Multimodality images of myofibroblastoma in the male breast: A case report and a review of the literature

doi:10.1016/j.clinimag.2018.06.004

Clinical Imaging

Volume 51, September–October 2018, Pages 300-306

https://doi.org/10.1016/j.clinimag.2018.06.004 Get rights and content

Abstract

We report a case of a 58-year-old male diagnosed with myofibroblastoma using mammography, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI), as well as present a review of the literature. The pathological diagnosis was myofibroblastoma with spindle cell neoplasm with immunoreactivity. Myofibroblastoma is a rare benign disease and there is a lack of reports of multimodality imaging of this disease. We review the imaging features of this rare disease across multiple imaging modalities with pathological correlation, and provide current treatment recommendations as well.

Introduction

Myofibroblastoma of the breast is a rare benign tumor of a mesenchymal origin that is derived from the mammary stromal fibro-/myofibroblasts. These tumors are most commonly described in the 6th to 7th decades of the male breast, with a few cases also reported in postmenopausal women [[1], [2], [3]]. The majority of cases present clinically as movable, nontender palpable masses of the breast. A few reports describe the radiological and -pathological features of myofibroblastoma. We report a case of a 58-year-old man through the use of mammography, ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). We also provide a brief pathological review of this entity.

Section snippets

Case report

A 58-year-old male visited our hospital with a palpable mass of the left breast detected 4 months prior. He had no previous medical history although a paternal history of skin cancer was found. He had a history of sonography-guided core needle biopsy for a suspicious chest wall mass at an outside local hospital. A breast ultrasound performed in an outside hospital facility revealed an approximately 5 cm, circumscribed, oval, homogeneously isoechoic mass located in the retromammary fat tissue.

Discussion

Myofibroblastoma is a rare tumor characterized by spindle-shaped mesenchymal cells derived from fibroblasts. Myofibroblastoma of the breast is an extremely rare benign tumor, which might be confused with malignancy, both clinically and radiologically [[4], [5], [6], [7]]. Seventeen patients diagnosed with myofibroblastoma of the breast between 1997 and 2017 are listed in table (Table 1). The list includes 14 male patients and three female patients with a mean age of 64.5 years. The reported

Conflicts of interest

This work received Soonchunhyang University research funding. The authors declare that they have no other competing interests.

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Cited by (5)

Male breast myofibroblastoma: Imaging features and ultrasound-guided core biopsy diagnosis
2023, Radiology Case Reports
Citation Excerpt :
Given the nonspecific radiological appearances, we concur that Tru-cut biopsy is a reliable procedure in order to obtain histological diagnosis before planning complete surgical excision of the lesion [3]. Myofibroblastoma can be treated with local excision mainly for symptomatic relief; local recurrence is not a recognized feature of myofibroblastoma [8,9]. The differential diagnosis of breast masses in males is broad.
Mammary myofibroblastoma is a rare mesenchymal neoplasm that typically presents in older men and women. Less commonly, these benign tumors may also occur in soft tissues located outside of the breast, in which case they are referred to as mammary-type myofibroblastomas. The histologic composition of this benign spindle cell tumor can be markedly varied. We present one such case of myofibroblastoma of the male breast, describing its sonographic appearance and its diagnosis using ultrasound-guided core biopsy.
Myofibroblastoma of the male breast: A case report
2021, Revista de Senologia y Patologia Mamaria
Citation Excerpt :
Typically, spindle cells are arranged in short haphazardly intersecting fascicles or clusters, interrupted by collagen bundles, with a lack of ducts and lobules. Essential elements for diagnosis are the presence of thick hyalinized collagen bundles and low mitotic activity as well as the lack of myoepithelial component and necrosis.6,7 Immunohistochemistry is crucial for the diagnosis of MFB, showing consistently positive immunoreactivity to vimentin and CD34, while the expression of desmin, SMA, bcl-2 and CD99 varies.
Myofibroblastoma (MFB) is a rare spindle stromal tumour of the breast that predominates in 60–80 years-old adult males. Its imaging features are nonspecific, leading to misdiagnosis. Thus, core biopsy is needed for definitive diagnosis.
Macroscopically, MFB is usually a well-circumscribed, firm and rubbery, unencapsulated, pale white to grey round mass. Microscopically, it consists on spindle cells arranged in haphazardly intersecting fascicles or clusters, thick hyalinized collagen bundles and low mitotic activity with a lack of myoepithelial component and necrosis. Immunohistochemistry shows consistently positive immunoreactivity to vimentin and CD34, while expression of desmin, SMA, bcl-2 and CD99 varies. Oestrogen, progesterone and androgen receptors are usually expressed. They are constantly negative to cytokeratins, EMA, S100 protein, HMB-45 and c-kit (CD117). These differentiate them from fibroadenoma, phyllodes tumour, round pattern gynecomastia, carcinoma and sarcoma, since they present infiltrative growth and are negative to CD34.
Wide local excision is curative, with no need of sentinel lymph node biopsy, since local recurrence is extremely low and has been reported to be less than 1.5%. No distant metastases have been described on the literature.
We report a rare case MFB on a 73-year-old male attended at our institution presenting with a nodule on the right breast.
El miofibroblastoma (MFB) es un tumour estromal de células fusiformes que aparece en varones de 60-80 años. Las características radiológicas son inespecíficas, por lo que es necesaria la realización de biopsia para el diagnóstico definitivo. Macroscópicamente se trata de una lesión bien circunscrita, firme, no encapsulada. Microscópicamente consiste en células fusiformes organizadas en fascículos entremezclados con bandas de colágeno hialino, con baja actividad mitótica y ausencia de componente mioepitelial y necrosis. La inmunohistoquímica muestra la expresión constante de vimentina y CD34, con expresión variable de desmina, AML, bcl-2 y CD99. Los receptores de estrógenos, progesterona y andrógenos normalmente son positivos, mientras que la expresión de citoqueratinas, EMA, S100, HMB-45 y c-kit (CD117) es negativa. Estas características lo diferencian del fibroadenoma, tumour filodes, ginecomastia, carcinoma y sarcoma, ya que la mayoría de ellos se caracterizan por ser negativos para CD34 y presentar crecimiento infiltrativo. La tumorectomía es considerada curativa, sin necesidad de realizar biopsia selectiva de ganglio centinela, dado que la recurrencia local es baja (menos del 1,5%). No se ha descrito la presencia de metástasis a distancia en la literatura. Presentamos el caso de MFB en un varón de 73 años que debutó con un nódulo en la mama derecha.
Sonoelastography findings of myofibroblastoma
2022, Northern Clinics of Istanbul
Breast myofibroblastoma in a male patient
2021, Gaceta Mexicana de Oncologia
Inflammatory Myofibroblastoma of the Breast: A Case Report
2021, Frontiers in Oncology

^☆: This work received Soonchunhyang University research funding.

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Multimodality images of myofibroblastoma in the male breast: A case report and a review of the literature☆

Abstract

Introduction

Section snippets

Case report

Discussion

Conflicts of interest

Clin Imaging

Pathol Res Pract

Radiology Case Reports

Int J Surg Case Rep

Radiologic and pathologic findings in breast tumors with high signal intensity on T2-weighted MR images

Radiographics

Mammary-type myofibroblastoma: clinicopathologic characterization in a series of 143 cases

Am J Surg Pathol

Mammary myofibroblastoma: a tumor with a wide morphologic spectrum

Arch Pathol Lab Med

Myofibroblastoma of the female breast: mammographic, sonographic, and magnetic resonance imaging findings

J Ultrasound Med