Twenty-year-old female with leiomyosarcoma of the breast
A 20-year-old female with a history of neurofibromatosis, and left breast supernumerary nipple excision presented to her primary care physician, after noticing a lump in her left breast at the site of her previous surgical scar after accidentally bumping her breast in January 2012. Her primary care physician then referred her to the breast surgery clinic at St. Barnabas Hospital. She was seen and examined at the breast clinic, where a palpable firm 1 × 1 cm mass was identified at the 6 O'clock position. She denied any nipple discharge. The decision was made to obtain an ultrasound (seen in Fig. ) with close follow-up in the breast surgery clinic.\nShe returned to clinic later in January after the ultrasound, which revealed a 1.4 × 0.9 × 1.8 cm fluid collection at the 6 O'clock position most likely representing a hematoma; BIRADS #3 likely benign recommend short-term follow-up. She was scheduled for a repeat ultrasound in April 2012 with follow-up in breast clinic following the ultrasound. Repeat ultrasound (seen in Fig. ) revealed a stable fluid collection measuring 1.5 × 1.2 × 2.2 cm, once again BIRADS #3 likely benign recommend short-term follow-up with the breast surgeon. She was seen in clinic following the ultrasound in April and reported decreasing pain and no nipple discharge, she was given a 1-month follow-up appointment.\nThe patient's pain returned prior to her scheduled appointment, thus she went to the emergency room. The emergency room physician noted a 2-cm sub-areolar mass. She was discharged from the emergency room and given follow-up in the breast surgery clinic.\nShe was seen and evaluated in the breast surgery clinic following her emergency room visit. In the breast clinic the mass was noted to be 2.5 cm on examination. She denied any further pain and so a 1-month follow-up was given again. She returned to breast clinic 1 month later in May 2012 where the mass was noted to be 3 cm. Due to increasing size and persistence of the mass, she was scheduled for excisional biopsy.\nThe excisional biopsy was performed in June 2012, which revealed a diagnosis of leiomyosarcoma (slides seen in Figs. –).\nShe followed-up in the breast surgery clinic and was notified of the diagnosis. The patient was then scheduled for total mastectomy with axillary lymph node dissection of the left breast with tissue expander placement by the plastic surgery team. The specimen was again sent for pathology, which revealed residual leiomyosarcoma with no lymphovascular invasion, margins negative for sarcoma and sentinel lymph node biopsy negative for sarcoma.