대한유방검진의학회

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A 58-year-old woman presented with a palpable mass in her right breast. She had no significant past medical history. Her ultrasonography, chest CT, MRI, PET-CT images were presented as Fig. 1. The patient underwent an ultrasound-guided biopsy, which suggested a malignant spindle cell tumor. Subsequent right total mastectomy was performed. Final pathologic examination confirmed pleomorphic leiomyosarcoma. Histopathological evaluation revealed pleomorphic spindle cells with smooth muscle markers (e.g., desmin, SMA). Notably, there were no axillary lymph node metastases. Pleomorphic leiomyosarcoma of the breast is an extremely rare malignancy, representing a subtype of primary breast sarcomas. Radiologic findings are known to be nonspecific and can mimic benign lesions like fibroadenomas or phyllodes tumors. In our case, key differential diagnoses should include metaplastic carcinoma, squamous type, which presents with distinct imaging features such as irregular shape, internal cystic components with high T2 signal intensity with peripheral enhancement on MRI. Accurate diagnosis relies on histopathological evaluation, emphasizing the importance of biopsy in cases with suspicious radiologic findings. Therefore, radiologists should be aware of the possibility of pleomorphic leiomyosarcoma when facing a complex cystic and solid mass.
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