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Benign spindle cell lesions of the breast: a diagnostic approach to solitary fibrous tumour, nodular pseudoangiomatous stromal hyperplasia and nodular fasciitis
  1. Julia R Naso1,
  2. Connie G Chiu2,
  3. Michelle E Goecke2,
  4. Debra Chang3,
  5. Carolyn J Shiau1,4
  1. 1 Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
  2. 2 Department of Surgery, Royal Columbian Hospital, New Westminster, BC, Canada
  3. 3 Department of Radiology, Royal Columbian Hospital, New Westminster, BC, Canada
  4. 4 Department of Pathology, Royal Columbian Hospital, New Westminster, BC, Canada
  1. Correspondence to Dr Carolyn J Shiau, Department of Pathology, Royal Columbian Hospital, New Westminster, BC, Canada; carolyn.shiau{at}fraserhealth.ca

Abstract

Benign spindle cell lesions of the breast include neoplastic and reactive entities that are diagnostically challenging given their rarity and similar histomorphology. Accurate diagnosis on percutaneous core biopsy within this category is essential as some lesions require excision and surveillance, whereas others may be observed. We present three cases of rare benign spindle cell lesions of the breast that reflect the diversity of this group: solitary fibrous tumour, nodular pseudoangiomatous stromal hyperplasia and nodular fasciitis. Through these cases, we discuss the associated differential diagnosis and demonstrate how emerging ancillary studies can be integrated into a diagnostic approach. We highlight distinctive clinical and histopathological features and summarise recent updates to the clinical management of these lesions. An organised approach to the broad differential of spindle cell lesions is essential for appropriate diagnosis and treatment.

  • breast
  • soft tissue tumours
  • diagnosis
  • immunohistochemistry

https://doi.org/10.1136/jclinpath-2018-205561

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    Footnotes

    • Handling editor Cheok Soon Lee.

    • Contributors JN: collaborated with CS to determine the manuscript structure, compiled case study data, acquired the SFT gross pathology images, compiled and formatted images for the figures, reviewed the literature and drafted the manuscript.CC, MG: recommended inclusion of the selected cases in this study, collected clinical information and revised the content of the manuscript. DC: reviewed radiology images and selected images for inclusion in figures, reviewed pertinent radiology literature and revised the content of the manuscript. CS: conceived of the case series format, diagnosed the PASH and NF patients, acquired histology images and the PASH and NF gross pathology images, suggested the inclusion of table 1 and revised the content of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.