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An approach to the diagnosis of spindle cell lesions of the breast

Rakha, Emad A.; Aleskandarany, Mohammed A.; Lee, Andrew H. S.; Ellis, Ian O


Professor of Breast Cancer Pathology

Mohammed A. Aleskandarany

Andrew H. S. Lee


Although most breast spindle cell lesions (BSCLs) are rare, they constitute a wide spectrum of diseases, ranging from reactive processes to aggressive malignant tumours. Despite their varied histogenesis and behaviour, some lesions show an overlap of morphological features, making accurate diagnosis a challenging task, particularly in needle core biopsies. Clinical history and immunohistochemistry can help in making a correct diagnosis in morphologically challenging cases. To make an accurate diagnosis, it is important to maintain a wide differential diagnosis and be familiar with the diverse morphological appearances of these different entities. BSCLs can generally be classified into bland?looking and malignant?looking categories. In the former, the commonest diagnosis is scarring. However, it is important to distinguish low?grade spindle cell metaplastic breast carcinoma from other benign entities, as the management is clearly different. In the malignant category, it is important to differentiate metaplastic carcinoma from other malignant primary and metastatic malignant spindle cell tumours of the breast, such as malignant phyllodes tumour, angiosarcoma, and melanoma. This review focuses on the classification and histological and molecular diagnosis of various BSCLs, with an emphasis on the diagnostic approach, including in core biopsies.


Rakha, E. A., Aleskandarany, M. A., Lee, A. H. S., & Ellis, I. O. (2016). An approach to the diagnosis of spindle cell lesions of the breast. Histopathology, 68(1), 33-44. doi:10.1111/his.12865

Journal Article Type Article
Acceptance Date Sep 14, 2015
Online Publication Date Dec 4, 2015
Publication Date 2016-01
Deposit Date Nov 21, 2018
Journal Histopathology
Print ISSN 0309-0167
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 68
Issue 1
Pages 33-44
Public URL
Publisher URL