Fibromatosis mamaria, diagnóstico diferencial del carcinoma invasor. Reporte de un caso

Servicio Ginecología y Obstetricia. Hospital Clínico Universidad de Chile, Santiago, Chile
DOI: 10.4067/S0718-40262009000400012


Breast fibromatosis. Report of one case Desmoid tumors or fibromatosis, a rare lesion of the connective tissue, corresponds to 0.2% of breast tumors. It does not metastasize but has high local recurrence rates due to margin infiltration. The clinical presentation and imaging is almost indistinguishable from breast carcinoma. Diagnosis is histological and the treatment of choice is surgical excision. We report a 31 years old woman consulting for skin retraction in right breast, without previous history of trauma or surgery. Breast ultrasound showed an irregular nodule that extended into the skin. The mammogram showed a discrete retraction of the skin and increased density of adjacent subcutaneous tissue. An ultrasound guided percutaneous biopsy showed stromal fusocelular proliferation, suggesting a phyllodes tumor. A partial mastectomy was performed and the pathological study of the surgical piece showed a mesenchymal proliferation with infiltrative borders, consistent with breast fibromatosis.

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    ABSTRACT: Under the supervision of P. Kleihues and L. H. Sobin, the "World Health Organisation Classification of Tumours" with its numerous volumes is currently being re-edited. Following the first three volumes on "Central Nervous System", "Digestive System" and "Haematopoetic System", the volume on "Tumours of the Breast and Female Genital Organs" will be published this autumn. This volume will be edited by F. Tavassoli and P. Devilee. The new WHO books serve a double function of text books and atlases of tumour pathology. The first part of the new volume includes the genetics and pathology of the entire spectrum of malignant tumours and their precursor lesions. The following part is devoted to benign proliferative lesions.
    Verhandlungen der Deutschen Gesellschaft für Pathologie 02/2002; 86:116-9.
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    ABSTRACT: Summary Background: Breast fibromatosis (BF) is a rare benign pathological entity. Its etiology is unknown, but it has been associated with surgical trauma and certain genetic disorders. Clinical cases: Case 1. The patient was a 17-year-old female with a 20 × 15 cm firm and fixed mass in the right breast. A core- needle biopsy was taken with a pathology report of a phyllodes tumor. Mastography revealed a well-differentiated lesion with no evidence of muscle invasion. The patient underwent wide surgical resection with thoracotomy and chest wall resection of the affected ribs. Pathology reported a 19 × 18 × 9 cm BF with a positive surgical margin. Oral colchicine was administered and at 3 months of follow-up the patient is disease free. Case 2. The patient was a 49-year-old female with a 7 × 5 cm solid right breast mass that was located at the medial-upper quadrant and fixed to the pectoralis major muscle. Mastography and magnetic resonance imaging revealed a mass infiltrating thoracic muscles. Wide surgical resection was performed with immediate latissimus dorsi reconstruction. Pathology report showed a BF with muscle invasion. At 3 months postsurgery, the patient is disease free. Conclusions: BF is a rare entity with a locally aggressive behavior. The infiltrative nature of this disease is associated with a tendency to recur locally. Its clinical and imaging features can mimic breast cancer. Differential diagnosis should be made before attempting treatment. The standard therapeutic modality is wide surgical resection, and radiotherapy is reserved in some cases with positive surgical margins.
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    ABSTRACT: We have reviewed the Columbia-Presbyterian Hospital experience with fibromatosis of the breast, a most uncommon lesion that frequently mimics carcinoma. Very few examples of this rare lesion have been reported previously, and the lack of follow-up data has made it difficult to evaluate treatment. Five patients were cared for at the Columbia Presbyterian Medical Center and an additional 12 patients were reviewed after slides were sent for consultation. Complete clinical information and follow-up data were obtained in a total of 13 patients, three of whom had recurrences. There were no histologic features that served to distinguish those patients who had a recurrence from those who did not. While there were no recurrences when adequate excision was carried out, it is worth noting that we found one instance of spontaneous regression as well as two patients who did well despite the fact that tumor was found at the margin of the specimen. The results of this review suggest that the major problem facing the surgeon, once the diagnosis has been made, relates to the difficulty in defining the extent of the tumor in the breast. Careful orientation of the specimen and repeated use of frozen sections should make it possible to perform a complete excision and, at the same time, remove a minimum amount of breast tissue. Since fibromatosis is a benign process, the cosmetic impact of surgical therapy certainly deserves careful consideration.
    Surgery, gynecology & obstetrics 08/1981; 153(1):57-60.
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