J Breast Cancer.  2011 Sep;14(3):241-246.

Undifferentiated Pleomorphic Sarcoma of the Male Breast Causing Diagnostic Challenges

• Jeong YJ
• Oh HK
• Bong JG

Abstract

Undifferentiated pleomorphic sarcoma of the breast are uncommon and often present diagnostic challenges. Herein, we report a case of the undifferentiated pleomorphic sarcoma occurring in the male breast. A 76-year-old man presented with a palpable bean-sized mass in his left breast for two months. Core needle biopsy revealed the presence of atypical cells in a fibrous proliferative lesion, which was removed by wide excision. Based on examination of the excised tumor, the initial pathologic diagnosis was atypical spindle cell lesion with uncertain malignant potential. One year later, the patient returned with a recurrent mass atthe previous surgical site. The mass was again surgically removed using wide excision. Based on histological findings with immunomarkers, the final diagnosis was undifferentiated pleomorphic sarcoma. Undifferentiated pleomorphic sarcoma of the breast can cause genuine diagnostic difficulty and appropriate immunohistochemistry is mandatory for differential diagnosis.

Keyword

Breast neoplasms; Male; Malignant fibrous histiocytoma; Sarcoma

MeSH Terms

Aged
Biopsy, Large-Core Needle
Breast
Breast Neoplasms
Diagnosis, Differential
Histiocytoma, Malignant Fibrous
Humans
Immunohistochemistry
Male
Sarcoma

Figure

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  Figure 1 Initial radiologic findings. (A) Mammography showing prominent fibroglandular tissue in the subareolar area of left breast. (B) Ultrasonographic scan showing heterogeneous hypoechoic lesion with diffuse skin thickening and fatty infiltration.

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  Figure 2 Histological findings of the left breast mass by core needle biopsy. Marked infiltration of plasma cells and eosinophils have been shown. Many atypical cells with large nuclei in the abundant collagenous stroma can be seen (H&E stain, ×400).

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  Figure 3 Initial histological appearance of the left breast mass after wide excision. (A, B) Microscopic findings of the specimen showing nodular proliferation of fibrous tissue with focal infiltrating margins. Spindle fibroblasts with many lymphoplasma cells and eosinophils were apparent. A few atypical cells and pleomorphic cells were noted, but abnormal mitosis was not identified (H&E stain; A, ×40; B, ×400). (C) Immunohistochemical staining for S-100 protein shows negative staining in tumors (×200).

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  Figure 4 Radiologic findings of a recurrent mass in left breast. (A) Computed tomography (CT) image showing a low attenuating mass in the subareolar area of the left breast (arrow) without significant lymph node enlargement. (B) Positron emission tomography-CT image showing faint FDG uptake area in the left breast (arrow) without other metabolically significant FDG uptake lesions that would suggest axillary nodal or distant organ metastasis.

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  Figure 5 Histological appearance of the recurrent left breast mass, diagnosed as pleomorphic spindle cell sarcoma. (A) Fibrous bands and lobular adipose tissue with focal congestion and no necrosis (H&E stain, ×40). (B) Microscopic findings showed spindle tumor cells with many lymphoplasma cells and eosinophilic infiltrates (H&E stain, ×200). (C) Many atypical cells and abnormal mitoses were noted (H&E stain, ×400 ).

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