From the histological point of view, all types of breast sarcoma are extremely malignant tumors formed from mesenchymal tissues. According to statistics, the share of breast sarcoma is not more than 2% of the total number of malignant breast tumors.
An affliction, most often affecting the tissues of only one breast( although there are exceptions), can be detected in patients of any age, both in representatives of both sexes.
All sarcomas are characterized by rapid progressive growth, accelerated hematogenous dissemination with an inevitable metastasis and an extremely high percentage of deaths.
Types of breast sarcoma
The structure of malignant sarcoma neoplasms does not contain epithelial and glandular cells, since most often they are formed by immature, actively dividing cells of connective tissues( stroma).In the mammary gland these tissues are represented by fibrous lobes interleaving its lobules.
The histological structure of breast sarcoma is extremely diverse. They can be:
- spindle-celled( 67%);
- is round-celled( 29%);
- giant cell( 4%).
Morphological forms of sarcoma localized in the tissues of the mammary gland are also diverse. They are presented:
- Liposarcomas - malignant tumors that develop as a result of the degeneration of fat cells. Liposarcomb is characterized by simultaneous damage of both mammary glands( accompanied by ulceration) and extremely rapid progression.
- Fibrosarcomas - the most common( accounting for about a third of all cases) of malignant tumors formed by connective tissue cells. Fibrosarcomas can reach large sizes, but they are not accompanied by ulceration.
- Rhabdomyosarcomas - malignant tumors arising from mutated cells of striated muscle. This type of tumor that affects the mammary glands of young( under the age of twenty-five) women is characterized by extreme malignancy, rapid growth and infiltration( impregnation) of neighboring tissues.
- Osteosarcomas and chondrosarcomas are very rare forms of the disease that develop in women over the age of fifty years.
- Angiosarcomas is a variant of malignant tumors arising from the mutation of endothelial cells lining the inner surface of the blood and lymphatic vessels. This kind of ailment affects women from thirty to forty-five years old. Angiosarcomas grow rapidly and are prone to recurrence.
The picture clearly shows the symptom of "umbiliculation" in breast sarcoma
The origin allows us to divide the breast sarcoma into:
- Primary , characterized by the original content of cancer cells.
- Secondary , developed either as a result of malignancy of benign neoplasms, or as a result of metastasis of cancer cells from other parts of the body.
Causes of
To determine the exact causes of the development of breast sarcoma has so far failed. In the course of scientific research, a certain relationship between this ailment and a number of factors attributed to the risk group was identified:
- With a hereditary predisposition( confirmed by cases of similar diseases in one of the patient's relatives).
- With work in hazardous chemical production.
- With prolonged contact with a range of carcinogenic substances( eg arsenic).
- With various injuries of the mammary glands that appeared to be the probable culprits for the development of benign tumors( such as leaf-like fibrosarcoma).
- With exposure to radiation of varying intensity.
Symptoms of breast sarcoma
- The onset of the tumor process is characterized by the formation in the mammary gland of a dense nodule with clear boundaries and a bumpy surface.
- Tumor growth leads to thinning and cyanosis of the skin covering it, as well as to the penetration of the subcutaneous enlarged venous pattern on their surface.
- Further increase in neoplasm, inevitably increasing the volume of the affected breast, leads to asymmetry of the mammary glands, the appearance of painful sensations and the formation of numerous ulcers on the surface of the skin.
- Palpation of the affected breast reveals the presence of a new growth of a heterogeneous consistency with distinct contours of a coarse-grained configuration. As shown by numerous studies of distant tumors, this effect gives an interchange of cystic cavities and tumor nodes, forming a solid conglomerate.
- There is deformation of the nipple-alveolar complex, occasionally accompanied by fixation or westernization of the nipple.
- When a disease is started, there is often a presence of bloody discharge from the nipple of the affected breast: this indicates the disintegration of tumor tissues. With the rapid growth of the tumor, the clinical course of the sarcoma may resemble the symptoms of mastitis or abscess of the mammary glands.
- The rate of development of the tumor process in sarcoma of the breast can be completely different. For highly malignant sarcoma species, rapid or spasmodic development takes several months, while neoplasms with a favorable prognosis develop very slowly, over a number of years.
- Sarcoma of the breast most often metastasizes to the tissues of the skeleton and the lungs is hematogenous( through the blood) way. Metastasis in regional lymph nodes is extremely rare.
Diagnosis
The rarity of the disease and the wide range of its histological variations are the reason that clear diagnostic criteria for it have not been developed so far.
- At the initial examination of the patient, the mammologist performs a palpation examination of the mammary gland and reveals the presence of a large-hummocked mobile neoplasm with a non-uniform consistency, freely moving under the skin when pressing on it. Skin covers of the affected organ, as a rule, are hyperemic and swollen, sometimes on their surface there are ulcerated areas.
- The data of the x-ray examination of mammary glands( mammography and uzi) in sarcoma are not specific. The roentgenogram shows the presence of a knobby conglomerate consisting of multiple nodes protruding to the sides and pushing adjacent tissues. With sarcoma, often cavities formed, filled with necrotic masses or liquid. The pictures clearly show the thinning of the skin over the tumor and the presence of dilated veins of the affected breast.
- To exclude or confirm the presence of hematogenous metastasis, the patient is prescribed a CT scan of the brain, abdominal and thoracic region.
- In a few cases, scintigraphy is performed using technetium.
- If there are no metastases in the patient's body, the biochemical and general blood test does not reveal changes in its usual characteristics. Accelerated growth of the sarcoma is reflected in the picture of a general blood test by a significant increase in ESR and leukocytosis. When metastasizing into internal organs, a number of biochemical indicators of blood also change.
- For the final diagnosis is necessary a whole complex of histological studies of tumor tissue. For this, a thin needle biopsy or trepanobiopsy is most often performed. Micro-preparations taken during the procedure show the presence of cancer cells with enlarged nuclei and a pronounced variety of variations( polymorphism), stromal elements and the absence of epithelial tissues.
Treatment of
Successful treatment of breast sarcoma should be comprehensive, involving a combination of surgical intervention, chemotherapy and radiation therapy.
- The leading method of treatment is the surgical removal of the tumor focus and surrounding tissues. In the early detection of a tumor, a mastectomy operation is performed - removal of the affected breast, together with small and large pectoral muscles, groups of adjacent lymph nodes and total excision of tissues surrounding the tumor. In some situations it is possible to preserve one or both pectoral muscles: this facilitates the patient's postoperative rehabilitation.
- With a highly differentiated small size sarcoma, quadrantectomy or sectoral resection is resorted to - operations that allow the preservation of a certain part of the breast. Complete restoration of the operated organ is performed by means of reconstructive mammoplasty( plastic surgery), using either implants or the patient's own tissues.
- When metastatic lesions of lymph nodes apply lymphadenectomy - an operation to remove them.
- To improve the long-term results of treatment( reducing the risk of recurrence and dissemination of cancer cells by hematogenous way, increasing the survival of patients), chemotherapy is used, consisting in the intake of anthracycline antibiotics, alkylating cytostatics and antimetabolites.
- Preoperative radiotherapy is used to reduce the size of malignant neoplasm and its delimitation from healthy tissues: this reduces the amount of follow-up surgery. Radiotherapy postoperative period is used to prevent the formation of metastases and the re-occurrence of malignant neoplasm.
Forecast of patients' life
For breast sarcoma prognosis is determined by:
- histological structure of the neoplasm;
- by the age of the patient;
- timely detection of the disease;
- by the degree of radicalism of the undertaken surgical intervention.
Given the high risk of recurrence of even successfully operated sarcomas, their prediction seems rather difficult.
The presence of metastases contributes to the deterioration of the prognosis: , skillful use of systemic palliative therapy can delay the occurrence of secondary tumor lesions for several months( in rare cases, for several years).