A 74-year-old woman presented with a fixed, non-painful, right axillary tumor measuring 5 cm.
Mammography and FNA were performed, with negative results. For this reason, follow-up was recommended.
At two years of follow-up this nodule is approximately 10 cm, well encapsulated and with well-defined borders, with probable diagnosis of fibromyolipoma midline.
Controls were performed in the following six years with mammograms and FNAB where no signs of malignancy appeared.
Eight years after the first diagnosis there is pain in the right breast, persisting a 10 cm tumor of hard consistency, not attached to skin or deep planes.
Inspection and consolidation of both breasts is normal.
The left armpit is free.
In the right axilla we found a tumor of more than 10 cm in diameter, hard consistency, not attached to skin or deep planes.
Physical examination was normal.
General analysis, ECG and chest X-ray within normal limits.
Mammography: calcified fat necrosis in the left breast.
Localized plaques of the tumor in the axilla have clear edges and are compatible with colitis.
FNAC: Frotis obtained by puncture in which an intense fundus of blood, fat and few epithelial cells are observed, without signs of malignancy.
Mammograms, compatible with ultrasound guidance and FNAB are repeated, showing no signs of malignancy.
Despite successive controls with no signs of malignancy, it was decided to remove the tumor.
The intraoperative pathological diagnosis was probably malignant mesenchymal tumor.
Macroscopically, there are several fragments of tissue measuring 3 x 2 x 2 cm grouped. An indurated zone with white coloration of white consistency is observed.
Microscopic description: tissue fragments show areas compatible with a malignant mesenchymal tumor of liposarcoma type.
Axilla dissection was completed without being able to completely remove the tumor because its origin was located on the scapula under the subscapularis muscle and reached the scapulo articulation.
The histological result was definitive in its macroscopic description of a tissue fragment of 16 x 12 cm, which apparently is less encapsulated in some peripheral areas.
The cut seems to correspond to adipose tissue that presents some areas of increased consistency and whiter color.
The microscopic description shows areas constituted by adipose tissue in which the presence of some cells with hyperchroidal nuclei and aspect of lipoblasts is noteworthy.
In these areas there is not much cellularity, but there are those corresponding to the areas of higher macroscopic density, which have little mature adipose component and are characterized by spindle cells, among which there are many gymphoblasts.
Histochemical techniques have been performed, being markedly positive for vimentin and positive in 20% of giant cells with S-100 as well as areas of mature adipose tissue.
Cytokeratin, desmin, actin and myoglobin were negative.
Histological characteristics and immunohistochemical studies diagnosed pleosarcoma pleo.
Radiotherapy was then performed on the tumor bed with acceptable tolerance.
A chest CT scan showed no parenchymal lung lesions or pathological lymph nodes.
Bone scan with little increased activity in the right scapulae.
The new annual control chest CT is normal and the new bone scintigraphy is similar to the previous one.
Two years after surgery, the patient developed dyspnea and fatigue. The chest X-ray showed a right pleural effusion, performing a cytological diagnosis of dyspnea. The chemotherapy was initiated because of malignancy.
Three years after surgery, the patient continued to present irritative pleural pain with dry cough and exertional dyspnea.
The right arm is slightly edematous.
In the metastatic series there is a right hiliar adenomegaly.
Later worsening of the general state with greater dyspnea and tiredness appearing in the chest X-ray appearance of a lung throughout the right lung, visualizing in the chest CT at the height of the right upper lobe a mass occupying almost the entire right tumor.
Establishing palliative treatment.
