Paving Paradise: The Peril of Impervious Surfaces

Background: Fibromatosis-like metaplastic carcinoma is a newly described metaplastic breast tumor, literature on which is still evolving. Case presentation: A 77-year-old lady presented with a 2 × 2 cm mass with irregular margins in the upper and outer quadrant of left breast. Fine needle aspiration cytology (FNAC) from the lump was inconclusive. A lumpectomy was performed and sent for frozen section, which revealed presence of spindle cells showing mild atypia in a sclerotic stroma. The tumor cells revealed prominent infiltration into the adjacent fat. A differential diagnosis of a low-grade sarcoma vs. a metaplastic carcinoma, favoring the former, was offered. Final histology sections revealed an infiltrating tumor with predominant spindle cells in a collagenous background, simulating a fibromatosis. Adjacent to the tumor were foci of benign ductal hyperplasia and a micropapilloma. Immunohistochemistry (IHC) showed diffuse co-expression of epithelial markers i.e. cytokeratins (CK, HMWCK, CK7) and EMA along with a mesenchymal marker i.e. vimentin in the tumor cells. Myoepithelial markers (SMA and p63) showed focal positivity. A diagnosis of a low-grade fibromatosis-like carcinoma breast associated with a micropapilloma was formed. Conclusion: Fibromatosis-like carcinoma is a rare form of a metaplastic breast tumor. This diagnosis requires an index of suspicion while dealing with spindle cell breast tumors. The importance of making this diagnosis to facilitate an intra operative surgical planning is marred by diagnostic difficulties. In such cases, IHC is imperative in forming an objective diagnosis. Background Metaplastic breast tumors exhibit a wide morphologic spectrum, ranging from tumors with clearly visualized epithelial elements to heterologous tumors with non-epithelial elements like spindle cells, cartilage and bone [14]. With the help of immunohistochemical (IHC) markers, different morphologic entities within the larger group of metaplastic tumors have been identified. Among these is an unusual, "fibromatosis-like" metaplastic carcinoma. Currently, there is a limited understanding for this tumor as a result of its rarity [4,5]. We present a case of a "fibromatosis-like" metaplastic carcinoma associated with a micropapilloma in an elderly lady. This rare case is discussed to highlight its diagnostic and management issues. Published: 27 February 2007 World Journal of Surgical Oncology 2007, 5:24 doi:10.1186/1477-7819-5-24 Received: 25 October 2006 Accepted: 27 February 2007 This article is available from: http://www.wjso.com/content/5/1/24 © 2007 Rekhi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.