Dhingra Kajal Kiran, Mandal Shramana, Roy Somak, Khurana Nita
Department of Pathology, Maulana Azad Medical College and associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi 110002, India.
World J Surg Oncol. 2007 Dec 21;5:142. doi: 10.1186/1477-7819-5-142.
Malignant peripheral nerve sheath tumor is a rare soft tissue sarcoma of ectomesenchymal origin. It is the malignant counterpart of benign soft tissue tumors like neurofibromas and schwannomas and may often follow them. Common sites include deeper soft tissues, usually in the proximity of a nerve trunk. Breast is an extremely rare location of this lesion and presentation as a breast lump in the absence of pain or previous benign neural tumor is even rarer.
A 38-year-old female presented with complaints of painless, hard breast lump for three months which was clinically suspected to be a ductal carcinoma with inconclusive fine needle aspiration cytology. Histopathology revealed a malignant spindle cell tumor which was confirmed to be malignant peripheral nerve sheath tumor on the basis of immunopositivity for vimentin, neurone specific enolase and S-100.
To the best of our knowledge only six such case reports have been published in literature. The differential diagnosis of malignant peripheral nerve sheath tumor should be considered by the clinician as well as the pathologists in the work-up of a breast neoplasm as treatment and prognosis of this rare malignancy is different.
恶性外周神经鞘瘤是一种罕见的起源于外胚间叶组织的软组织肉瘤。它是神经纤维瘤和施万细胞瘤等良性软组织肿瘤的恶性对应物,且常继发于这些良性肿瘤之后。常见部位包括深部软组织,通常靠近神经干。乳腺是该病变极为罕见的发生部位,而在无疼痛或既往无良性神经肿瘤的情况下以乳腺肿块形式出现则更为罕见。
一名38岁女性因无痛性乳腺硬肿块就诊,持续三个月,临床怀疑为导管癌,细针穿刺细胞学检查结果不明确。组织病理学显示为恶性梭形细胞瘤,基于波形蛋白、神经元特异性烯醇化酶和S-100免疫阳性,确诊为恶性外周神经鞘瘤。
据我们所知,文献中仅发表过六例此类病例报告。在乳腺肿瘤的检查过程中,临床医生和病理学家均应考虑恶性外周神经鞘瘤的鉴别诊断,因为这种罕见恶性肿瘤的治疗和预后有所不同。