Fibromatosis of the Breast: Complication of Previous Radiation and Surgery
Yaxia Zhang, Shai Libson, Eli Avisar, Merce Jorda, Carmen Gomez, Andrew E Rosenberg. University of Miami/Jackson Memorial Hospital, Miami, FL
Background: Fibromatosis of the breast is uncommon, and comprises less than 0.2% of all breast tumors. It is a locally aggressive neoplasm and often recurs. Fibromatosis harbors mutations in the beta catenin gene and predisposing factors include Gardner syndrome and a history of previous surgery. Herein, we report five cases of fibromatosis of the breast in patients with a history of prior surgery and radiation.
Design: Departmental and consultation files were searched from 2003 -2012 for cases diagnosed as “desmoid” or “fibromatosis” arising in the breast. Eleven patients with pathologically confirmed breast desmoid tumor were identified. Records were retrospectively reviewed.
Results: Among those eleven patients, one patient had Gardner syndrome, five patients had a history of surgery for breast cancer, two patients had a history of surgery for bilateral breast augmentation, and the remaining three had no documented surgery prior to the development of fibromatosis. Among the seven patients who had surgery, five of them, including one of the patients with breast augmentation, received radiation therapy before developing fibromatosis. The five patients were female and ranged in age from 36-57 (mean of 48.8) years. The fibromatosis tumors presented as palpable masses, clinically and radiographically suspicious for carcinoma. Four patients had a history of breast cancer treated with surgery and radiation (6 weeks of 6040 CGY). One patient had multiple bilateral breast augmentations and had superficial electron bean radiation for cosmetic reasons to prevent scar formation. Fibromatosis was diagnosed at a median of 28 months post-radiation therapy. The tumors ranged from 2.7 cm to 5 cm. All of the patients had their tumor resected and 1 patient had a local recurrence 8 months after the initial excision with positive margins. The remaining patients were disease free at last follow up (0 to 9 years). Microscopically, the tumors showed the classic features of fibromatosis. There was no significant cytologic atypia, pleomorphism or necrosis. Immunohistochemically, the tumor cells expressed beta-catenin in all cases.
Conclusions: The development of fibromatosis is a well recognized complication of different types of therapeutic interventions. Fibromatosis of the breast is uncommon and should be considered when a new mass develops in the breast following surgery and/or radiation. Excision of the mass with or without adjuvant medical therapy should be considered as possible forms of therapy.
Category: Bone & Soft Tissue
Monday, March 4, 2013 1:00 PM
Poster Session II # 21, Monday Afternoon