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Presented by Dr. Pedram Argani and prepared by Dr. Kevan Salimian
This is a 31 year old male with a chest wall/breast mass.
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1. Question
This is a 31 year old male with a chest wall/breast mass. Choose the correct diagnosis.
Correct
Answer: Nodular fasciitis
Histologic Description: This is a spindle cell proliferation characterized by loosely spaced cells with uniform chromatin and amphophilic cytoplasm. There are associated thin capillaries with extravasated red blood cells, along with lymphocytes. The nuclei are hypochromatic relative to the adjacent endothelial cells. These are the typical features of nodular fasciitis.
Differential Diagnosis: Fibromatosis would demonstrate more fibrous stroma, and more infiltrative borders. Nuclear labeling for beta-catenin would support the diagnosis of fibromatosis, but this was absent in the current case. Metaplastic carcinoma of the breast may be very bland and have a fasciitis-like pattern. However, these metaplastic carcinomas demonstrate strong immunoreactivity for high molecular cytokeratins. Leiomyomas would have more fascicular growth protein and less myxoid stroma. The neoplastic cells typically have dense eosinophilic cytoplasm and rectangular nuclei, and label diffusely for desmin.
Incorrect
Answer: Nodular fasciitis
Histologic Description: This is a spindle cell proliferation characterized by loosely spaced cells with uniform chromatin and amphophilic cytoplasm. There are associated thin capillaries with extravasated red blood cells, along with lymphocytes. The nuclei are hypochromatic relative to the adjacent endothelial cells. These are the typical features of nodular fasciitis.
Differential Diagnosis: Fibromatosis would demonstrate more fibrous stroma, and more infiltrative borders. Nuclear labeling for beta-catenin would support the diagnosis of fibromatosis, but this was absent in the current case. Metaplastic carcinoma of the breast may be very bland and have a fasciitis-like pattern. However, these metaplastic carcinomas demonstrate strong immunoreactivity for high molecular cytokeratins. Leiomyomas would have more fascicular growth protein and less myxoid stroma. The neoplastic cells typically have dense eosinophilic cytoplasm and rectangular nuclei, and label diffusely for desmin.
