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LETTER TO EDITOR  
Year : 2012  |  Volume : 55  |  Issue : 1  |  Page : 121-122
Myoid (muscular) hamartoma of the breast with chondroid metaplasia


1 Department of Pathology, P.D.U. Medical College, Rajkot, India
2 Gujarat Cancer and Research Institute, Ahmadabad, Gujarat, India

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Date of Web Publication11-Apr-2012
 

How to cite this article:
Nasit JG, Parikh B, Trivedi P, Shah M. Myoid (muscular) hamartoma of the breast with chondroid metaplasia. Indian J Pathol Microbiol 2012;55:121-2

How to cite this URL:
Nasit JG, Parikh B, Trivedi P, Shah M. Myoid (muscular) hamartoma of the breast with chondroid metaplasia. Indian J Pathol Microbiol [serial online] 2012 [cited 2014 Dec 17];55:121-2. Available from: http://www.ijpmonline.org/text.asp?2012/55/1/121/94883


Sir,

Breast hamartoma (BH) is an uncommon poorly recognized benign breast neoplasm with incidence of 0.1% to 0.7%. [1] Myoid hamartoma (MH) is an exceptionally rare variant of BH, which is characterized by the presence of marked component of smooth muscle cells. [2],[3] The exact incidence is not yet known as till date not more than 30 cases of MH have been described in the literature. [2]

A 45-year-old female presented with a slowly enlarging, painless breast lump for duration of two years. Physical examination revealed a circumscribed, nontender, mobile lump of 9 cm sized in upper outer quadrant of left breast. Overlying skin was unremarkable and there was no axillary lymphadenopathy. Clinical impression was fibroadenoma. Mammography showed a well-circumscribed, dense mass with a radiolucent periphery and moderately radiopaque center without calcifications [Figure 1].
Figure 1: Myoid hamartoma: Well -circumscribed mass with radiolucent periphery and moderately radiopaque center in a mammogram

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Fine needle aspiration cytology (FNAC) and core needle biopsy from breast mass showed few mammary lobules and ducts with some fibrous stroma. The patients underwent wide local excision. Grossly, the tumor was well circumscribed and measured 9.0 × 6.0 × 6.0 cm with solid, homogenous, whitish, rubbery cut surface. [Figure 2]a and b. Microscopically, the lesion was well circumscribed and showed mammary lobules, ducts, dense fibrous stroma, and fatty tissue intermingled with many bundles of smooth muscle fibers. The dominant feature was the presence of fascicles of spindle cells [Figure 3] a and b. Foci of cartilage were present in a haphazard manner [Figure 3]c. Cellular atypia, necrosis or mitoses were not evident [Figure 3] d. Immunohistochemistry (IHC) was given. Smooth muscle fibers showed positivity for vimentin, smooth muscle actin (SMA), desmin, estrogen receptors (ER), and progesterone receptors (PR) [Figure 4], but negative for cytokeratin, S -100 protein, and CD34. The diagnosis of MH with chondroid metaplasia was made. The patient was discharged without any recurrence after one year follow-up.
Figure 2: Myoid hamartoma, gross appearance: (a) Well circumscribed, non encapsulated mass, (b) Homogenous, yellowish grey white rubbery cut surface

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Figure 3: Myoid hamartoma: (a) Bundles of smooth muscle cells with ductal, adipose tissue and fibrous stroma (H and E stain, ×100), (b) Overgrowth of spindle shaped smooth muscle cell (H and E stain, ×100), (c) Focus of cartilage metaplasia (H and E stain, ×100), (d) smooth muscle proliferation without atypia (H and E stain, ×400)

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Figure 4: Myoid hamartoma: (a) Sooth muscle actin positivity (IHC, ×100), (b) desmin positivity (IHC, ×100), (c) ER positivity (IHC, ×100), (d) PR positivity (IHC, ×100)

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MHs composed of overgrowth of mammary lobules and ductules with dense fibrous stroma, adipose tissue, and marked groups of smooth muscle fibers. [2],[3] It was first described by Davies and Riddel [4] in 1973. It can be single, multiple, or bilateral. It can be seen in extra -mammary locations such as axilla and inguinal region. [2] Majority of these lesions represent adenosis tumor with leiomyomatous metaplasia of the myoepithelial components. The expression of CD34 antigen in smooth muscle cells suggests that MH originates from stromal cells via leiomyomatous metaplastic changes. [4] Very few cases have been reported with the presence of cartilage in MH of breast, which supports the hypothesis of metaplastic cell differentiation. [5] The role of FNAC and core needle biopsy in making the diagnosis is limited. Tse et al., [6] reviewed 25 cases of BH and found that core needle biopsies and FNAC were largely insufficient, inconclusive, or nonspecific.

Various differential diagnoses for MH include fibroadenoma, leiomyoma, benign nerve sheath tumour, pleomorphic adenoma of breast, and fibromatosis. Other malignant breast lesions that need to be considered include mesenchymal metaplastic carcinomas with chondroid and osseous components.

Although BH is benign breast lesions, rare recurrences, malignant transformation, or coincidental malignancy is possible. [2],[6] Thus, wide excision of the lesion with detailed histopathological examination is the recommended treatment for MH. [3]

To conclude, MH is very rare benign breast lesion with unclear origin. Diagnostic modalities like mammography, ultrasonography, FNAC, and core needle biopsy may not give the definitive diagnosis. Detailed histopathological examination with immunohistochemistry is essential to diagnose this rare lesion. Local wide excision with surgical free margins is the treatment of choice.

 
   References Top

1.Fisher CJ, Hanby AM, Robinson L, Millis RR. Mammary hamartoma. A review of 35 cases. Histopathology 1992;20:99-106.  Back to cited text no. 1
[PUBMED]    
2.Al -Sindi K.- Myoid hamartoma: An exceptionally rare breast lesion. Bahrain Med Bull 2008;30:1-6.  Back to cited text no. 2
    
3.Stafyla V, Kotsifopoulos N, Grigoriadis K, Bokoyiannis CN, Peros G, Sakorafas GH. Myoid hamartoma of the breast: A case report and review of the literature. Breast J 2007;13:85-7.  Back to cited text no. 3
    
4.Kajo K, Zubor P, Danko J. Myoid (Muscular) Hamartoma of the Breast: Case Report and Review of the Literature. Breast Care 2010;5:331-4.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Khoo JJ, Alwi RI, Abd-Rahman I. Myoid hamartoma of breast with chondroid metaplasia: A case report. Malaysian J Pathol 2009;31:77-80.  Back to cited text no. 5
    
6.Tse GM, Law BK, Ma TK, Chan AB, Pang LM, Chu WC, et al. Hamartoma of the breast: A clinicopathological review. J Clin Pathol 2002;55:951-4.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Jitendra G Nasit
C/4, Suryadeep Society, Near Nutan School, B/H Chankyapuri Society, New Sama Road, Vadodara - 390 008, Gujarat
India
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DOI: 10.4103/0377-4929.94883

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

This article has been cited by
1 Bilateral myoid hamartoma of breast: An exceptionally rare lesion
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