Breast malignant, males, children - Malignant Fibrous Histiocytoma (MFH)

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Breast malignant, males, children

Sarcoma

Malignant Fibrous Histiocytoma (MFH)

Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 7 November 2012, last major update November 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Terminology
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● Not part of WHO breast classification
● Rare in breast or elsewhere under new WHO definition (see micro description)

Clinical features
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● Aggressive, with frequent distant metastases and death due to disease (Am J Surg Pathol 1992;16:667)

Case reports
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● 32 year old woman with recurrent primary MFH of breast (Acta Cytol 2010;54:985)
● 44 year old woman post-radiation therapy for invasive ductal carcinoma (Int Semin Surg Oncol;3:18)
● 46 year old woman post-radiation therapy for invasive ductal carcinoma (Cases J 2008 Nov 17;1(1):313)

Clinical images
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Cystic tumor with skin tethering

Gross images
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Tumor invades skin

Specimen includes ribs posteriorly

Micro description
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● High grade spindle cell tumor
● Excludes tumors with any recognizable line of differentiation other than fibroblasts or myofibroblasts
● May show various patterns such as storiform-pleomorphic, myxofibrosarcoma or giant cell type
● Entrapped breast ductal epithelium should not be misinterpreted as the epithelial component of a biphasic tumor
● A florid lymphoid response should not be confused with metaplastic carcinoma

Micro images
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Marked nuclear pleomorphism and giant cells

Tumor necrosis after neoadjuvant chemotherapy

Cytology description
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● May show cell clusters, fascicles, and dissociated cells displaying spindle cell morphology, marked pleomorphism, bizarre uninucleate/multinucleate giant cells, prominent mitotic activity

Cytology images
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stromal sarcoma with features of giant cell MFH

Positive stains
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● CD68 (71%), smooth muscle actin (36%), rare focal ER and PR (Ann Diagn Pathol 2011;15:407)

Negative stains
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● CD34, S100, desmin, keratins (CK7, CK20, CK5/6, CK18, Ann Diagn Pathol 2011;15:407)

Differential diagnosis
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● May resemble medullary carcinoma at FNA (Acta Cytol 2006;50:577)

End of Breast malignant, males, children > Sarcoma > Malignant Fibrous Histiocytoma (MFH)

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