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Presented by Dr. Pedram Argani and prepared by Dr. Robby Jones.
This is a 62 year old female with a breast mass.
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1. Question
This is a 62 year old female with a breast mass.
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D. Malignant phyllodes tumor
Histologic Description: Most of the sections of this case demonstrate a highly pleomorphic, mitotically active, malignant spindle cell neoplasm. There is no epithelial component. The clue to the diagnosis comes from additional sections, demonstrating an associated lower grade phyllodes tumor component with associated epithelium demonstrating an intracanalicular pattern. By immunohistochemistry, this neoplasm was negative for high molecular cytokeratin, and demonstrated focal immunoreactivity for CD34.
Differential Diagnosis: Sarcomatoid carcinoma would label for cytokeratins, and frequently would demonstrate an associated epithelial component. Fibromatosis would lack the pleomorphism and mitotic activity of the current case. Malignant melanoma would demonstrate diffuse immunoreactivity for S100, along with immunoreactivity for melanocytic markers.
This case highlights the importance of thorough sectioning in establishing at the diagnosis of a malignant spindle cell breast tumor.Incorrect
D. Malignant phyllodes tumor
Histologic Description: Most of the sections of this case demonstrate a highly pleomorphic, mitotically active, malignant spindle cell neoplasm. There is no epithelial component. The clue to the diagnosis comes from additional sections, demonstrating an associated lower grade phyllodes tumor component with associated epithelium demonstrating an intracanalicular pattern. By immunohistochemistry, this neoplasm was negative for high molecular cytokeratin, and demonstrated focal immunoreactivity for CD34.
Differential Diagnosis: Sarcomatoid carcinoma would label for cytokeratins, and frequently would demonstrate an associated epithelial component. Fibromatosis would lack the pleomorphism and mitotic activity of the current case. Malignant melanoma would demonstrate diffuse immunoreactivity for S100, along with immunoreactivity for melanocytic markers.
This case highlights the importance of thorough sectioning in establishing at the diagnosis of a malignant spindle cell breast tumor.
