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Presented by Pedram Argani, M.D. and prepared by Hillary Ross, M.D.
Case 2: This is an 18 year old female with a breast mass.
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Question 1 of 1
1. Question
Week 454: Case 2
This is an 18 year old female with a breast mass.images/1alex/10112010case2image1.jpg
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images/1alex/10112010case2image2.jpgCorrect
Answer: Fibromatosis
Histology: This is a bland infiltrate of myofibroblastic lesional cells which dissects apart skeletal muscle fibers. The fascicles of bland fibroblastic cells are separated from the prominent capillary vasculature by a clear space. Cytologic atypia and significant mitotic activity are not present. The lesional cells do not label for cytokeratin, but do demonstrate nuclear labeling for beta-catenin.
Discussion: Metaplastic carcinoma may be very bland, and have a fibromatosis like appearance. Nuclear â-catenin labeling has also been described in metaplastic carcinoma. However, metaplastic carcinoma should label at least focally for cytokeratin or p63. Phyllodes tumors may have a fibroblastic appearance; however, they should also have an epithelial component which is typically arranged in a leaf-like pattern. Fibrosarcoma would demonstrate a great degree of cytologic atypia and mitotic activity.
Incorrect
Answer: Fibromatosis
Histology: This is a bland infiltrate of myofibroblastic lesional cells which dissects apart skeletal muscle fibers. The fascicles of bland fibroblastic cells are separated from the prominent capillary vasculature by a clear space. Cytologic atypia and significant mitotic activity are not present. The lesional cells do not label for cytokeratin, but do demonstrate nuclear labeling for beta-catenin.
Discussion: Metaplastic carcinoma may be very bland, and have a fibromatosis like appearance. Nuclear â-catenin labeling has also been described in metaplastic carcinoma. However, metaplastic carcinoma should label at least focally for cytokeratin or p63. Phyllodes tumors may have a fibroblastic appearance; however, they should also have an epithelial component which is typically arranged in a leaf-like pattern. Fibrosarcoma would demonstrate a great degree of cytologic atypia and mitotic activity.
