What are the other Names for this Condition? (Also known as/Synonyms)

• Postoperative Mammary Spindle-Cell Nodule
• Postoperative Pseudosarcoma of Breast
• PSCN of Breast

What is Postoperative Spindle-Cell Nodule of Breast? (Definition/Background Information)

• Postoperative Spindle-Cell Nodule of Breast is a rare and benign tumor that forms due to an injury (tissue damage); particularly because of a surgical procedure. It is observed in a wide age range of women
• Postoperative Spindle-Cell Nodule of Breast can appear within a few weeks to a few months following the surgical procedure (typically a needle biopsy procedure). It forms at the site of the surgery as a benign reactive lesion
• The tumor is also known as a postoperative pseudosarcoma, since it resembles a sarcoma, which is a malignant tumor. This can lead to misdiagnosis and over-treatment of Postoperative Mammary Spindle-Cell Nodule. For this reason, it is important that a healthcare provider carefully examine and recognize the tumor (i.e., postoperative spindle-cell nodule or PSCN)
• The tumor appears as a solitary nodule with poorly or well-defined borders. These tumors are frequently associated with bleeding
• The treatment course may include a ‘wait and watch’ approach or a surgical excision and removal of the lesion. In general, the prognosis of Postoperative Spindle-Cell Nodule of Breast is excellent with suitable treatment, but the tumor is known to recur locally

Who gets Postoperative Spindle-Cell Nodule of Breast? (Age and Sex Distribution)

• Postoperative Spindle-Cell Nodule of Breast is a rare tumor that is generally observed in young, middle-aged, and older women (around 30-75 years with average age of 55 years)
• Even males may be affected by this tumor type
• There is no known ethnic or racial preference

Overall, considering the general incidence of PSCN, it is more common in males than females with a male-female ratio of 3:1.

What are the Risk Factors for Postoperative Spindle-Cell Nodule of Breast? (Predisposing Factors)

Any surgical procedure performed involving the breast can be a potential risk factor for Postoperative Spindle-Cell Nodule of Breast. Such invasive procedures may include any of the following:

• Breast biopsy by needle aspiration surgical procedure: Fine needle aspiration (FNA) biopsy of the breast to examine/diagnose any disease of the breast tissue, including breast cancer
• Stereotactic core needle biopsy of breast tissue

A past history of postoperative spindle-cell nodule either at the same site or other location may increase the risk; this implies that some individuals are more prone to development of this reactive tumor.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Postoperative Spindle-Cell Nodule of Breast? (Etiology)

• Currently, the exact cause and mechanism of formation of Postoperative Spindle-Cell Nodule of Breast is unknown
• The tumors are seen to form as a reactive process at the site of surgical injury or trauma

What are the Signs and Symptoms of Postoperative Spindle-Cell Nodule of Breast?

The signs and symptoms of Postoperative Spindle-Cell Nodule of Breast may include:

• Small tumors usually do not cause any symptoms and may remain unnoticed/undetected
• The reactive lesions (fibrous tissue) form at the site of trauma/surgery and can be nodular in shape. The lesions are known to grow and develop rapidly
• In a majority of cases, the time period between the surgical procedure and formation of the reactive lesion in the breast ranges from 1-10 weeks
• The borders of the nodules may be well-defined or irregularly-defined
• The size of the tumor may be less than 1 cm
• These postoperative spindle-cell nodules show ulceration in most cases
• Some may be swollen with fluid; many lesions are known to bleed (hemorrhage)

Note: But for metastasis, a postoperative spindle-cell nodule is similar to a sarcoma (a malignant tumor with infiltrative margins), both in behavior and on a histopathological evaluation.

How is Postoperative Spindle-Cell Nodule of Breast Diagnosed?

A diagnosis of Postoperative Spindle-Cell Nodule of Breast may involve the following steps:

• Complete physical and pelvic examination and evaluation of the individual’s medical history: In order to establish a diagnosis of a Postoperative Mammary Spindle-Cell Nodule, a history of a prior surgical procedure/operation at the site of the tumor is key
• Breast exam to check for any lumps or unusual signs in the breasts
• Mammogram: A mammogram uses x-rays to provide images of the breast. These benign tumors are identified as a mammogram mass, which may or may not be associated with microcalcification. The mammography findings may raise enough suspicion to warrant a tissue biopsy
• Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast, the type of tumor, whether fluid-filled cyst or solid mass type, may be identified
• Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast

Breast biopsy:

• A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

• Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue. FNAB cannot help definitively diagnose the breast tumor. It only helps determine if the tumor is malignant or benign. This can help the healthcare provider discuss and plan the next steps (with respect to diagnosis and treatment)
• Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
• Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

Note:

• A Postoperative Mammary Spindle-Cell Nodule shows sarcomatoid features (sarcoma resemblance), both in terms of behavior and morphologically. The healthcare provider should be aware of such tumors and the nature of these tumors, in order to make an accurate diagnosis. Otherwise, it can lead to an incorrect diagnosis and over-treatment of this benign tumor
• A postoperative spindle-cell nodule (PSCN) is also known to be histologically similar to inflammatory myofibroblastic tumor (IMT). IMTs are benign tumors with aggressive behavior that can occur anywhere in the body. However, unlike PSCNs, IMTs are not seen against a background of trauma

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Postoperative Spindle-Cell Nodule of Breast?

Significant complications from Postoperative Spindle-Cell Nodule of Breast are generally not noted. However, the following may be observed in some cases:

• Stress due to a concern for breast cancer
• Tumor masses may get secondarily infected with bacteria or fungus
• Providing inappropriate or ineffective treatment due to misdiagnosis of the tumor as a sarcoma
• Damage to the muscles, vital nerves, and blood vessels, during surgery
• Post-surgical infection at the wound site is a potential complication
• Local recurrence of the tumor after its surgical removal is known to occur

How is Postoperative Spindle-Cell Nodule of Breast Treated?

Treatment measures for Postoperative Spindle-Cell Nodule of Breast may include the following:

• Majority of asymptomatic tumors are not surgically removed: The healthcare provider may recommend a ‘wait and watch’ approach for small-sized tumors presenting mild (or no) signs and symptoms, after a diagnosis of postoperative spindle-cell nodule is established
• Surgical intervention with complete excision may result in a complete cure. Advanced surgical techniques may help decrease the incidence of recurrence after removal of the lesion. The surgical procedures undertaken may include:
  • Excisional biopsy
  • Wide surgical excision of the tumor
  • Partial mastectomy
• Post-operative care is important: Minimum activity level is to be ensured until the surgical wound heals
• Follow-up care with regular screening may be recommended by the healthcare provider

How can Postoperative Spindle-Cell Nodule of Breast be Prevented?

• The development of reactive lesions, such as due to surgical trauma, is difficult to predict. Currently, no specific measures are available to prevent the formation of Postoperative Spindle-Cell Nodule of Breast
• However, prompt treatment may help in decreasing the amount of fibrous tissue formation at the site of surgery

What is the Prognosis of Postoperative Spindle-Cell Nodule of Breast? (Outcomes/Resolutions)

• The prognosis of Postoperative Spindle-Cell Nodule of Breast is excellent with appropriate treatment, since it is a benign tumor
• However, the tumor is known to locally recur, and hence, close follow-up may be necessary

Additional and Relevant Useful Information for Postoperative Spindle-Cell Nodule of Breast:

The following DoveMed website links are useful resources for additional information:

http://www.dovemed.com/healthy-living/womens-health/

http://www.dovemed.com/diseases-conditions/cancer/