PMC4665918_01
Mammary desmoid tumor: radiological and pathological aspects. a Breast MRI of January 2011: T1-weighted Fat Sat images of the right breast after gadolinium injection. The white star shows the desmoid tumor. b Microscopic aspect (hematoxylin and eosin staining, HES) of the diagnostic biopsy showing a poorly cellular proliferation of bland elongated cells in a collagen-rich stroma. Proliferation infiltrates adipose tissue (right upper corner)
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Fig1
Breast MRI revealed spread infiltration of breast and pectoralis muscle (Fig. 1a). Pathological analysis (Fig. 1b) revealed a poorly cellular proliferation of myofibroblastic spindle cells, without histological evidence of malignancy (no atypia, no mitosis, no necrosis).
Appearance of a tumor within the desmoid tumor: radiological aspect. Breast T1-weighted Fat Sat MR imaging of middle (top) and upper (bottom) sections of the right breast after gadolinium injection in January 2001 (a) and in January 2013 (b). The desmoid tumor (white star) increased in size between the two dates. Surprisingly, a 2-cm tissue mass (white arrow), corresponding to an undifferentiated sarcoma, appeared in the upper-inner quadrant within the desmoid tumor in January 2013
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Fig2
Breast MRI showed the appearance of a 2-cm tissue mass in the upper-inner quadrant within the DT (Fig. 2).
Pathological aspect of the surgical specimen containing the desmoid tumor and the sarcoma. a Macroscopic aspect: an ill-defined fibrous-like area occupies most of the specimen, with contact to resection margin (arrow). Within this lesion two less fibrous areas are identified (black lines). These ones correspond to high-grade sarcoma zones on microscopic examination. b Microscopic aspect (HES) showing abrupt transition between high grade sarcoma (left) and DT (right). c Microscopic aspect (HES) showing the DT: spindle cell proliferation of fibroblastic-like cells, interspersed within a collagenous matrix. Spindle cells are void of cytological atypia, and no mitosis or necrosis are seen. d Microscopic aspect (HES) showing the high grade sarcoma area. The neoplastic proliferation is more cellular and dense. Spindle cells are disposed in sheets infiltrating the skeletal muscle bundles. They appear small with indistinct cytoplasmic limits; nuclei are oval or round and display dense chromatin. Mitoses are easily found (black arrow)
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Fig3
The macroscopic pathological report described a white mass with a hard consistency, an aspect sometimes fasciculated, realizing subcutaneous nodules (Fig. 3a). Microscopic analysis revealed two lesions (Fig. 3b-d): the DT, with spindle cell proliferation of fibroblast-like cells, without atypia, without mitosis, nor necrosis, interspersed within a dense collagenous matrix, contrasting with a high-grade sarcoma in the two less fibrous areas showing a more cellular and dense proliferation of spindle cells disposed in sheets infiltrating the skeletal muscle bundles, with indistinct cytoplasmic limits, atypia and numerous mitoses.
Relapse of the high-grade sarcoma: radiological aspect. a CT-scan in June 2013 showed the appearance of a 2-cm right pleural nodule in the operative field (white arrow). The percutaneous biopsy achieved 2 months later will identify high-grade undifferentiated spindle-cell sarcoma. b Major disease progression in September 2014, involving the pleura, the right anterior chest wall and the liver
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Fig4
During follow-up, on June 2013, the CT scan showed the appearance of a suspect 2-cm pleural nodule in the operative field (Fig. 4a). On September 2014, loco-regional progression involving the right anterior chest wall and the liver was documented on CT scan (Fig. 4b).