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Breast-nonmalignant
Benign tumors / changes
Inflammatory myofibroblastic tumor
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 7 October 2012, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Tumor of myofibroblastic spindle cells and inflammatory cells
Terminology
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● Also called inflammatory pseudotumor, plasma cell granuloma
Epidemiology
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● Extremely rare in breast with <20 cases reported
Sites
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Etiology
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● May be part of an IgG4 related sclerosing disease (New Engl J Med 2001;344:732, World J Gastroenterol 2008;14:3948)
Clinical features
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Prognostic factors
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Case reports
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● 46 year old woman with IgG4 related inflammatory pseudotumor (Am J Surg Pathol 2005;29:275)
● 50 year old woman with breast mass (University of Oklahoma)
● 60 year old woman with suspicious mammogram (Korean J Radiol 2009;10:515)
Treatment
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Clinical images
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Gross description (Macroscopy)
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● Firm, circumscribed, yellow
Gross images
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Micro description (Histopathology)
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● Nodular with fibrovascular stroma containing myofibroblast-like cells and lymphoplasmacytic infiltrate
● May have primarily inflammatory features (diffuse lymphoplasmacytic infiltration and lymphoid follicles), resemble myofibroblastic tumors or be hypocellular (scar-like)
● Often mixed patterns (Am J Clin Path 1988;90:627)
Micro images
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Myoblastic spindle cells Various images
and inflammatory cells
Various images
H&E and ALK1 CD34+ p53-
Bladder: spindle cells and inflammatory cells in myxoid stroma
Virtual Slides
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Videos
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Cytology description
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● Inflammatory lesion with occasional aggregates of cellular connective tissue fragments, sheets of uniform ductal epithelial cells with myoepithelial cells, spindle cells, lymphocytes and histiocytelike cells (Acta Cytol 2003;47:1077)
Cytology images
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Positive stains
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● Spindle cells - smooth muscle actin, vimentin, variable keratin
● Plasma cells may be IgG4+
Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Myofibroblastic features of rough endoplasmic reticulum,
peripheral smooth muscle myofilaments and fibronectin fibrils
Molecular / cytogenetics description
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● Some cases are clonal (J Pathol 2002;196:97)
Molecular / cytogenetics images
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Fig A: ALK gene rearrangement
Differential Diagnosis
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● Spindle cell carcinoma: sarcoma like features but keratin+ (Ann Diagn Pathol 2005;9:123)
Additional references
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End of Breast-nonmalignant > Benign tumors / changes > Inflammatory myofibroblastic tumor
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