We report a case of myofibroblastoma (MFB) of the breast in a 58-year-old man who presented with a large painless lump in the left breast. Radiologic breast imaging showed a well-circumscribed mass with no microcalcifications. Microscopic examination revealed fascicles of spindle cell neoplasm with intervening thick bundles of hyalinized collagen and interspersed vessels. Pertinent immunohistochemistry markers showed positivity for CD34, estrogen receptor, progesterone receptor and androgen receptor. A diagnosis of MFB of the breast was rendered. It is crucial to differentiate MFB from other entities in the breast like fibroadenoma, phyllodes tumor, gynecomastia, carcinoma and sarcoma for its appropriate management.
Objective: Minimally invasive breast surgery (MIBS) via an extramammary approach offers an alternative to conventional open lumpectomy, eliminating breast scarring and improving psychological outcomes in patients with benign breast lesions. While endoscopic MIBS (EMIBS) has been described, data on robotic MIBS (RMIBS) are sparse. We analyzed the clinical and cosmetic outcomes of EMIBS and RMIBS. Materials and Methods: Eighty patients undergoing MIBS for benign breast lumps were divided into endoscopic (n = 40) and robotic (n = 40) groups. Primary endpoints included cosmetic outcomes [evaluated via Patient and Observer Scar Assessment Scale (POSAS) and BREAST-Q], total operative and docking times, and complications, which were statistically analysed (IBM SPSS Statistics version 30). Results: Groups were comparable in age (p = 0.325), lesion size (median 2.0 vs. 2.75 cm; p = 0.247), and number of lumps (median 1 in both groups; p = 0.165). Operative time analysis showed that operative time was significantly longer in the robotic group (median 150 vs. 95 minutes; p<0.001). Complications were minor, self-resolving, and comparable across both groups (Fisher’s exact p = 0.647). Cosmetic outcomes (at 1 month) were comparable between the two groups: median POSAS score 2 and median BREAST-Q score 88 (breast-conserving therapy module, satisfaction with breasts subscale). A subjective reduction in physical strain on the surgeon was noted in the robotic group; no objective ergonomic measurements were performed. Conclusion: We demonstrate the feasibility and safety of both approaches for benign breast lesions, with comparable and favorable cosmetic outcomes, and with the robotic platform offering subjective improvement in ergonomic strain, especially in difficult-to-access medial quadrants. These findings are hypothesis-generating and require validation using instruments such as NASA-TLX or the Borg CR-10 scale in larger studies.
Objective: As breast cancer survivorship improves, quality of life (QoL) has become a key determinant in treatment decision-making. While breast-conserving approaches are widely adopted, variations in surgical extent persist across clinical settings. This study aimed to compare patient-reported QoL scores between women undergoing breast-conserving surgery and those undergoing modified radical mastectomy in the context of adjuvant radiotherapy. Materials and Methods: This single-center, cross-sectional, observational study included 98 women who were treated at a tertiary hospital between January 2021 and January 2024. Of 200 potentially eligible patients contacted, 98 consented and completed the European Organisation for Research and Treatment of Cancer core quality of life questionnaire (QLQ-C30) and the breast cancer-specific module (QLQ-BR23) after radiotherapy. Fifty-eight patients underwent breast-conserving surgery, and 40 underwent modified radical mastectomy. Scores were transformed to a 0-100 scale; functional and global health scales were interpreted conventionally, and symptom summaries were oriented so that higher scores reflected lower symptom burden. Unadjusted group comparisons were performed using the Mann-Whitney U test, and exploratory correlations were assessed using Spearman correlation coefficients. Results: Patients treated with breast-conserving surgery reported higher QLQ-C30 functional scores than those treated with modified radical mastectomy (median 60.00 vs. 46.66; p = 0.005) and higher global health status scores (66.66 vs. 37.50; p<0.001). Symptom summary scores also favored breast conservation (67.94 vs. 58.97; p = 0.001). On the QLQ-BR23, the breast-conserving group reported higher functional scores (57.77 vs. 44.44; p = 0.008) and higher symptom summary scores (87.50 vs. 84.38; p = 0.045). These values represent unadjusted between-group differences and should be interpreted in light of the observational design and the unavailability of clinical covariates. Conclusion: In patients receiving adjuvant radiotherapy, less extensive breast surgery was associated with more favorable patient-reported quality of life outcomes. These findings highlight the importance of incorporating survivorship outcomes into shared decision-making in breast cancer care.
Neuroendocrine carcinoma of the breast is a very rare malignancy, and when it presents with characteristics similar to Merkel cell carcinoma (MCC), it is even more uncommon. This report discusses a case of small cell carcinoma exhibiting Merkel cell-like features in an 80-year-old woman who had a history of rheumatoid arthritis under treatment with immunosuppressive drugs. Microscopic analysis showed tissue fragments with areas of necrosis, as well as focal regions containing neoplastic cells. These cells were small to medium in size, with poorly defined borders, scant cytoplasm, and hyperchromatic, atypical nuclei. Immunohistochemical staining revealed perinuclear (dot-like) positivity for cytokeratin 18/8 and strong positivity for cytokeratin 20 and cluster of differentiation 56. The cell proliferation marker Ki-67 was positive in over 80% of the cells. What is extremely rare in this case is the presentation of MCC of the breast as a retro areolar lesion, located behind the areola and associated with nipple discharge, without evidence of a primary cutaneous lesion.
Objective: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare CD30-positive, anaplastic lymphoma kinase (ALK)-negative peripheral T-cell lymphoma now recognized as a distinct entity in the 5th edition World Health Organization Classification of haematolymphoid tumors. Its clinicopathologic profile, treatment patterns, and outcomes, relative to those of other primary breast lymphomas, have not been characterized in large population-based comparative studies. Materials and Methods: Using the Surveillance, Epidemiology and End Results (SEER) database (2017–2022), we identified patients with primary breast lymphoma based on ICD-O-3 site (C50.0–C50.9) and morphology codes for BIA-ALCL (9715/3), diffuse large B-cell lymphoma (DLBCL, 9680/3), extranodal marginal zone [mucosa-associated lymphoid tissue (MALT)] lymphoma (9699/3), and Burkitt lymphoma (BL, 9687/3). Baseline characteristics, treatment, overall survival (OS), and cancer-specific survival (CSS) were compared between BIA-ALCL and other mammary lymphomas. Results: Two hundred fifty-two patients with BIA-ALCL were identified and compared with 185,019 patients with other mammary lymphomas. Patients with BIA-ALCL were younger than those with DLBCL and MALT, but older than those with BL (mean age 62.8 years, p<0.001). BIA-ALCL demonstrated higher rates of surgical management and lower rates of radiotherapy compared with DLBCL and MALT. Chemotherapy utilization was intermediate among lymphoma subtypes. In unadjusted analyses, DLBCL was associated with worse OS [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.03–2.08] and CSS (HR 1.84, 95% CI 1.21–2.79) relative to BIA-ALCL; BL was associated with worse CSS (HR 2.08, 95% CI 1.37–3.16); MALT lymphoma showed better CSS (HR 0.54, 95% CI 0.35–0.81). Multivariable analysis yielded HRs that were not statistically distinguishable from those for BIA-ALCL, but estimates were imprecise (adjusted OS for DLBCL: HR 1.53, 95% CI 0.21–10.90; for BL: HR 2.66, 95% CI 0.37–19.20); these wide CIs reflect sparse events within the BIA-ALCL cohort and preclude conclusions about survival equivalence. Conclusion: In this SEER-based analysis, breast-localized ALK-negative ALCL showed a distinct demographic and treatment profile characterized by surgical management, with favorable crude survival compared with that of DLBCL and BL. Early recognition and complete surgical excision remain central to the management of localized BIA-ALCL.
