Mesenchymal tumours of the breast and their mimics: a review with approach to diagnosis

Abstract

Mesenchymal tumours of the breast comprise a broad spectrum of entities that frequently pose diagnostic challenges to surgical pathologists. Metaplastic carcinoma and phyllodes tumour are site-specific mimics that account for the majority of tumours in the breast with a sarcomatoid appearance. Although uncommon, mammary tumours with fibroblastic, adipocytic or vascular differentiation may be encountered, spanning the spectrum from benign to malignant. Tumours with histiocytoid morphology are potential traps due to bland cytomorphology and resemblance to reactive processes. This comprehensive review provides a diagnostic approach to specific challenging mesenchymal tumours of the breast and their mimics, with a discussion on the salient morphological, immunohistochemical and molecular features that allow accurate diagnosis and will help the pathologist avoid potential pitfalls.

Keywords: Breast; adipocytic tumours; fibroblastic tumours; histiocytoid morphology; mesenchymal breast tumours; metaplastic carcinoma; phyllodes tumour; sarcoma; soft tissue; spindle cell; vascular tumours.