Mammary-type Myofibroblastoma of the Pre-sacral Space: A Rare Neoplasm

Mammary-type myofibroblastoma is a very rare, benign, mesenchymal neoplasm that is histologically identical to a myofibroblastoma of the breast but located in an extra-mammary location. To our knowledge, there have been about 160 cases of extra-mammary myofibroblastoma reported to date. Our report describes a mammary-type myofibroblastoma located retro-rectally in the pre-sacral space.

Our patient is a 55-year-old male that presented via referral for evaluation of a pelvic mass. He noted having a few loose stools since the mass had become apparent but did not report any other associated symptoms. An MRI of the pelvis revealed a 9 cm, fat containing, solid, retro-rectal mass within the pre-sacral space, which did not appear to be contiguous with the rectum, ureters, or pelvic sidewall. He elected to have the mass surgical removed. The mass was removed as a single specimen that measured 9.5 x 7.5 x 7.0 cm. By immunohistochemistry, the neoplastic cells show co-expression of desmin, CD34, estrogen receptor, and loss of RB1 expression, which is consistent with the diagnosis of mammary-type myofibroblastoma.

Mammary-type myofibroblastoma is a very rare, benign, soft tissue neoplasm. These neoplasms most often present as a painless slow growing mass in a middle-aged male. Although exceedingly rare, mammary-type myofibroblastoma should be on the differential diagnosis of patients presenting with a mass that was found incidentally or one that is producing mass-effect symptoms. When found, these tumors should be investigated to rule out other more serious pathologies and removed due to their high curability with surgical resection.