Introduction: Primary breast sarcoma (PBS) is a rare and aggressive malignancy arising from the breast’s mesenchymal tissues. Its clinical and imaging features are non-specific, often mimicking benign or epithelial malignancies, which makes early diagnosis challenging. Given the rarity of PBS, detailed case series are essential to enhance understanding and guide management. This study presents a case series of PBS, focusing on its clinical, radiological, and pathological characteristics. Methods: A retrospective review was conducted at a single tertiary care institution between January 2008 and December 2022. Nine pathologically confirmed PBS cases were included. Mammographic and ultrasound findings were reviewed by experienced radiologists. Clinical presentations, imaging features, histopathology, and outcomes were analyzed. Results: Nine cases of PBS were identified, including five angiosarcomas, one myxofibrosarcoma, one liposarcoma, one rhabdomyosarcoma, and one spindle cell sarcoma. The patients ranged in age from 18 to 83 years (mean age: 38.3 ± 21.1 years). Most presented with palpable breast masses, and three experienced rapid tumor growth. Imaging commonly demonstrated oval or round masses with obscured or indistinct margins. Tumor sizes ranged from 1.5 to 14.0 cm (mean: 7.0 ± 4.9 cm). Initial pathological sampling suggested sarcoma or malignant mesenchymal neoplasm in five of nine cases (55.6%), with immunohistochemistry (IHC) aiding final subtype classification. Three cases demonstrated local breast recurrence, and four patients experienced distant metastases. Conclusion: PBS often presents with nonspecific clinical and radiological features, with rapid tumor growth being a key characteristic. Core biopsy remains essential for diagnosis, frequently supported by IHC for subtype differentiation. Greater awareness of these aggressive tumors may facilitate earlier diagnosis and improved clinical management.
Patanawanitkul et al. (Wed,) studied this question.