Vol.3, No.10, 620-622 (2011) Health
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Primary breast leiomyosarcoma: case report and
literature review
Fatima Zahra EL M’ra bet1,2*, Hanane El kac emi1, Omar El Mesbahi2, Khal id El Hasso uni1,
Brahim khalil El Gu eddari1
1Radiotherapy unit, National Institute of Oncology, Rabat, Morocco; *Corresponding Author: fazoumed@hotmail.com
2Departement of medical oncology, university hospital Hassan II, Fez, Morocco.
Received 4 April 2011; revised 16 May 2011; accepted 29 May 2011.
PURPOSE: Leiomyosarcoma of the breast is
extremely rare. To date, the factors that are
predictive of patient prognosis have not been
identified. To clarify the nature of leiomyosa-
rcoma of the breast, and also to establish the
proper treatment strategy, we report this case
We report this case while discussing The Cli-
nical presentation, diagnosis, therapy and path-
ologic feature. INTRODUCION: Sarcomas com-
prise less than 1% of all primary breast neo-
plasms and only a minority of these are leio-
myosarcomas. There were only 35 cases being
reported in English literature. The mainstay of
treatment is surgical excision with clear mar-
gins and longterm followup is essential. Its pro-
gnosis is better compared to other breast sar-
coma. CASE PRESENTATION: We report a case
of primary leiomyosarcoma of the breast occ-
urring in young female patient which was succ-
essfully treated by surgery and radiotherapy.
CONCLUSION: According to literature data,
primary leiomyosarcoma is characterized by a
better prognosis compared with other breast
sarcomas, To date, the factors that are predic-
tive of patient prognosis have not been iden-
tified. The rarity and diagnostic difficulty impo-
sed a multidisciplinary approach.
Keywords: leiomyosarcoma; Breast;
Immunohistochemistry; Mastectomy
Sarcomas of the breast account for less than 1% of all
malignant tumors of the breast. Leiomyosarcomas bel-
ong to a less common subgroup (5% to 10%) of sar-
comas of the breast [1]. There were only 35 cases being
reported in English literature. Confirming the diagnosis
on either immunohistochemistry is important as it is
sometimes difficult to differentiate these pathologically
from poorly differentiated sarcomatoid carcinomas. To
date, the factors that are predictive of patient prognosis
have not been identified. [2]
In this report, we describe case with this uncommon
Tumor, which was treated successfully in The Institute
of National Oncology Rabat, Morocco.
A 40-year-old female patient, without any significant
history, who presented a left breast lump, it has been pre-
sent for 17 months. There was no other breast complaint
and no family history of breast cancer. Physical exam-
ination found a tumor of 6 cm in diameter in the lower
inner quadrant of her right breast with ipsilateral axillary
lymph node. The left breast was unremarkable. Mam-
mography showed a dense, well circumscribed mass
with little evidence of local invasion and the lump was
easily detectable by ultrasound. An incisional biopsy was
performed, the histological exam showed a sarcomatous
proliferation, Immunohistochemically, the tumor cells
were diffusely and strongly positive for α-smooth mus-
cle actin and vimentin (Figure 1), while negative for
cytokeratin, CD34 and S-100 protein ,which concludes
with primary breast leiomyosarcoma .
Investigations including Liver echography, chest scan
and bone scan were showed no evidence of another
primary tumor or metastatic disease. The patient under-
went a radical mastectomy with lymph node dissection.
Additional immunohistochemical examen routinely perf-
ormed in breast carcinomas (oestrogen, progesteron rec-
eptors, Her 2) also proved to be negative. Tumor cells
showed strong positivity for vimentin, desmin and smoo-
th muscle actin (SMA). Axillary lymph nodes were free
of metastases Axillary. Subsequently the patient had rec-
eived adjuvant radiotherapy to 50 Gray, the patient is in
good control until now. A follow-up examination revea-
led no evidence of distant metastasis or local recurrences
8 years after the treatment.
F. Z. EL. M’rabet et al. / Health 3 (2011) 620-622
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Figure 1. The immunohistochemical stains for α-smooth muscle actin are diffusely and strongly positive in the tumor cells.
Sarcomas comprise less than 1% of all primary breast
neoplasms and only a minority of these are leiomy-
osarcomas [1] Leiomyosarcoma is not rare among soft
tissue tumors. It can exist in any part of the body.
However, its most common primary sites are the uterus,
retroperitoneum, subcutaneous tissues and gastrointes-
tinal tract [3]. Leiomyosarcomas of the breast are extre-
mely rare, either primary or metastatic from other sites.
The smooth muscle component might be originated from
the blood vessels and sarcomatous change is usually
from leiomyoma or other spindle cell tumors [4]. Our
presented case should be regarded as primary leiomyo-
sarcoma of the breast since there was no other primary
focus being found after staging. Confirming the diagno-
sis on either IHC or electron microscopy is important as
it is sometimes difficult to differentiate these patholo-
gically from poorly differentiated sarcomatoid carcino-
mas [5].
Diagnosis can be challenging because of the nonspe-
cific clinical and radiological findings. Clinically they
present with a progressively enlarging tumour. The pre-
sence of enlarged axillary nodes is rare making axillary
node staging unnecessary [6]. Our patient had a progr-
essively tumor evolving for 17 months, with ipsilateral
axillary lymphadenopathy nonspecific.
Radiological findings are also non specific. Leiom-
yosarcoma is observed as a dense, circumscribed, lobu-
lated mass on mammography, showing features similar
to phyllodes tumors or fi broadenomas as described in
most reports. Furthermore, on ultrasonography, as repor-
ted in all the reports cited, leiomyosarcomas are either
oval or lobulated tumors with a smooth clear border, mi-
micking a fi broadenoma, phyllodes tumor, or an intra-
cystic papilloma. Therefore, with an image analysis alo-
ne, differential diagnosis between a leiomyosarcoma and
a benign tumor can be extremely diffi cult [7,8].
Histologically, leiomyosarcoma is characterized by
interlacing bundles of spindle cells and the absence of
ductal or epithelial differentiation. Assessment, Immu-
nohistochemical staining is essential as adjuncts to diff-
erentiate leiomyosarcomas from other tumours and soft
tissue sarcomas. These tumours are usually positive for
desmin, smooth muscle actin, muscle specific actin and
negative for neural tumour marker (PS 100), cytoker-
atins, and epithelial markers. [2,9]
The principal treatment strategy is surgical resection.
The complete excision of the tumor by completely inclu-
ding the surgical margin should be recommended as the
F. Z. EL. M’rabet et al. / Health 3 (2011) 620-622
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
best treatment. Most authors advice either radical or sim-
ple mastectomy arguing that wide excision is associated
with higher rate of recurrence [2,5]. Though axillary
node dissection is not necessary, it has been performed
in many of the reported cases because of uncertain pre-
operative diagnosis or if there were clinically palpable
nodes [6]. In our case, the patient underwent a radical
mastectomy with lymph node dissection for the presence
of clinically palpable axillary lymph nodes, lymph nodes
were free of metastases Axillary. There is no evidence
describing whether radiation therapy and/or chemothe-
rapy improve the disease-free rate or overall survival [10].
In general, the prognosis of patients with leiomy-
osarcoma of the breast is considered to be better than
that for patients with other sarcomas of the breast [11]
Leiomyosarcoma of the breast is extremely rare. To
date, the factors that are predictive of patient prognosis
have not been identified. Since local recurrences and
distant metastases could occur after a relatively long
period, a long-term follow-up is necessary.
Written informed consent was obtained from the pa-
tient for publication of this case report.
The authors declare that they have no competing in-
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