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Presented by Dr. Pedram Argani and prepared by Dr. Katherine Fomchenko
This is a middle-aged female with a breast mass.
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1. Question
This is a middle-aged female with a breast mass.
Correct
Answer: C. Malignant phyllodes tumor
Histologic Description: The vast majority of this neoplasm consists of a nondescript high grade pleomorphic spindle cell sarcoma. The neoplastic cells demonstrate high mitotic activity including atypical mitoses, and extensive necrosis. Focally, after multiple additional sections were taken, a lower grade phyllodes tumor component with liposarcomatous differentiation was identified. This latter area was key to the diagnosis of malignant phyllodes tumor in this case, as the high grade spindle cell areas demonstrated no specific immunostaining.
Differential Diagnosis: Metaplastic carcinoma would be expected to either demonstrate immunoreactivity for epithelial markers and or a carcinomatous component. A primary mammary sarcoma is a diagnosis of exclusion, since phyllodes tumors with stromal overgrowth overlap with primary mammary sarcomas. Fibromatosis would lack the pleomorphism, mitotic activity and necrosis of the current case.
This case highlights the utility of additional tissue sampling in characterizing high grade pleomorphic neoplasms. Multiple rounds of immunostains on a high grade anaplastic component are less useful than well taken additional sections.
Incorrect
Answer: C. Malignant phyllodes tumor
Histologic Description: The vast majority of this neoplasm consists of a nondescript high grade pleomorphic spindle cell sarcoma. The neoplastic cells demonstrate high mitotic activity including atypical mitoses, and extensive necrosis. Focally, after multiple additional sections were taken, a lower grade phyllodes tumor component with liposarcomatous differentiation was identified. This latter area was key to the diagnosis of malignant phyllodes tumor in this case, as the high grade spindle cell areas demonstrated no specific immunostaining.
Differential Diagnosis: Metaplastic carcinoma would be expected to either demonstrate immunoreactivity for epithelial markers and or a carcinomatous component. A primary mammary sarcoma is a diagnosis of exclusion, since phyllodes tumors with stromal overgrowth overlap with primary mammary sarcomas. Fibromatosis would lack the pleomorphism, mitotic activity and necrosis of the current case.
This case highlights the utility of additional tissue sampling in characterizing high grade pleomorphic neoplasms. Multiple rounds of immunostains on a high grade anaplastic component are less useful than well taken additional sections.
