoma of the breast arising in a mammary hamartoma (MH), present a review of the clinicopathological features of these lesions, and make some diagnostic considerations. The tumour consisted of a well-circumscribed nodule. MFB component comprised about fifty percent of the lesion and was made up of bipolar spindle cells arranged in fascicular clusters separated by bands of hyalinized collagen. There were fat cells and several residual hamartoma glands intermingled and distorted in MFB area. MFB component was positive for Desmin, CD34, bcl-2, and Calponin. To the best of our knowledge, MFB has not been reported in MH, neither has any of the reports described mammary glands joined within MFB. 1. Introduction Myofibroblastoma (MFB) is a rare mesenchymal tumor arising in breast’s soft tissue [1, 2]. In 1987, Wargotz et al. [2] described a benign tumour of the breast composed of spindle cells arranged in fascicular clusters with interspersed bands of hyalinized collagen and called this lesion “myofibroblastoma”. After that, several cases have subsequently been reported, and it has become clear that MFB of the breast may exhibit a greater variety of morphological features than originally described. Glandular structures have not been described in MFB [3–9]. Mammary hamartomas (MH) comprise about 0.7% of all benign breast masses that were first described in 1928 by Prym [10], who referred to them as “mastomas”. Further cases were reported as adenolipomas and fibroadenolipomas. In 1971, Arrigoni was the first to introduce the term mammary hamartoma, that is further characterized by the variety of mature tissues they contain [11]. The authors report a case of MFB developed in MH. This very rare association may be a potential diagnostic pitfall in the spectrum of biphasic cell lesions of the breast. To our knowledge, the coexistence of MFB and MH in the same mass has not been published. 2. Case Report A 59-year-old woman presented with a solitary nodule in the left breast which was first noted on routine mammography. Left breast echography showed a sharply demarcated nodule in the breast parenchyma. A complete surgical excision of the mass was performed. Gross pathology showed a well-circumscribed, round to slightly lobulated, tan, rubbery, 2,5?cm nodule. On cut sections, a whitish tumour mass with scanty interspersed yellow areas was
References
[1]
C. Toker, C. Tang, F. Whitely, S. W. Berkheiser, and R. Rachman, “Benign spindle cell breast tumor,” Cancer, vol. 48, no. 7, pp. 1615–1622, 1981.
[2]
E. S. Wargotz, S. W. Weiss, and H. J. Norris, “Myofibroblastoma of the breast: sixteen cases of a distinctive benign mesenchymal tumor,” American Journal of Surgical Pathology, vol. 11, no. 7, pp. 493–502, 1987.
[3]
F. A. Tavassoli and P. Devilee, Tumours of the Breast and Female Genital Organs, World Health Organization Classification of Tumours-Pathology and Genetics, IARC Press, Lyon, France, 2003.
[4]
F. Maggiani, M. Debiec-Rychter, G. Verbeeck, and R. Sciot, “Extramammary myofibroblastoma is genetically related to spindle cell lipoma,” Virchows Archiv, vol. 449, no. 2, pp. 244–247, 2006.
[5]
C. Charpin, M. P. Mathoulin, and M. P. Mathoulin, “Reappraisal of breast hamartomas: a morphological study of 41 cases,” Pathology Research and Practice, vol. 190, no. 4, pp. 362–371, 1994.
[6]
G. Magro, M. Bisceglia, and M. Michal, “Expression of steroid hormone receptors, their regulated proteins, and bcl-2 protein in myofibroblastoma of the breast,” Histopathology, vol. 36, no. 6, pp. 515–521, 2000.
[7]
G. Magro, M. Bisceglia, M. Michal, and V. Eusebi, “Spindle cell lipoma-like tumor, solitary fibrous tumor and myofibroblastoma of the breast: a clinico-pathological analysis of 13 cases in favor of a unifying histogenetic concept,” Virchows Archiv, vol. 440, no. 3, pp. 249–260, 2002.
[8]
G. Magro, R. Caltabiano, A. Di Cataldo, and L. Puzzo, “CD10 is expressed by mammary myofibroblastoma and spindle cell lipoma of soft tissue: an additional evidence of their histogenetic linking,” Virchows Archiv, vol. 450, no. 6, pp. 727–728, 2007.
[9]
D. R. Salom?o, T. B. Crotty, and A. G. Nascimento, “Myofibroblastoma and solitary fibrous tumour of the breast: hispathologic and immunohistochemical studies,” Breast, vol. 10, no. 1, pp. 49–54, 2001.
[10]
P. Prym, “Pseudoadenome, Adenome and Mastome der weinblichen Brustdrüse über die Entstehung umschriebener adenom?hnlicher Herde in die Mamma und über die Nachahmung des Brustdrüsengewebes durch echte Adenome und Fibroadenome,” Beitr Pathol Anat Pathol, vol. 81, p. 221, 1928.
[11]
M. G. Arrigoni, M. B. Dockerty, and E. S. Judd, “The identification and treatment of mammary hamartoma,” Surgery Gynecology and Obstetrics, vol. 133, no. 4, pp. 577–582, 1971.
[12]
V. Stafyla, N. Kotsifopoulos, K. Grigoriadis, C. N. Bakoyiannis, G. Peros, and G. H. Sakorafas, “Myoid hamartoma of the breast: a case report and review of the literature,” Breast Journal, vol. 13, no. 1, pp. 85–87, 2007.
[13]
L. Di Tommaso, G. Pasquinelli, and S. Damiani, “Smooth muscle cell differentiation in mammary stromo-epithelial lesions with evidence of a dual origin: stromal myofibroblasts and myoepithelial cells,” Histopathology, vol. 42, no. 5, pp. 448–456, 2003.
[14]
G. Magro, M. Michal, E. Vasquez, and M. Bisceglia, “Lipomatous myofibroblastoma: a potential diagnostic pitfall in the spectrum of the spindle cell lesions of the breast,” Virchows Archiv, vol. 437, no. 5, pp. 540–544, 2000.
[15]
J. S. Silverman and A. Tamsen, “Mammary fibroadenoma and some phyllodes tumour stroma are composed of CD34+ fibroblasts and factor XIIIa+ dendrophages,” Histopathology, vol. 29, no. 5, pp. 411–419, 1996.
[16]
G. Magro, M. Michal, and M. Bisceglia, “Benign spindle cell tumors of the mammary stroma: diagnostic criteria, classification, and histogenesis,” Pathology Research and Practice, vol. 197, no. 7, pp. 453–466, 2001.
[17]
E. Brogi, “Benign and malignant spindle cell lesions of the breast,” Seminars in Diagnostic Pathology, vol. 21, no. 1, pp. 57–64, 2004.
[18]
R. K. Jacklin, P. F. Ridgway, P. Ziprin, V. Healy, D. Hadjiminas, and A. Darzi, “Optimising preoperative diagnosis in phyllodes tumour of the breast,” Journal of Clinical Pathology, vol. 59, no. 5, pp. 454–459, 2006.
[19]
B. K. McLaren, J. Smith, P. A. Schuyler, W. D. Dupont, and D. L. Page, “Adenomyoepithelioma: clinical, histologic, and immunohistologic evaluation of a series of related lesions,” American Journal of Surgical Pathology, vol. 29, no. 10, pp. 1294–1299, 2005.