J Breast Cancer.  2015 Jun;18(2):200-205. 10.4048/jbc.2015.18.2.200.

Primary Inflammatory Myofibroblastic Tumors of the Breast with Metastasis: Radiographic and Histopathologic Predictive Factors

• Choi EJ
• Jin GY
• Chung MJ
• Moon WS
• Youn HJ

• KMID: 2374537
• DOI: http://doi.org/10.4048/jbc.2015.18.2.200

Abstract

Primary inflammatory myofibroblastic tumors (IMTs) of the breast are uncommon and metastasis of IMTs is extremely rare. To date, the natural course of this disease is not fully understood. Although patients with IMTs should undergo regular follow-up after complete surgical resection of the tumor, the appropriate interval and method of follow-up are unclear. We report the case of a patient with an IMT of the breast that metastasized 2 years after complete surgical resection. This unusual case emphasizes the importance of preoperative examinations to determine whether the IMT has atypical features that should guide the interval and method of follow-up.

Keyword

Breast neoplasms; Granuloma; Metastasis; Plasma cells

MeSH Terms

Breast Neoplasms
Breast*
Follow-Up Studies
Granuloma
Humans
Myofibroblasts*
Neoplasm Metastasis*
Plasma Cells

Figure

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  Figure 1 Imaging findings of inflammatory myofibroblastic tumor at the time of initial diagnosis. (A) On mammography, an oval-shaped, microlobulated, hyperdense mass with some coarse heterogeneous microcalcifications was observed. (B) A color Doppler study showed an irregularly shaped, microlobulated, hypoechoic mass with combined posterior features and increased vascular flow in the peripheral portion of the lesion. Subtraction imaging on T1-weighted contrast-enhanced breast magnetic resonance imaging (MRI) showed an irregular mass with heterogeneous enhancement, with the periphery enhancing more than the center. In addition, MRI showed a fast rate of enhancement in the initial period (C) and a washout in the delayed period of enhancement (D).

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  Figure 2 Histologic, immunohistochemical analyses of inflammatory myofibroblastic tumor (IMT) at initial diagnosis. (A) A sample of the IMT obtained on excisional biopsy shows mainly composed of spindle cells forming swirling storiform-like patterns, as well as inflammatory cells including plasma cells and lymphocytes (H&E stain, ×100). (B) The mass showed high mitotic activity and mild cellular pleomorphism (H&E stain, ×400). (C) Immunohistochemical analysis shows positive staining for smooth muscle actin (SMA) in the spindle tumor cells (SMA, ×400) and (D) positive staining for Ki-67 in about 30% of the spindle tumor cells (Ki-67, ×400).

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  Figure 3 Imaging findings of inflammatory myofibroblastic tumor at metastasis after complete surgical resection. (A) Two years after complete surgical resection, chest computed tomography (CT) showed an irregularly shaped, heterogeneous, enhancing metastasis to the internal mammary chain on post-contrast-enhanced images. (B) Positron emission tomography/CT showed increased 18F-fluorodeoxyglucose uptake in metastases to the internal mammary chain and two supraclavicular lymph nodes.

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  Figure 4 Histologic, immunohistochemical analyses of inflammatory myofibroblastic tumor (IMT) at metastasis diagnosis after complete surgical resection. (A) A sample of the IMT obtained on core needle biopsy shows that the tumor was mainly composed of a conspicuous proliferation of spindle cells arranged in a loose fashion and surrounded by infiltrating inflammatory cells (H&E stain, ×100). (B) Tumor showed increased cellularity and cellular atypia of spindle cells compared to first excisional biopsy. Tumor cells showed high mitotic activity (10 mitoses per 10 high-power field) (H&E stain, ×400). (C) Immunohistochemical analysis shows positive staining for smooth muscle actin (SMA) in the spindle tumor cells (SMA, ×400) and (D) positive staining for Ki-67 in about 40% of the spindle tumor cells (Ki-67, ×400).

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