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Special Feature
December 1, 2006

Image of the Month—Diagnosis

Arch Surg. 2006;141(12):1264. doi:10.1001/archsurg.141.12.1264

Answer: Leiomyosarcoma of the Breast

Leiomyosarcomas of the breast are rare and constitute fewer than 1% of all breast malignancies. Sarcomas can occur in the setting of postradiation therapy to the chest wall or chronic lymphedema. However, to our knowledge, there have only been 20 cases (including this one) of primary leiomyosarcoma of the breast. This case is one of the largest leiomyosarcomas reported, measuring 18 × 23 cm.1,2While patients typically present with a palpable mass, our patient came to medical attention because of her weakness from the blood loss and her inability to function as a hotel maid. Sarcomas are typically well encapsulated and usually do invade the surrounding tissue. Electron microscopy and immunohistochemistry are needed to differentiate leiomyosarcomas from other sarcomas.

The only known curative treatment is surgical removal including wide local excision or complete mastectomy. Our patient underwent mastectomy and postoperative irradiation. Because the deepest margin of the specimen was only 0.5 cm, complete excision was possible without the need for removing any muscle. Ten months after the mastectomy, this patient had no evidence of local recurrence or metastases. In patients with leiomyosarcoma, there is no clear role for lymph node dissection or adjuvant chemotherapy, and the value of radiotherapy is also disputed.3There is 1 case report4in the literature describing a patient who received postoperative chemotherapy but still developed local recurrence and distant metastases 2 months after therapy. Current recommendations include postoperative irradiation if the microscopic margins are questionable. Prognostic factors may include the size of the tumor, histologic grade, and surgical margins. Late recurrence can occur; therefore, patients need long-term follow-up.

Correspondence:Lan T. Vu, MD, Department of Surgery, University of California, San Francisco, 513 Parnassus Ave, S-343, San Francisco, CA 94143 (lan.vu@ucsfmedctr.org).

Accepted for Publication:October 11, 2005.

Author Contributions:Study concept and design: Vu and Knudson. Acquisition of data: Vu. Analysis and interpretation of data: Luce. Drafting of the manuscript: Vu and Luce. Critical revision of the manuscript for important intellectual content: Luce and Knudson. Administrative, technical, and material support: Vu. Study supervision: Luce and Knudson.

Financial Disclosure:None reported.

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