B10
Primary leiomyosarcoma of the male breast: a case report
Haytham Sumrien1, Yazan Masannat2, Yousef Sharaiha1
1Prince Philip Hospital, Llanelli, UK, 2Conquest Hospital, UK
Background
Primary leiomyosarcoma of the breast is a rare tumour with only around thirty cases reported in the literature. Most of the cases reported are in females, while only a few are reported in males. We present a case of primary breast leiomyosarcoma in a 59-year-old man.
Case report
A 59-year-old male patient was referred with a right retro-areolar breast lump. Clinically it was a firm, discrete benign feeling lesion, about 15 mm in diameter with no palpable axillary nodes. Both ultrasound scan and mammography showed an 1813 mm benign looking mass lateral to the right nipple.
Excision biopsy showed a 20 mm spindle cell tumour which was positive for Desmin and SMA on immunohistochemistry in keeping with primary leiomyosarcoma. Staging investigations were normal. Simple mastectomy without axillary dissection was performed and the patient didnt need any further adjuvant therapy.
Discussion
Sarcomas comprise less than 1% of all primary breast neoplasms and only a minority of these are leiomyosarcomas. Confirming the diagnosis on either IHC or electron microscopy is important as it is difficult to differentiate these from poorly differentiated carcinomas.
Radiological findings are non specific. Some has reported benign looking lesions as in our case while others have reported malignant looking lesions. On cytology they can be mistaken for poorly differentiated carcinoma, metaplastic carcinoma or other sarcomas. On histopathology, Immunohistochemical staining is essential as adjuncts to differentiate leiomyosarcomas from other tumours.
The cornerstone of treatment is surgical excision. Long term follow up is important as some of these tumours have been reported to recur more than 10 years post treatment.
Conclusion
In summary, this tumour is a rare tumour that can be a diagnostic challenge. This emphasizes the importance of triple assessment in all breast lumps, even if clinically and radiologically they are benign.
