Diagnostic difficulties of breast sarcomas at the Thiès Regional Hospital Center

Introduction: Breast sarcomas are exceptionally rare, accounting for less than 1% of malignant breast tumors. Clinically, they typically present as unilateral breast masses that often grow more rapidly than epithelial breast carcinomas. Surgical excision remains the cornerstone of management. Prognosis depends primarily on histologic grade and the status of surgical margins, which are the main predictors of local recurrence. Case Series: We report four cases of primary breast sarcomas treated in the Gynecology–Obstetrics Department of the Regional Hospital of Thiès. The mean age at diagnosis was 37.7 years. All patients presented with a large unilateral breast mass measuring between 4 and 32 cm, with rapid enlargement; two exhibited cutaneous fistulization. The three patients had undergone two biopsies due to the discrepancy between the clinical and histological results. Immunohistochemistry, which is very crucial for diagnosis, could not be performed due to lack of financial resources. All four underwent mastectomy with axillary lymph node clearance, with histologically negative margins. One patient experienced local recurrence following a palliative mastectomy performed on an ulcerated-necrotic breast. Adjuvant radiotherapy was recommended for three patients; one received it. One patient with metastatic condition received adjuvant chemotherapy. The 3 patients diagnosed at T4N1M pulmonary stage died with an average overall survival of 10.6. Conclusion: Primary breast sarcomas are diagnostically challenging, and any delay worsens prognosis. In our setting, mastectomy with axillary lymph node dissection represents the gold-standard treatment, especially in locally advanced or metastatic cases.