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Background: Dermatofibrosarcoma protuberans (DFSP) of the breast is a rare entity. It is a slow-growing soft tissue tumor of low to intermediate grade. The risk of metastasis is low, but its likelihood of local recurrence is significant., Objective: Our study aims to present the clinical and histological features of DFSP of breast and follow-up., Material and Methods: Patients with histologically proven DFSP between 01 January 2010 and 31 October 2023 were identified from a prospectively maintained pathology database. Two senior pathologists reviewed the clinical data and histological slides, and a follow-up was obtained., Results: Twenty-six cases of DFSP breast were diagnosed between 01 January 2010 and 31 October 2023. Out of 26, 10 (38.5%) were male and 16 (61.5%) were female. The mean age of presentation was 37.2 years in females and 40.7 years in males. The mean tumor size in females was 4.7 cm and in males was 5.4 cm. Histologically, the 15 DFSP cases (58%) showed spindle cells arranged in a storiform pattern with honeycomb-type fat infiltration. Fibrosarcomatous transformation was noted in 11 (42%) cases comprising a fascicular pattern. The median follow-up period was 6.1 years. Three (12%) patients experienced recurrence. No recurrence was observed in 23 (88%) patients with complete surgical resection., Conclusions: We present the largest series of breast DFSP. The recurrence rate of 12% aligns with the DFSP of other common sites. Fibrosarcomatous transformation in breast DFSP (42%) is higher as compared to DFSP in other common locations and its long-term clinical behavior cannot be reliably predicted due to lack of long-term follow-up., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Aga Khan University Ethics Review Committee issued approval 2022-6912-21068. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Safdar et al.)

Background Axillary lymph node status is one of the most important prognostic factors in breast cancer treatment, which can be confirmed by sentinel lymph node biopsy (SLNB). Intraoperative frozen section is an alternative method for SLNB, which can reduce the risks associated with secondary surgery. The feasibility and accuracy of SLNB after post-neoadjuvant chemotherapy (NACT) are affected by many factors as lymphatic drainage from the breast could be impaired due to fibrosis, fat necrosis, and granulation tissue formation, thus hampering the detection of the sentinel lymph node and afterward interpretation by pathologists due to therapy-related changes. Despite the increasing use of SLNB in post-NACT settings, there is still limited information on the accuracy of SLNB in resource-limited countries. Objective Our study aims to detect the sensitivity and predictive value of frozen section SLNB in the post-NACT setting while comparing it with final permanent histopathological results and considering final permanent histopathological results as standard. Materials and methods A total of 286 patients meeting the inclusion criteria from 2021 to 2022 were included in the study. Hematoxylin and eosin (H&E)-stained microscopic glass slides of frozen SLNB after NACT, permanent paraffin-embedded sections, and immunohistochemical stains were retrieved and reviewed. For all the categorical variables, including histologic type and grade, frequencies and percentages were obtained. Measures of central tendency and variability for continuous data such as age, number of sentinel lymph nodes received, and size of the largest nodal deposit were calculated. The chi-square test was used for the comparison of qualitative variables. A p-value of less than or equal to 0.05 was considered statistically significant. Results The median age of presentation was 47 years (range = 39 to 55 years). The median number of sentinel lymph nodes received was three (range = 2-4). At the time of frozen section reporting, out of a total of 286 cases, 229 (80.1%) cases were labeled as negative, 55 (19.2%) cases as positive, and two (0.7%) cases were deferred for permanent section results. Out of 229 cases labeled as negative at the time of the frozen section, 220 (76.9%) cases were true negative confirmed on permanent sections. A total of 66 (33.1%) cases were true positive, including two deferred cases and nine false negative cases, in addition to 55 cases labeled as positive on the initial frozen section. The study showed sensitivity, specificity, and accuracy of frozen section analysis of SLNB at 83.00%, 100%, and 96.15%, respectively, with a false negative rate (FNR) rate of 16.7%. Conclusion Further follow-up studies to definitively determine the role of SLNB following post-NACT in patients who did not undergo axillary lymph node dissection (ALND) are needed. Continuous monitoring of the rate of false positives and false negatives of frozen sections on SLNB is essential as feedback for pathologists., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Review Committee, Aga Khan University Hospital issued approval 2022-7303-20844. This study was reviewed and approved as an exemption. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Safdar et al.)

Background Core needle biopsy (CNB) for fibroepithelial lesions (FELs) of the breast is commonly encountered by histopathologists. The distinction between fibroadenoma (FA) and phyllodes tumor (PT) can be challenging due to overlapping histological features and the limited nature of CNB material.  Objective This study aimed to assess the accuracy of CNB diagnosis of FA and PT by comparing it with a diagnosis on subsequent surgical excision specimen. Materials and methods A total of 166 cases of FELs of the breast who underwent CNB and subsequent surgical excision between January 2001 and December 2020 were included in our study. All microscopy glass slides were reviewed, and diagnosis confirmed. Results While 125 (75%) cases based on CNB received a definitive diagnosis of either fibroadenoma or PT, the remaining 41 (25%) cases were better classified on excision specimens and were descriptively diagnosed as fibroepithelial lesions on CNB. Diagnoses on CNB and on subsequent excision specimens were concordant in 113 (90.4%) cases. Among 12 cases that were discordant, three cases diagnosed as FA on CNB were upgraded to PT on excision specimens. Nine cases diagnosed as PT on CNB were diagnosed as FA on excision specimens. These included conventional, cellular, juvenile, and complex FA types. Three PTs, which were reported as FA on CNB, measured 6, 12.5, and 17.5 cm in the greatest dimension. Among 23 cases of PT which were further categorized on CNB, tumor categories changed on excision specimens in three cases. The diagnostic accuracy of CNB diagnosis was 90.4%. Conclusion CNB diagnosis showed good accuracy. PT diagnosis should be strongly considered in all tumors measuring >5 cm, especially those exceeding 10 cm. Cellular, juvenile, and complex FAs can be misdiagnosed as PT on CNB. Correlation with clinical and radiological findings can be helpful in establishing correct diagnosis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Review Committee of Aga Khan University Hospital, Karachi issued approval 2023-6988-24562. The study was performed by reviewing the archived microscopy slides of already diagnosed cases and no identifying information (in the text or image) was included. Exemption from approval was granted by the institutional ethics review committee. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tariq et al.)