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Presented by Hind Nassar, M.D. and prepared by Aatur Singhi, M.D., Ph.D.
Case 2: 66 year old woman with a large recurrent breast mass, underwent mastectomy.
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Question 1 of 1
1. Question
Week 424: Case 2
66 year old woman with a large recurrent breast mass, underwent mastectomy.images/1Alex/02072010case2image1.jpg
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images/1Alex/02072010case2image4.jpgCorrect
Answer: Malignant phyllodes tumor (high grade)
Histology: none provided
Discussion: The lesion in this case is entirely composed of sarcomatous elements (osteosarcoma). The diagnosis of primary osteosarcoma of the breast is extremely uncommon. Before rendering this diagnosis the diagnoses of metaplastic carcinoma, phyllodes tumor and metastatic sarcoma should be ruled out. The diagnosis of metaplastic carcinoma is usually confirmed by the presence of a component of conventional invasive carcinoma, DCIS and/or a positive staining with at least one keratin marker. In this case, the diagnosis of a recurrent phyllodes tumor was made due to the patient’s history although no epithelial component was seen. These neoplasms are very aggressive with almost half of the patients developing recurrence or distant metastases, particularly large tumors (>5.0cm) and tumors with osteoblastic and chondroblastic differentiation. Lymph node metastases are usually absent.
Incorrect
Answer: Malignant phyllodes tumor (high grade)
Histology: none provided
Discussion: The lesion in this case is entirely composed of sarcomatous elements (osteosarcoma). The diagnosis of primary osteosarcoma of the breast is extremely uncommon. Before rendering this diagnosis the diagnoses of metaplastic carcinoma, phyllodes tumor and metastatic sarcoma should be ruled out. The diagnosis of metaplastic carcinoma is usually confirmed by the presence of a component of conventional invasive carcinoma, DCIS and/or a positive staining with at least one keratin marker. In this case, the diagnosis of a recurrent phyllodes tumor was made due to the patient’s history although no epithelial component was seen. These neoplasms are very aggressive with almost half of the patients developing recurrence or distant metastases, particularly large tumors (>5.0cm) and tumors with osteoblastic and chondroblastic differentiation. Lymph node metastases are usually absent.
