Abstract
Differential diagnosis of spindle cell lesions of breast is challenging for certain reasons. The most important reason is the presence of cytological atypia and mitosis in all three conditions: reactive, benign, and malignant. Patients diagnosed with benign and malignant tumor/tumor-like lesions that had spindle cell components following the histopathological examination were included in the study. The patients’ medical records were accessed to obtain the clinical history, follow-up notes, and radiological findings. Following histopathological, immunohistochemical, and clinical evaluations, the patients were diagnosed as follows: pseudoangiomatous stromal hyperplasia (PASH), bilateral desmoid-type fibromatosis (FM), adenomyoepithelioma (AME), myofibroblastoma (MFB), malignant phyllodes tumor (MF), high-grade AS, post-chemotherapy osteosarcoma (OS) + Paget’s disease, and metaplastic carcinoma (MC). An algorithmic approach should be used in the diagnosis; cellular structure, presence and grade of atypia, growth pattern, mitotic activity, immunohistochemical staining, and clinical and radiological features should be evaluated together. Detection of some molecular changes can be useful in differential diagnosis.
Highlights
Spindle cell lesions of the breast are rare entities; the differential diagnosis is challenging for certain reasons (Länger et al 2014)
If the cells show atypia, the following conditions should be considered in the differential diagnosis: spindle cell metaplastic carcinoma, adenomyoepithelioma, adeno sarcoma (AS), osteosarcoma, myofibroblastic sarcoma, other primary breast sarcomas, and metastasis
If the cells do not show signs of prominent atypia, the following conditions should be initially considered in the differential diagnosis: fibromatosis, granulation tissue, pseudoangiomatous stromal hyperplasia (PASH), low-grade AS, myofibroblastoma, inflammatory myofibroblastic tumor, nodule with spindle cells, lipoma with spindle cells, schwannoma, and neurofibromas (Tan and Ellis 2013; Lakhani et al 2012; Tavassoli and Devilee 2003; Stolnicu et al 2015)
Summary
Spindle cell lesions of the breast are rare entities; the differential diagnosis is challenging for certain reasons (Länger et al 2014). Varma and Shin (2013) suggested an algorithmic approach for the differential diagnosis, and stated that the following parameters should be definitely evaluated: (1) cellular structures, (2) presence and degree of atypia, (3) growth pattern, (4) mitotic activity, and (5) clinical and radiological features (Varma and Shin 2013; Al-Nafussi 1999). If the cells show atypia, the following conditions should be considered in the differential diagnosis: spindle cell metaplastic carcinoma, adenomyoepithelioma, adeno sarcoma (AS), osteosarcoma, myofibroblastic sarcoma, other primary breast sarcomas, and metastasis. If the cells do not show signs of prominent atypia, the following conditions should be initially considered in the differential diagnosis: fibromatosis, granulation tissue, pseudoangiomatous stromal hyperplasia (PASH), low-grade AS, myofibroblastoma, inflammatory myofibroblastic tumor, nodule with spindle cells, lipoma with spindle cells, schwannoma, and neurofibromas (Tan and Ellis 2013; Lakhani et al 2012; Tavassoli and Devilee 2003; Stolnicu et al 2015)
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