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DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. REFERENCES 1. Maijers MC, Niessen FB. The clinical and diagnostic consequences of poly implant prothese silicone breast implants, recalled from the European market in 2010. Plast Reconstr Surg. 2013;131:394e–402e. 2. Hölmich LR, Vejborg I, Conrad C, Sletting S, McLaughlin JK. The diagnosis of breast implant rupture: MRI findings compared with findings at explantation. Eur J Radiol. 2005;53:213–225. 3. Kallergi M, Gavrielides MA, He L, Berman CG, Kim JJ, Clark RA. Simulation model of mammographic calcifications based on the American College of Radiology Breast Imaging Reporting and Data System, or BIRADS. Acad Radiol. 1998;5:670–679. 4. Taplin SH, Ichikawa LE, Kerlikowske K, et al. Concordance of breast imaging reporting and data system assessments and management recommendations in screening mammography. Radiology 2002;222:529–535. 5. Timmers JM, van Doorne-Nagtegaal HJ, Zonderland HM, et al. The Breast Imaging Reporting and Data System (BIRADS) in the Dutch breast cancer screening programme: Its role as an assessment and stratification tool. Eur Radiol. 2012;22:1717–1723.

Glomus Body Tumor of the Breast: A Rare Cause of Isolated Breast Pain Sir:

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reast pain is common for most women. Focal, severe pain is uncommon and characteristic of a glomus body tumor of the breast. There are few reported cases, with the first declared in 2009 and only a few others since then.1 We present a case of glomus tumor of the breast with both clinical and immunohistological evidence. A 66-year-old white woman presented with complaints of severe localized tenderness in the left breast toward the axillary tail over the preceding 6 years. She experienced exquisite pain when she rubbed her arm across her breast. Focal pressure caused exacerbation of the pain. She had also noticed a bluish discoloration under the skin 1 year earlier. She was a G3P3 female with a family history of breast and lung cancer. A mammogram taken 2 months earlier showed an indeterminate left breast mass at 1:30 o’clock, 10  cm from the nipple. Ultrasound showed a palpable, 1.3-cm, lobulated hypoechoic mass. Believed to be a dermal cyst, a core biopsy was scheduled, but targeted real-time and color flow ultrasound were performed and showed

Fig. 1. (Above) Glomus tumor (left) with epidermis (right) shown on low-power hematoxylin and eosin stain; well-circumscribed, aggregate nests of glomulocytes associated with vasculature can be seen on their periphery. (Below) High-power hematoxylin and eosin stain shows small, round glomus cells with distinct nuclei, associated with small vessels in a hyaline/myxoid stroma. Glomulocytes are round or cuboidal, are small with scant cytoplasm, have distinct cell borders, and have features similar to those of smooth muscle cells.

considerable blood flow within the mass, contraindicating the biopsy. The patient was referred to the senior author for surgical biopsy. Physical examination prior to surgery confirmed a bluish cystic mass in the axillary tail; it was extremely tender to palpation, freely mobile, firm, nonpulsatile, and nonexpansile. Assessment of venous malformation was made, and outpatient excision under local anesthesia was performed. The mass was excised with a wide elliptical excision and noted to “shell out quite easily” with one small feeding vessel that was venous in nature. Pathologic analysis demonstrated a nonencapsulated tumor with a proliferation of atypical cells in between numerous vascular channels. The cells demonstrated round nuclei and conspicuous nucleoli with

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Plastic and Reconstructive Surgery • December 2013 the clinical criteria but also histologic and immunohistochemical criteria necessary for establishing the diagnosis of glomus body tumor of the breast (Table  1). Although rare, glomus body tumor should be considered with severe localized breast pain, the treatment of which is simple and curative. DOI: 10.1097/PRS.0b013e3182a9803f

Geoffrey A. Crandall, B.A. Glyn E. Jones, M.D. University of Illinois College of Medicine at Peoria Peoria, Ill.

Fig. 2. High-power immunohistochemical analysis with smooth muscle actin staining of glomus tumor; associated small vessels can be seen.

eosinophilic cytoplasm and ill-defined cell borders, and two mitotic figures per 50 high-power field (Fig.  1). Immunohistochemical analysis showed positive results for vimentin and smooth muscle actin and negative results for synaptophysin, CD34, chromogranin, pankeratin, MART 1, and factor VIII (Fig. 2). A diagnosis of glomus body tumor with atypical nuclei was made, and due to the tumor’s close proximity to the lateral and deep margins, a conservative reexcision was recommended. The patient reported immediate and complete pain relief with primary excision. Reexcision was performed a week later for wider margins and revealed no remaining glomus tumor. Most commonly presenting as small (

Glomus body tumor of the breast: a rare cause of isolated breast pain.

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