|Year : 2022 | Volume
| Issue : 1 | Page : 54-55
Gross picturesque: Case of the journal
Amrit Kaur Kaler
Department of Pathology, The Oxford Medical College, Hospital and Research Centre, Bengaluru, Karnataka, India
|Date of Submission||12-Oct-2021|
|Date of Decision||06-Jan-2022|
|Date of Acceptance||02-Apr-2022|
|Date of Web Publication||03-May-2022|
Dr. Amrit Kaur Kaler
Consultant Molecular Pathologist, Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kaler AK. Gross picturesque: Case of the journal. J Precis Oncol 2022;2:54-5
A 73-year-old woman presented with a large painless lump on her right breast that had gradually grown over the past 5 years. The physical examination revealed a very large, ill-defined mass that bordered on her lower abdomen. There was no skin ulceration, nipple discharge, or axillary adenopathy, and there was also no tumor in the other breast. Ultrasonography showed a solid tumor mass with heterogeneous internal echo. Fine-needle aspiration cytology of the mass showed fragments of adipose tissues with atypical spindle cells, suggestive of low-grade spindle cell lesion. A modified radical mastectomy of the right breast was performed with a high suspicion of malignancy.
Grossly, the tumor was large, measuring 20 cm × 15 cm × 12 cm, irregular, multilobulated with yellow cut surface [Figure 1].
Histopathological examination showed a tumor composed of mature adipose tissues separated by fibrous septa with prominent blood vessels and stromal cells showing enlarged and hyperchromatic nuclei. Atypical lipoblasts with scalloped and vacuolated cytoplasm were seen scattered among mature fat. No mitotic figures or necrosis was seen, but an invasion into the fascia of the pectoral muscles was noted. Based on positive IHC finding for S100 and MDM2, the patient was diagnosed with a well-differentiated liposarcoma (WDL).
| Discussion|| |
Primary breast sarcomas are rare, arising from the connective tissues of the breast and accounting for <1% of breast malignancies. Liposarcoma represents 3%–24% of the primary breast sarcoma, mostly arises de novo but may arise from a preexisting Cystosarcoma Phyllodes. The diagnosis of soft tissue sarcoma in breast is based not only on morphology, IHC and clinicopathological correlation; but cytogenetic and molecular testing contributes towards diagnosis, prognostic stratification and predictive information regarding concerned therapies. WDL are known to arise from the accumulation of chromosomal abnormalities, the most common being 12q13–15 amplification, with Murine Double Minute Clone 2 (MDM2) being the most common gene identified in that region. MDM2 is an oncogene which functions as a negative regulator of tumor suppressor gene TP53. By overexpressing MDM2, cancer cells have the ability to block TP53 which is commonly known as the “Giardian of the Genome”. FISH studies for MDM2 amplification is a hall mark in differentiating Liposarcomas from other non-lipomatous sarcomas. The World Health Organization has classified liposarcoma into seven distinct histological subtypes: atypical lipomatous tumor/WDL, dedifferentiated liposarcoma, myxoid liposarcoma, round cell liposarcoma, pleomorphic liposarcoma, mixed-type liposarcoma, and liposarcoma not otherwise specified. Surgery is a potentially curative modality; the role of adjuvant chemo- and radiotherapy needs to be decided on the size of tumors (>5 cm), high grade, and positive margins. Eribulin is a microtubule inhibitor chemotherapy has been approved for the treatment of liposarcomas who have progressed after treatment. In a subgroup analysis of Liposarcoma cohort of the Phase III, eribulin versus dacarbazine trial, median overall survival and progression free survival improved with eribulin without additional toxicity. Clinical trials are underway for CDK4/6 inhibitors (Palbocicilib), MDM2 inhibitors (milademetan) and Tyrosine kinase inhibitors (Pazopanib, Regorafenib).
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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