Sarcoma of the breast. A study of 32 patients with reappraisal of classification and therapy.

A retrospective clinicopathologic review of 32 patients with mammary sarcoma exclusive of angiosarcoma or lymphoma was performed. For 25 patients with previously untreated lesions, the median tumor diameter was 4 cm and 14 patients had high or intermediate grade lesions. One of 22 patients treated by mastectomy and one of three patients treated by local excision died of sarcoma yielding an actuarial 5-year survival of 91%. None of the 25 patients had received adjuvant chemotherapy and only one treated by mastectomy had post-operative radiation therapy. Seven other patients were referred for treatment of recurrent mammary sarcoma. In this group, median size of the primary tumor was 6 cm and four had high or intermediate grade histology. Tumor control was achieved for only one of five patients with local recurrence and neither of the two with distant metastases. Median survival was 6 months following initiation of treatment for recurrence. Whenever possible breast sarcomas should be classified according to histologic cell type and grade. For lesions not readily classified, the terms unclassified or anaplastic sarcoma should be used. The diagnosis of stromal sarcoma is best reserved for those infrequent sarcomas that can be traced to the specialized periductal and perilobular stroma of the breast. Total mastectomy is recommended for most patients with postoperative radiation therapy indicated when the adequacy of the margin is in doubt. The role of adjuvant chemotherapy in the primary management of mammary sarcoma is yet to be determined.