Kilmartin Catherine, Westover Clinton, Raghavan Shyam, Dillon Patrick M, Campbell Chris A
Department of Plastic and Reconstructive Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA.
Case Rep Oncol. 2023 Feb 14;16(1):74-80. doi: 10.1159/000525350. eCollection 2023 Jan-Dec.
Desmoid tumors are rare locally aggressive myelodysplastic tumors that are usually abdominally based. They account for 0.2% of breast tumors. Certain factors like prior surgery, familial adenomatous polyposis, pregnancy, and high estrogen states are associated with chest wall desmoid tumor occurrence. We present a patient with a history of intraductal carcinoma of the left breast who underwent mastectomy with implant-based reconstruction who had a desmoid tumor of the breast detected during workup for cardiac transplantation for chemotherapy-induced heart failure. The tumor was originally thought to be recurrent breast cancer during workup with imaging obscured by the implant. Excisional biopsy demonstrated a desmoid tumor with a positive deep margin requiring rib resection, synthetic mesh, and pectoralis major flap reconstruction. Breast desmoid tumors are reactive malignancies that have been diagnosed after prior breast implant surgery but without an established risk associated with breast implants. Excision with microscopically negative margins and chest wall reconstruction when indicated is the current established treatment protocol; however, recent paradigm shifts include "watchful waiting" and medical management among treatment strategies.
韧带样瘤是罕见的局部侵袭性骨髓增生异常性肿瘤，通常发生于腹部。它们占乳腺肿瘤的0.2%。某些因素，如既往手术、家族性腺瘤性息肉病、妊娠和高雌激素状态，与胸壁韧带样瘤的发生有关。我们报告一名有左乳导管内癌病史的患者，该患者接受了乳房切除术并进行了植入物重建，在因化疗所致心力衰竭接受心脏移植检查期间发现了乳腺韧带样瘤。在检查过程中，最初认为肿瘤是复发性乳腺癌，植入物掩盖了影像学表现。切除活检显示为韧带样瘤，深部切缘阳性，需要切除肋骨、使用合成补片并进行胸大肌皮瓣重建。乳腺韧带样瘤是反应性恶性肿瘤，在既往乳房植入手术之后被诊断出来，但与乳房植入物并无既定的风险关联。目前既定的治疗方案是在切缘显微镜检查阴性时进行切除，并在必要时进行胸壁重建；然而，最近的模式转变包括治疗策略中的“观察等待”和药物治疗。
