Benign and malignant spindle cell lesions of the breast

Spindle cell lesions of the breast constitute a wide spectrum of benign and malignant proliferations. Myofibroblasts, normal cellular constituents of the mammary intra- and interlobular stroma, compose many of these lesions, which include reactive proliferations and benign or locally aggressive neoplasms. Because of its morphology, low-grade metaplastic spindle cell carcinoma, "fibromatosis-like" is also considered together with spindle cell lesions of the breast. Although certain of the lesions do not occur commonly, they represent diagnostic challenges. This review outlines the morphology of certain spindle cell lesions of the breast including pseudoangiomatous stromal hyperplasia, reactive spindle cell nodule, nodular fasciitis, myofibroblastoma, primary mammary fibromatosis, and low-grade metaplastic spindle cell carcinoma, "fibromatosis-like." The differential diagnosis and diagnostic work-up of these lesions is discussed, and their clinical treatment and prognosis briefly summarized.