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Saga Medical School Saga 849-8501, Japan
A 32-year-old woman found a hard, movable mass in her left breast while performing self-examination. Dimpling was not observed. Mammography showed a spiculated mass measuring 2.5 x 2.0 cm on the upper lateral quadrant of the left breast (Fig. 1A). Because of the spiculated margin, we initially suspected that the mass was breast cancer. On sonography, the mass was flat and hypoechoic; on unenhanced T1-weighted images, the mass showed isointensity. On fat-suppressed T2-weighted images, the mass exhibited areas that were lower or higher in intensity than the normal tissue of the mammary gland (Fig 1B). On contrast-enhanced fat-suppressed T1-weighted images, the mass had an ill-defined margin and heterogeneous enhancement (Fig. 1C). The mass showed no ringlike enhancement. On dynamic MRIs obtained before and 30 sec, 1 min, 2 min, 3 min, 4 min, and 5 min after injection of the contrast material, the mass showed a gradual enhancement (Fig. 1D). MR findings were not typical of a breast carcinoma.
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In the specimens collected by aspiration and needle biopsies, benign fibroblastlike cells, collagen fibers, and inflammatory cells were noted with a benign breast epithelium. Fibromatosis was suspected, and excision of the mass was performed. Macroscopically, an infiltrative whitish mass was observed in the mammary gland. Microscopically, the lesion was an unencapsulated infiltrative growth of spindle cells and collagenous material. Tumor cells were distributed evenly in broad sheets of nuclei, but mitosis was not apparent. Myxoid areas were also seen in certain areas of the stroma. The results of immunohistochemical tests showed that some spindle cells were positive for alpha smooth muscle actinin. These findings were compatible with fibromatosis of the breast. In the 2 years since the excision, no evidence of recurrence has been found.
Fibromatosis is a benign disease of infiltrative fibroblastic and myofibroblastic proliferation with no metastatic potential but with significant risk for local recurrence [1]. Fibromatosis of the breast is extremely rare and accounts for only 0.2% of primary breast tumors. All cases reported in the literature have occurred in women whose mean age was younger than that of patients with breast cancer [2]. Breast fibromatosis is a movable hard or firm mass. Skin retraction and fixation to the muscle are often present [2]. On mammography, fibromatosis appears as an ill-defined, dense mass that mimics breast cancer [3]. The sonographic appearance of this disease has been reported to be an irregular and ill-defined hypoechoic mass that is indistinguishable from breast cancer [4]. To the best of our knowledge, no report to date has described the MRI appearance of fibromatosis of the breast.
Previous reports on musculoskeletal fibromatosis have described the lesions as isointense on T1-weighted images and heterogeneously low to highly intense on T2-weighted images, with areas of intensity relative to skeletal muscle. The lesions displayed moderate to strong enhancement after IV administration of contrast material [5]. However, we believe that there has been no previous report of the dynamic enhancing pattern of fibromatosis. In our patient, high-intensity areas on T2-weighted images were correlated with prominent myxoid change, and low-intensity areas were correlated with dense collagenous tissue in the tumor. Gradual enhancement was thought to reflect the significant amount of collagenous tissue in and myxoid change of the tumor. Many typical lesions of invasive breast cancers enhance rapidly. Dynamic MRI and biopsy are helpful for preoperative diagnosis of fibromatosis of the breast.
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  H. B. Neuman, E. Brogi, A. Ebrahim, M. F. Brennan, and K. J. Van Zee Desmoid Tumors (Fibromatoses) of the Breast: A 25-Year Experience Ann. Surg. Oncol., January 1, 2008; 15(1): 274 - 280. [Abstract] [Full Text] [PDF]
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B. Mesurolle, I. Leconte, L. Fellah, C. Feger, T. Nakazono, and S. Kudo Dynamic Breast MRI in Recurrent Fibromatosis Am. J. Roentgenol., February 1, 2005; 184(2): 696 - 697. [Full Text] [PDF]
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