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© 2003 American Society for Clinical Oncology
Unusual Problems in Breast Cancer and a Rare Lung Cancer CaseCase 2. Aggressive Fibromatosis of the Chest Wall Arising Near a Breast ProsthesisInstitut Gustave Roussy, Villejuif, France
A 52-year-old woman with a diffuse intraductal carcinoma of the left breast underwent a radical mastectomy and immediate reconstruction with a saline-filled silicone breast implant. Seven months later, the 195-mL expander was replaced by a 240-mL implant, and the nipple areola was reconstructed. One year later, she complained of increasing asymmetry and firmness in the left breast, and the implant was exchanged. However, pain in the breast and tenderness persisted. Physical examination revealed an indurated mass deeply attached to the chest wall. A blood cyst was suspected. A thoracic computed tomography scan depicted a low-density mass measuring 80 x 50 mm situated below the prosthesis (Fig 1
Histologic analysis of the biopsy samples disclosed aggressive fibromatosis that was confirmed by immunohistochemical tests (Fig 3  ). The patient refused radical surgery for personal and cosmetic reasons and, therefore, received a weekly combination of methotrexate and vinblastine (8 weeks) followed by hormonal therapy (6 months). She experienced slow disease progression during this period, which necessitated radical surgery including a partial sternectomy, anterior resection of four ribs, and breast reconstruction with a de-epithelialized flap allowing immediate defect closure.
Fibromatosis is a benign neoplasm derived from fibrous tissue that arises in musculoaponeurotic structures from the supporting connective tissue.1 The tumors occur most frequently in the musculature of the anterior abdominal wall. Musculoaponeurotic fibromatosis, extra-abdominal desmoid aggressive fibromatosis, and low-grade sarcoma are the variety of terms used to describe this lesion. Heredity, hormones, trauma, and a previous surgical incision have been indicated as etiologic factors. Cytogenetic abnormalities consistent with clonality have also been reported.2 In this case, however, karyotype analysis did not reveal any chromosomal abnormality. A review of the literature indicated that aggressive fibromatosis arising near a breast prosthesis is a rare event, with only sporadic cases occurring. Such cases have indeed been documented after surgical placement of saline-filled implants and silicone gel–filled implants, all of which were in a silicone pouch.3–6 Tumor may arise from the fibrous capsule developing around the implant.3,4 Radical surgery is the treatment of choice for fibromatosis, but recurrence is common despite adequate, free-tumor margins. External-beam irradiation or brachytherapy may be helpful in the management of these neoplasms, in particular for recurrence and positive margins at excision.7 Tumor regression has been reported in advanced inoperable fibromatosis with conventional chemotherapy, such as vincristine, dactinomycin, and cyclophosphamide, or more recently, with a weekly schedule of vinblastine and methotrexate.8 Hormonal therapy with tamoxifen could be an alternative treatment option in estrogen receptor–positive fibromatosis.9
REFERENCES 1. Enzinger FM, Weiss SW: Soft tissue tumors. St Louis, MO, CV Mosby, 1983, pp 53–71 2. Bridge JA, Sreekantaiah C, Mouron B, et al: Clonal chromosomal abnormalities in desmoid tumors: Implications for histopathogenesis. Cancer 69:430–436, 1992[CrossRef][Medline]
3. Schiller VL, Arndt R, Brenner R: Aggressive fibromatosis of the chest associated with a silicone breast implant. Chest 108:1466–1468, 1995 4. Jewet ST, Mead JH: Extra-abdominal desmoid tumor arising from a capsule around a silicone breast implant. Plast Reconstr Surg 63:577–579, 1979[Medline] 5. Schuh ME, Radford DM: Desmoid tumor of the breast following augmentation mammoplasty. Plast Reconstr Surg 93:603–605, 1994[Medline] 6. Rosen PP, Ernsberger D: Mammary fibromatosis: A benign spindle-cell tumor with significant risk for local recurrence. Cancer 63:1363–1369, 1989[CrossRef][Medline]
7. Ballo MT, Zagars GK, Pollack A, et al: Desmoid tumor: Prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy. J Clin Oncol 17:158–167, 1999 8. Azzarelli A, Gronchi A, Bertulli R, et al: Low dose chemotherapy with methotrexate and vinblastine for patients with advanced aggressive fibromatosis. Cancer 92:1259–1264, 2001[CrossRef][Medline] 9. Kinzbrunner B, Ritter S, Domingo J, et al: Remission of rapidly growing desmoid tumors after tamoxifen therapy. Cancer 52:2201–2204, 1983[CrossRef][Medline] This article has been cited by other articles:
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Copyright © 2003 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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