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Arch Surg. 2005;140:96.

Answer: Stromal Cell Sarcoma of the Breast
Nonepithelial lesions of the breast have been broken into 2 classes: true sarcomas (malignant fibrous histiocytoma, fibrosarcoma, malignant fibromatosis, leiomyosarcoma, osteogenic sarcoma, chondrosarcoma, liposarcoma, stromal cell sarcoma, and spindle-cell or undifferentiated sarcoma) and others (including angiosarcoma, lymphangiosarcoma, lymphoma, and cystosarcoma phyllodes).¹

Stromal sarcomas of the breast are slow-growing, extremely rare mesenchymal tumors with no epithelial components (unlike cystosarcoma phylloides, hemangiosarcoma, and lymphangiosarcoma). Stromal cell sarcoma had previously been defined as "all sarcomas of the breast excluding cystosarcoma phylloides and angiosarcoma,"² but it has recently been redefined in reference to "rare sarcomas of a nonspecific type that arose in intralobular stroma. Both malignant fibrous histiocytoma and stromal cell sarcoma consist of spindled cells resembling fibroblasts; the only distinguishing feature is the primary involvement of intralobular stroma in the former and extralobular stroma in the latter. This distinction is difficult in proliferating tumors."^2-3

The median diameter of this tumor has been reported to be 6 cm.⁴ An extensive literature search on breast sarcomas of any type failed to reveal any sarcomas of the size in this case. Only 3 similar cases could be located (1 36-cm nonstromal cell sarcoma⁵ and 2 8-kg stromal cell sarcomas^{2, 6}), but none was larger than the tumor in this case.

Local recurrence is frequent with simple excision. Resection of the tumor is usually best achieved with a simple mastectomy. Approximately 25% of these tumors are capable of systemic metastases. There has been no documentation of a role for radiation or chemotherapy.⁴

Submissions The Editor welcomes contributions to the "Image of the Month." Send manuscripts to Archives of Surgery, Johns Hopkins Medical Institutions, 720 Rutland Ave, Ross 759, Baltimore, MD 21205; (443)287-0026. e-mail: archsurg@jama-archives.org. Articles and photographs accepted will bear the contributor’s name. Manuscript criteria and information are per the "Instructions for Authors" for Archives of Surgery. No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations.

AUTHOR INFORMATION

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Correspondence: Kenneth A. Lipshy, MD, VA Northern Indiana Health Care System, 2121 Lake Ave, Fort Wayne, IN 46805 (kenneth.lipshy{at}med.va.gov).

Accepted for Publication: April 27, 2003.

REFERENCES

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1. Callery CD, Rosen PP, Kinne DW. Sarcoma of the breast: a study of 32 cases with reappraisal of classification and therapy. Ann Surg. 1985;201:527-532. PUBMED 2. Kaminski D, Taylor HB. Stromal sarcoma of the breast. Mo Med. 1972;69:672-677. PUBMED 3. Jones M, Weiss S. Fibrosarcoma-malignant fibrous histiocytoma of the breast: a clinicopathological study of 32 cases. Am J Surg Pathol. 1992;16:667-674. FULL TEXT | ISI | PUBMED 4. Berg JW. Stromal sarcoma of the breast. Cancer. 1962;15:418-424. PUBMED 5. Pollard SG, Marks PV, Temple N, Thompson HH. Breast sarcoma: a clinicopathological review of 25 cases. Cancer. 1990;66:941-944. FULL TEXT | ISI | PUBMED 6. Kennedy T, Biggart JD. Sarcoma of the breast. Br J Cancer. 1967;21:635-644. PUBMED

SECTION EDITOR: GRACE S. ROZYCKI, MD