Primary Inflammatory Myofibroblastic Tumour of the Breast: A Potential Diagnostic Pitfall on Aspiration Cytology.
Neelam Sood, Ruchika Gupta, Ruhi et al.
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Case in brief
A 47-year-old woman presented with a painless right breast mass. Imaging showed a well-defined lobulated soft-tissue lesion categorised as BI-RADS 4A. Fine-needle aspiration revealed spindle-cell fragments with inflammatory cells, interpreted as suggestive of chronic inflammation. Examination of the excised lesion instead showed proliferating spindle cells with a dense lymphoplasmacytic infiltrate, consistent with inflammatory myofibroblastic tumour (IMT). Immunohistochemistry helped distinguish it from myofibroblastoma, fibromatosis and IgG4-related sclerosing disease. She remained recurrence-free after lumpectomy through 24 months of follow-up.
What made this case unusual
The aspiration cytology suggested a chronic inflammatory lesion rather than IMT, illustrating how this rare breast tumour can be obscured by inflammatory cells and overlap with other spindle-cell lesions.
Diagnostic / clinical pearl
When breast aspiration shows spindle cells with an inflammatory background, cytology alone may not establish IMT; correlate with excision histology and use ancillary testing, including immunohistochemistry, to assess the differential.