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Leiomyosarcoma arising in irradiated region after breast-conserving surgery: a case report.

Hayashi S, Kitada M, Matsuda Y, Ishibashi K, Takahashi N - Surg Case Rep (2015)

Bottom Line: All of the resection margins in the specimen were tumor-free.She has been disease-free for over 20 months.Post-irradiation leiomyosarcoma is an extremely rare tumor with high malignant potential, and thus, multidisciplinary therapy and close follow-up are advised.

View Article: PubMed Central - PubMed

Affiliation: Breast Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido 078-8510 Japan.

ABSTRACT

Background: Radiation therapy (RT) is considered a risk factor for the development of sarcoma in patients with breast cancer. However, there are few reports regarding post-irradiation sarcoma (PIS).

Case presentation: The patient was a 59-year-old woman who presented with a chief complaint of induration in the lower outer quadrant of the left breast. She underwent breast-conserving surgery (BCS) for breast cancer located in the left upper inner region and received endocrine therapy following RT (50 Gy/25 fractions/5 weeks) for breast conservation 6 years previously. Core needle biopsy revealed leiomyosarcoma. There was no distant metastasis. Repeat BCS including part of the pectoralis major muscle was performed. Chest wall resection was not performed because of the lack of invasion. Based on the morphological and immunohistochemical features, a diagnosis of leiomyosarcoma was made. All of the resection margins in the specimen were tumor-free. She has been disease-free for over 20 months.

Conclusions: Post-irradiation leiomyosarcoma is an extremely rare tumor with high malignant potential, and thus, multidisciplinary therapy and close follow-up are advised.

No MeSH data available.


Related in: MedlinePlus

Macroscopic appearance of the resected tumor. The tumor was solid and grayish with smooth margins
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Fig2: Macroscopic appearance of the resected tumor. The tumor was solid and grayish with smooth margins

Mentions: A 59-year-old woman was referred to our hospital with a lump located in the lower outer quadrant of the left breast. She underwent BCS as well as endocrine therapy and RT (50 Gy/25 fractions/5 weeks) delivered to the residual breast for breast cancer of the left breast upper inner region 6 years previously. Clinical examination revealed a 20-mm firm lump fixed to the underlying pectoralis major muscle. The overlying skin was free of tumor. There was no palpable axillary lymph node. Mammography revealed a focal asymmetrical density in the retromammary space. Ultrasonography revealed a lobulated and well-defined mass (17.5 × 16.4 × 10.6 mm in size) with relatively hypoechoic, heterogeneous internal echoes. Core needle biopsy (CNB) of the lump suggested atrophic mammary glands. The tumor had increased in size after 3 months of follow-up. Re-CNB was performed, and pathological diagnosis was leiomyosarcoma. On positron emission tomography with 18F-fluorodeoxyglucose, the maximum standardized uptake value was 12.7, which corresponded to the tumor finding on computed tomography (Fig. 1a, b). The tumor was limited to the breast and pectoralis major muscle, and there was no distant metastasis. Biochemical blood examinations did not reveal abnormalities. She underwent local excision of the mass with a 2-cm margin including the skin and pectoralis major muscle under general anesthesia. The macroscopic specimen was solid and grayish with smooth margins (Fig. 2). Postoperative histopathology revealed a 30 × 23 mm tumor with atypical spindle cells arranged in a fascicular histoid pattern (Fig. 3a). Immunohistochemistry demonstrated that the tumor cells were positive for α-smooth muscle actin (α-SMA), desmin, and vimentin (Fig. 3b–d). Based on the morphological and immunohistochemical features, the tumor was diagnosed as leiomyosarcoma. Our findings for this case corresponded with the criteria for PIS [1]. All of the resection margins were free of tumor. She has been alive for 20 months without recurrence.Fig. 1


Leiomyosarcoma arising in irradiated region after breast-conserving surgery: a case report.

Hayashi S, Kitada M, Matsuda Y, Ishibashi K, Takahashi N - Surg Case Rep (2015)

Macroscopic appearance of the resected tumor. The tumor was solid and grayish with smooth margins
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562007&req=5

Fig2: Macroscopic appearance of the resected tumor. The tumor was solid and grayish with smooth margins
Mentions: A 59-year-old woman was referred to our hospital with a lump located in the lower outer quadrant of the left breast. She underwent BCS as well as endocrine therapy and RT (50 Gy/25 fractions/5 weeks) delivered to the residual breast for breast cancer of the left breast upper inner region 6 years previously. Clinical examination revealed a 20-mm firm lump fixed to the underlying pectoralis major muscle. The overlying skin was free of tumor. There was no palpable axillary lymph node. Mammography revealed a focal asymmetrical density in the retromammary space. Ultrasonography revealed a lobulated and well-defined mass (17.5 × 16.4 × 10.6 mm in size) with relatively hypoechoic, heterogeneous internal echoes. Core needle biopsy (CNB) of the lump suggested atrophic mammary glands. The tumor had increased in size after 3 months of follow-up. Re-CNB was performed, and pathological diagnosis was leiomyosarcoma. On positron emission tomography with 18F-fluorodeoxyglucose, the maximum standardized uptake value was 12.7, which corresponded to the tumor finding on computed tomography (Fig. 1a, b). The tumor was limited to the breast and pectoralis major muscle, and there was no distant metastasis. Biochemical blood examinations did not reveal abnormalities. She underwent local excision of the mass with a 2-cm margin including the skin and pectoralis major muscle under general anesthesia. The macroscopic specimen was solid and grayish with smooth margins (Fig. 2). Postoperative histopathology revealed a 30 × 23 mm tumor with atypical spindle cells arranged in a fascicular histoid pattern (Fig. 3a). Immunohistochemistry demonstrated that the tumor cells were positive for α-smooth muscle actin (α-SMA), desmin, and vimentin (Fig. 3b–d). Based on the morphological and immunohistochemical features, the tumor was diagnosed as leiomyosarcoma. Our findings for this case corresponded with the criteria for PIS [1]. All of the resection margins were free of tumor. She has been alive for 20 months without recurrence.Fig. 1

Bottom Line: All of the resection margins in the specimen were tumor-free.She has been disease-free for over 20 months.Post-irradiation leiomyosarcoma is an extremely rare tumor with high malignant potential, and thus, multidisciplinary therapy and close follow-up are advised.

View Article: PubMed Central - PubMed

Affiliation: Breast Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido 078-8510 Japan.

ABSTRACT

Background: Radiation therapy (RT) is considered a risk factor for the development of sarcoma in patients with breast cancer. However, there are few reports regarding post-irradiation sarcoma (PIS).

Case presentation: The patient was a 59-year-old woman who presented with a chief complaint of induration in the lower outer quadrant of the left breast. She underwent breast-conserving surgery (BCS) for breast cancer located in the left upper inner region and received endocrine therapy following RT (50 Gy/25 fractions/5 weeks) for breast conservation 6 years previously. Core needle biopsy revealed leiomyosarcoma. There was no distant metastasis. Repeat BCS including part of the pectoralis major muscle was performed. Chest wall resection was not performed because of the lack of invasion. Based on the morphological and immunohistochemical features, a diagnosis of leiomyosarcoma was made. All of the resection margins in the specimen were tumor-free. She has been disease-free for over 20 months.

Conclusions: Post-irradiation leiomyosarcoma is an extremely rare tumor with high malignant potential, and thus, multidisciplinary therapy and close follow-up are advised.

No MeSH data available.


Related in: MedlinePlus