# Sarcoma

Sarcoma

Sarcomas, most commonly fibrosarcoma and angiosarcoma, may arise de novo from the mesenchymal tissues of  the breast. Enrico Sertoli , 1842–1910, Italian physiologist, discovered the Sertoli cells of  the testis in 1865. Thomas Hodgkin , 1798–1866, lecturer in morbid anatomy and curator of  the museum, Guy’s Hospital, London, UK, described Hodgkin’s lymphoma in 1832. Summary box 58.6 Prognosis /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - /uni25CF Some genetic conditions (Li–Fraumeni, neurofibromatosis type 1), exposure to alkylating agents, vinyl chloride or arsenic, - prior radiotherapy (e.g. for Hodgkin’s lymphoma) and chronic lymphoedema are associated with the development of  sarcoma. Angiosarcoma ( Figure 58.40 ) is the most aggressive of  all breast tumours and arises from the endothelial cell lining of vascular or lymphatic channels. Angiosarcoma is associated with prior radiotherapy and carries a very poor prognosis. 

Figure 58.39
Carcinoma of the male left breast (courtesy of Professor
Mike Dixon).
Disease factors
Patient factors
a
Size of tumour
Younger age
Stage of disease
Premenopausal
a
women
Axillary lymph node involvement
a
BRCA
-associated
Grade of tumour
tumour
Histopathological variant
Family history of
(metaplastic carcinoma is
breast cancer
aggressive):
Prior history of
Her2/neu positive and triple
breast cancer
negative
Obesity, sedentary
Presence of lymphovascular
lifestyle
invasion
Failure to complete
Extensive DCIS component
intended treatment
High Ki-67 index
DCIS, ductal carcinoma
in situ
.
a
The Nottingham prognostic index (NPI) is used to determine
prognosis following surgery. It is calculated using tumour size
/uni00A0
(S),
number of involved lymph nodes (N) and tumour grade (G). NPI
= (0.2
/uni00A0×/uni00A0
S)
/uni00A0
+
/uni00A0
N
/uni00A0
+
/uni00A0
G. Patients are grouped into four categories
according to the NPI score: I (excellent)
≤
2.4; II (good) >2.4 but
≤
3.4; III (moderate) >3.4 but
≤
5.4; and IV (poor) >5.4.