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Presented by Pedram Argani, M.D. and prepared by Marc Halushka M.D., Ph.D.
Case 3: 40 year-old female with a 2 cm breast mass.
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1. Question
Week 181: Case 3
40 year-old female with a 2 cm breast mass.images/Halushka/conf51804/case3image1.jpg
images/Halushka/conf51804/case3image2.jpg
images/Halushka/conf51804/case3image3.jpg
images/Halushka/conf51804/case3image4.jpgCorrect
Answer: Fibromatosis
Histology: The tumor is composed of spindle cells with somewhat wavy nuclei separated by abundant collagen. Blood vessels stand out in relation to the tumor cells and often appear to be separated from them by a clear space. The tumor was completely nonreactive for all cytokeratins (including CAM 5.2, AE1/AE3 and 34BetaE12), and demonstrated nuclear labeling for beta-catenin. This supports the diagnosis of fibromatosis.The tumor is composed of spindle cells with somewhat wavy nuclei separated by abundant collagen. Blood vessels stand out in relation to the tumor cells and often appear to be separated from them by a clear space. The tumor was completely nonreactive for all cytokeratins (including CAM 5.2, AE1/AE3 and 34BetaE12), and demonstrated nuclear labeling for beta-catenin. This supports the diagnosis of fibromatosis.
Discussion: Metaplastic carcinomas may have a fibromatosis-like pattern; therefore, exclusion of metaplastic carcinoma by utilization of multiple cytokeratin cocktails for immunohistochemistry, (particularly those with high molecular-weight cytokeratins) is crucial. Fasciitis is extremely rare within the breast, but is characterized by a more myxoid stroma and a tissue-culture-like appearance of the fibroblastic cells. A hypertrophic scar would not show the orderly pattern of growth of the current lesion, as well as the large size. Like deep fibromatoses, mammary fibromatoses demonstrate activation of the Wnt/beta-catenin pathway, which correlates with their association with Familial Adenomatous Polyposis.
Reference(s):
Hum Pathol 2002;22:39-46Incorrect
Answer: Fibromatosis
Histology: The tumor is composed of spindle cells with somewhat wavy nuclei separated by abundant collagen. Blood vessels stand out in relation to the tumor cells and often appear to be separated from them by a clear space. The tumor was completely nonreactive for all cytokeratins (including CAM 5.2, AE1/AE3 and 34BetaE12), and demonstrated nuclear labeling for beta-catenin. This supports the diagnosis of fibromatosis.The tumor is composed of spindle cells with somewhat wavy nuclei separated by abundant collagen. Blood vessels stand out in relation to the tumor cells and often appear to be separated from them by a clear space. The tumor was completely nonreactive for all cytokeratins (including CAM 5.2, AE1/AE3 and 34BetaE12), and demonstrated nuclear labeling for beta-catenin. This supports the diagnosis of fibromatosis.
Discussion: Metaplastic carcinomas may have a fibromatosis-like pattern; therefore, exclusion of metaplastic carcinoma by utilization of multiple cytokeratin cocktails for immunohistochemistry, (particularly those with high molecular-weight cytokeratins) is crucial. Fasciitis is extremely rare within the breast, but is characterized by a more myxoid stroma and a tissue-culture-like appearance of the fibroblastic cells. A hypertrophic scar would not show the orderly pattern of growth of the current lesion, as well as the large size. Like deep fibromatoses, mammary fibromatoses demonstrate activation of the Wnt/beta-catenin pathway, which correlates with their association with Familial Adenomatous Polyposis.
Reference(s):
Hum Pathol 2002;22:39-46
