Primary Undifferentiated Pleomorphic Sarcoma of the Breast: A Case Report with Literature Review of Similar Cases

Abstract

Breast sarcoma is a rare but aggressive tumor. There are few case reports in the literature and several aspects of this disease are still not completely comprehended. Therefore, reporting new cases can help to enrich the literature. We report a patient with breast mass and pus secretion from her right breast, misdiagnosed as an abscess and mistreated by antibiotics. The patient was referred for an ultrasound examination and mammography, and a needle biopsy was performed that suggested an aggressive tumor. By the pathologist's suggestion, a total mastectomy of the right breast was performed with the excision of sentinel nodes. A pathological examination revealed a high-grade undifferentiated pleomorphic sarcoma (UPS) without vascular or lymph node invasion as the final diagnosis. The patient underwent postoperative chemotherapy and is currently in good condition. This case emphasizes considering this rare tumor when approaching a breast mass. Performing surgery with adequate resection margin can improve the patient's prognosis. Some suggested breast UPS cases with lung and brain metastasis would be more aggressive tumors than other breast sarcomas. Total mastectomy with negative margins and free-of-tumor lymph nodes may be the key to improve prognosis in such patients.

Keywords: Breast; Breast neoplasms; Mastectomysarcoma.

Fig. 1

The results of the mammography examination of the right breast

Fig. 2

Ultrasound examination of the right breast

Fig. 3

Immunohistochemical staining of the needle biopsy specimen showing positivity of the tumoral cells for A. CD68 (×400), B. Vimentin (×100), and C. Ki67 index was 50% (×100); but negative for D. CK (×100), E. ER (×400), and F. EMA (×100)

Fig. 4

Macroscopic image of the right breast

Fig. 5

Microscopic images with hematoxylin and eosin staining showing atypical spindle and epithelial cells (A and B ×100) with osteoclastic-like giant cells, high mitotic rate, and pleomorphism (C and D ×400); the arrow indicates mitosis

Fig. 6

Immunohistochemical staining of the resected specimen showing negativity of t the tumoral cells for A. CK (×100), B. P63 (×100), and C. CD34 (×100)