Galama Rita, Matoso João, Capela Germano, Bôto Carlos, Duarte Cristina, Mendes António Ribeiro
Department of Surgery, Centro Hospitalar do Médio Tejo, Tomar, Portugal.
Department of Surgery, Centro Hospitalar do Médio Tejo, Tomar, Portugal.
Int J Surg Case Rep. 2021 Jan;78:201-203. doi: 10.1016/j.ijscr.2020.12.050. Epub 2020 Dec 24.
Breast sarcomas are a rare group of malignant tumors accounting for less than 1% of all malignant neoplasms of the breast and fewer than 5% of all sarcomas. We report a case of an 87-year-old caucasian female who recurred to the emergency department with complaints of a painful mass of the left breast with purulent discharge. Observation revealed a volumous mass in the inferior quadrants of the breast, ill defined, with petrous consistency, areas of necrosis, and inflammatory signs. She was admitted to Surgery ward for further study and therapy of a probable inflammatory tumor of the breast. Magnetic resonance image was obtained, raising suspicion on papillary carcinoma and classified the breast as BIRADS5. Microbiological and cytological exams of the exudate were negative. An incisional biopsy of the tumoral mass was also obtained, and the patient discharged while waiting for surgery. Histological exam and immunohistochemical essay were compatible with leiomyosarcoma. Left mastectomy was performed and the patient was discharged with no morbidities on the 5th day after surgery. Histological exam of mastectomy piece showed a metaplastic carcinoma, with osteosarcomatous and focal leiomyosarcomatous differentiation. The lesion was classified as pT4N0M0 and subsequent radiotherapy was performed. Twenty months after surgery the patient was being followed-up on Oncology and Senology consultations and remained asymptomatic. Consensus on ideal management of this diseases is still on debate. Some authors defend the treatment of this entity in a similar way to sarcoma of the breast. More studies are needed to better understand this entity.
乳腺肉瘤是一组罕见的恶性肿瘤，占所有乳腺恶性肿瘤的比例不到1%，占所有肉瘤的比例不到5%。我们报告一例87岁的白种女性病例，她因左乳疼痛性肿块伴脓性分泌物而复诊至急诊科。检查发现乳房下象限有一个体积较大的肿块，边界不清，质地坚硬，有坏死区域和炎症迹象。她被收入外科病房，以便对可能的乳腺炎性肿瘤进行进一步检查和治疗。进行了磁共振成像检查，怀疑为乳头状癌，乳房被分类为BIRADS5级。渗出液的微生物学和细胞学检查均为阴性。还对肿瘤肿块进行了切开活检，患者在等待手术期间出院。组织学检查和免疫组化分析结果与平滑肌肉瘤相符。实施了左侧乳房切除术，患者术后第5天出院，无并发症。乳房切除标本的组织学检查显示为化生癌，伴有骨肉瘤样和局灶性平滑肌肉瘤样分化。病变被分类为pT4N0M0，随后进行了放疗。手术后20个月，患者在肿瘤学和乳腺病学门诊接受随访，仍无症状。关于这种疾病的理想治疗方案仍存在争议。一些作者主张以与乳腺肉瘤相似的方式治疗这种疾病。需要更多的研究来更好地了解这种疾病。
