This is a 79-year-old woman with a history of hypertension and unrelated cardiac arrhythmia, who came to our center after finding a non-painful tumor in the left breast, which refers to a month of evolution approximately.
On examination, a solid tumor measuring about 4 cm in diameter, hard, poorly defined, fixed and adhered to deep planes was found in the inferior-intern quadrant of the left breast.
A mammographic study of both breasts was performed without being able to clearly appreciate the mass for being in a deep plane.
The ultrasound study showed a hypoechogenic and heterogeneous mass of approximately 28 x 30 mm with signs of malignancy, irregular borders and posterior acoustic shadowing.
A clinical tri-tru-cut microbiopsy of the lesion was performed, showing the histology a malignant neoformation of cellular character and surrounding acinar duct structures not fuscuts.
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Malignant neoplasms of the fusiform cells of the breast raise the differential diagnosis mainly between metaplastic carcinomas of fusiform cells and sarcomas, so the complete excision of the lesion is indicated and the histological study differs the definitive diagnosis.
Given the age of the patient and after assessing their wishes and therapeutic possibilities, surgical treatment was decided, performing an infero-medial quadrantectomy without axillary lymphadenectomy.
The histological size of the neoplasm is 5 x 4.8 x 3.5 cm, with abundant infiltration of the skin and fascicles and microscopically shows irregular areas of necrosis characterized by spindle cells.
Stem cells show marked nuclear atypia, hyperchromasia and abundant mitoses.
None of the areas studied showed neoplasic ductolobular epithelium or component of the lesion. The few ducts found correspond to non-observed structures due to the tumor.
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In the immunohistochemical study, cytostatic proteins are intensely positive with AE1-AE3, keratin 22, vimentin, smooth muscle actin, Cerb-2 and CD10 actin, total HMA 7,45 and negative with quera
Hormonal estrogen and progesterone receptors are negative.
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With all these data the diagnosis of metaplastic spindle cell carcinoma is established.
The patient had no signs of residual tumor and adjuvant radiotherapy was decided at a dose of 60 Gy, at a dose of 2 Gy per fraction, in 5 cases per week.
The patient is currently asymptomatic two months after the end of treatment.
