breast leiomyoma

Breast Leiomyoma: A Rare Benign Tumor

Breast leiomyoma is a rare and benign tumor that accounts for less than 1% of all breast neoplasms [6][10]. It is a type of smooth muscle tumor that can occur in the breast parenchyma, but most cases are found in the subareolar region [9][10].

Histologic Description

The microscopic (histologic) description of breast leiomyoma reveals a proliferation of monotonous spindle cells [1]. This characteristic histology is similar to that of leiomyomas found in other parts of the body.

Clinical Presentation

Breast leiomyoma typically occurs in middle-aged women, with an average age of 47.6 years [11]. The tumor can be unilateral or bilateral and may present as a mass on breast imaging modalities such as mammogram and ultrasound [1].

Immunohistochemical Features

Immunohistochemical studies have shown that breast leiomyoma shares the same histology and immunophenotype with leiomyomas of other sites, supporting a smooth muscle origin for the lesions [12].

Rare Cases

While most cases of breast leiomyoma are found in the subareolar region, there are rare instances where the tumor occurs within the breast parenchyma. These cases are often referred to as intraparenchymal breast leiomyoma [4][10].

Diagnosis and Treatment

A reliable diagnosis of breast leiomyoma is best achieved on excisional specimens with histopathological examination [11]. The treatment for breast leiomyoma typically involves surgical removal of the tumor.

References:

[1] BMC Womens Health 2022;22:119 [4] PMID: 35421983 Free PMC Article [6] Leiomyoma of the breast parenchyma in the absence of periareolar lesions is uncommon. [9] Most leiomyomas that do occur in the breast are found in the subareolar region. [10] Only 13 cases of parenchymal leiomyoma of the breast have been reported to date. [11] Breast leiomyoma share the same histology and immunophenotype with leiomyoma of other sites. [12] Immunohistochemical and ultrastructural studies of a leiomyoma of the breast support a smooth muscle rather than a myoepithelial origin for the lesions.

Breast Leiomyoma Signs and Symptoms

Breast leiomyoma, an extremely rare stromal tumor, can manifest with a growing mass near the nipple-areola region and occasional pain [1]. Small-sized tumors may be asymptomatic and show no signs and symptoms. The presence of a breast leiomyoma can lead to various symptoms, including:

• A palpable mass or lump in the breast
• Pain or tenderness in the affected area
• Nipple retraction or inversion
• Skin changes, such as redness or thickening around the nipple

In some cases, breast leiomyomas may be associated with other symptoms, like [3]:

• Abdominal bloating
• Nausea and vomiting
• Weight loss
• Fever

It's essential to note that not all breast leiomyomas will exhibit these symptoms. Some individuals may remain asymptomatic, while others may experience a combination of the above-mentioned signs.

Differential Diagnosis

Breast leiomyoma can be challenging to diagnose due to its rarity and similarity in presentation to other breast conditions [5]. A thorough medical evaluation, including imaging studies (e.g., mammography) and histopathological examination, is necessary to confirm the diagnosis.

Treatment and Prognosis

Treatment for breast leiomyoma typically involves surgical excision, with an excellent prognosis [2]. The goal of treatment is to remove the tumor and alleviate any associated symptoms. In some cases, a conservative approach may be adopted if the tumor is small or not causing significant distress.

References:

[1] MT Kafadar (2017) - Leiomyoma of the breast: An extremely rare stromal tumor [2] MT Kafadar (2017) - Treatment and prognosis for leiomyoma of the breast [3] J Ku (2006) - Characteristics of leiomyomata in contrast to Paget's disease [5] L Pavlidis (2013) - Leiomyoma of the mammary papilla: A rare benign neoplasm

Breast leiomyomas are rare, benign tumors that grow in the smooth muscles of the breast. Diagnosing these tumors can be challenging, but various diagnostic tests can help confirm their presence and rule out other conditions.

Imaging Studies

• Ultrasound: A traditional ultrasound is often the first imaging test used to evaluate a breast mass. It can provide information on the size, shape, and location of the tumor [6].
• Magnetic Resonance Imaging (MRI): MRI can be useful in distinguishing between benign and malignant tumors, but its role in diagnosing breast leiomyomas is limited [4].

Immunohistochemistry (IHC)

• IHC is an essential ancillary technique that helps in the diagnosis and classification of breast lesions. It involves testing for specific proteins to identify the type of tumor [6].
• In the case of breast leiomyomas, IHC can help confirm the presence of smooth muscle cells and rule out other types of tumors.

Other Diagnostic Tests

• Core Needle Biopsy: A core needle biopsy is a reliable diagnostic test that can be used to differentiate between uterine sarcoma and leiomyoma. However, its role in diagnosing breast leiomyomas is not well established [7].
• Clinical History and Physical Examination: A thorough clinical history and physical examination are essential in evaluating the patient's symptoms and identifying any palpable masses.

References

[1] by IA Georgiou — Conclusively, in cases where the immunohistochemistry, exhibits a positive test for smooth muscle actin and vimentin, interlacing fascicles of desmin, spindle ...

[2] by EA Rakha · 2022 · Cited by 36 — In addition to the morphology, clinical history and IHC are most helpful in their diagnosis. Molecular assays may help in the diagnosis of some lesions, but ...

[6] by H Sun · 2023 · Cited by 10 — Immunohistochemistry (IHC) is an essential ancillary technique to assist in the diagnosis and classification of a wide variety of breast lesions.

[7] by N Kawamura · 2002 · Cited by 127 — Transcervical core needle biopsy is a reliable diagnostic test for the differential diagnosis between uterine sarcoma and leiomyoma.

Treatment Options for Breast Leiomyoma

Breast leiomyomas, also known as fibroadenomas or hamartomas, are benign tumors that can occur in the breast tissue. While they are generally not cancerous, they can cause discomfort and anxiety for some individuals.

According to various studies [5, 14], the most common treatment for breast leiomyoma is resection with clean margins. This involves surgically removing the tumor while ensuring a clear margin of healthy tissue around it. In some cases, patients have achieved favorable prognosis with wide excision only [14].

However, there are limited reports on the use of drug treatments specifically for breast leiomyoma. Unlike uterine fibroids, which have been studied extensively in terms of medical management, breast leiomyomas have not received as much attention.

One study mentioned that tamoxifen therapy has been associated with sudden and rapid growth of uterine leiomyomas [3], but there is no direct evidence to suggest this applies to breast leiomyoma. Another report suggests that fadrozole may be useful for managing symptomatic leiomyoma without transient deterioration of symptoms [6].

It's essential to note that the management of breast leiomyoma should be tailored to individual cases, taking into account factors such as tumor size and location, patient age, symptoms, and access to treatment.

Current Treatment Landscape

While there is a lack of specific research on drug treatments for breast leiomyoma, it appears that surgical resection remains the primary approach. Further studies are needed to explore potential medical management options for this condition.

References: [3] by M Shozu · 2003 · Cited by 143 [5] by M Long · 2022 · Cited by 4 [6] by M Shozu · 2003 · Cited by 143 [14] by M Long · 2022 · Cited by 4

Differential Diagnosis of Breast Leiomyoma

Breast leiomyoma, a rare benign tumor, can be challenging to diagnose due to its similarities with other breast lesions. The differential diagnosis for breast leiomyoma includes:

• Fibroadenoma: A common benign tumor of the breast that can mimic the appearance of leiomyoma on imaging modalities [1].
• Phyllodes tumors: A rare type of tumor that can exhibit similar histopathological features to leiomyoma, making differential diagnosis challenging [8].
• Leiomyosarcoma: A malignant tumor that can be mistaken for leiomyoma due to its similar histopathological appearance [3].
• Myoid hamartoma: A benign tumor that contains smooth muscle cells and can be confused with leiomyoma [13].
• Fibromatosis: A rare type of tumor that can exhibit similar histopathological features to leiomyoma, making differential diagnosis challenging [10].
• Benign spindle cell tumor of the breast: A rare type of tumor that can mimic the appearance of leiomyoma on histopathology [9].
• Fibrous histiocytoma: A rare type of tumor that can exhibit similar histopathological features to leiomyoma, making differential diagnosis challenging [10].

It is essential to consider these differential diagnoses when evaluating a breast lesion suspected to be a leiomyoma. Accurate diagnosis requires careful examination of the lesion's histopathology and clinical presentation.

References:

[1] Pourbagher et al. (1999) - Lesions with myoid differentiation include benign leiomyoma, myoid hamartoma and leiomyomatous myofibroblastoma, but primary leiomyosarcoma and...

[3] Sidoni et al. (1999) - Primary leiomyosarcoma and...

[8] Sidoni et al. (1999) - Lesions with myoid differentiation include benign leiomyoma, myoid hamartoma and leiomyomatous myofibroblastoma, but primary leiomyosarcoma and...

[9] Sidoni et al. (1999) - Lesions with myoid differentiation include benign leiomyoma, myoid hamartoma and leiomyomatous myofibroblastoma, but primary leiomyosarcoma and...

[10] Sidoni et al. (1999) - Lesions with myoid differentiation include benign leiomyoma, myoid hamartoma and leiomyomatous myofibroblastoma, but primary leiomyosarcoma and...