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Fibroblastic and myofibroblastic tumors are a variable group of neoplasms ranging from benign to malignant. These lesions may affect patients of any age group but are more frequently encountered in the pediatric population. Patient clinical presentation depends on the location, growth pattern, adjacent soft-tissue involvement, and pathologic behavior of these neoplasms. In the 2020 update to the World Health Organization (WHO) classification system, these tumors are classified on the basis of their distinct biologic behavior, histomorphologic characteristics, and molecular profiles into four tumor categories: (a) benign (eg, fibrous hamartoma of infancy, nodular fasciitis, proliferative fasciitis, fibroma of the tendon sheath, calcifying aponeurotic fibroma); (b) intermediate, locally aggressive (eg, desmoid fibromatosis); (c) intermediate, rarely metastasizing (eg, dermatofibrosarcoma protuberans, myxoinflammatory fibroblastic sarcoma, low-grade myofibroblastic sarcoma, infantile fibrosarcoma); and (d) malignant (eg, sclerosing epithelioid fibrosarcomas; low-grade fibromyxoid sarcoma; myxofibrosarcoma; fibrosarcoma, not otherwise specified). Detection of various components of solid tumors at imaging can help in prediction of the presence of corresponding histopathologic variations, thus influencing diagnosis, prognosis, and treatment planning. For example, lesions with a greater myxoid matrix or necrotic components tend to show higher signal intensity on T2-weighted MR images, whereas lesions with hypercellularity and dense internal collagen content display low signal intensity. In addition, understanding the radiologic-pathologic correlation of soft-tissue tumors can help to increase the accuracy of percutaneous biopsy and allow unnecessary interventions to be avoided. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

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Optimal breast care requires a multidisciplinary and integrated approach, including appropriate processes and communication between the radiology and pathology departments. It is important for breast radiologists to have an understanding of the important events that occur between the time a percutaneous biopsy sample is obtained and the point at which the final pathology report is issued. This article reviews the essential processes from breast biopsy through to pathology diagnosis, including the general pathology workflow, tissue preparation, immunohistochemical staining, and pathologic reporting. Upon completion of this educational article, participants will have gained an understanding of the essential steps in the pathology workflow. This article will also highlight the important clinical information a radiologist should provide to the pathologist to ensure the most accurate and clinically relevant diagnosis. This clinical information includes the BI-RADS assessment category, the type of imaging finding that was targeted for biopsy (particularly when there are calcifications), the location of the targeted lesion relative to other findings, and other pertinent patient history.

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Content available: Audio Recording.

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Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma that arises in the setting of textured breast implants. In this case report, a 69-year-old woman with a remote history of right-sided invasive lobular carcinoma status post right mastectomy and bilateral breast reconstruction presents with spontaneous right breast swelling and pain, suspicious for implant rupture. Diagnostic MRI revealed a peri-implant fluid collection in the right breast and focal nonmass enhancement in the left breast. The patient was ultimately diagnosed with right-sided BIA-ALCL and left-sided invasive lobular carcinoma. Although intravenous gadolinium contrast is not needed to assess implant integrity, it can be used to evaluate for malignancy when the patient is at an increased risk for developing breast cancer. In this case, the use of contrast revealed the rare instance of a synchronous contralateral invasive lobular carcinoma. Despite the rarity of BIA-ALCL with an estimated incidence of 1:30,000 in women with textured implants, it is essential that radiologists include this entity in the differential in the appropriate clinical setting as surgical resection is curative if performed before the disease has spread.

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Differentiation between endometrial stromal sarcomas (ESSs) and smooth muscle tumors of the uterus can be challenging. Transgelin, a 22 kDa actin-binding protein has recently been shown to be a smooth muscle specific marker. The goal of this study was to determine whether transgelin could accurately distinguish ESSs from smooth muscle tumors. The expression of transgelin, CD10 and smooth muscle actin (SMA) in 13 ESSs (4 low grade, 6 undifferentiated and 3 metastatic), 9 smooth muscle tumors (1 leiomyoma and 8 leiomyosarcomas (LMSs) and 15 soft tissue LMSs was studied. The diagnostic performance of transgelin compared to the other smooth muscle markers was assessed. Transgelin was diffusely strongly positive in all myometria, leiomyoma, and uterine and soft tissue LMSs. In contrast, transgelin expression was totally absent in all endometria, primary and metastatic ESSs. SMA positivity was noticed in 4 of the 13 ESSs. CD10 was positive in most ESSs. Transgelin appears to be a specific marker of smooth muscle differentiation in the uterus with 100% sensitivity and specificity and may be useful for distinguishing LMS from ESS. It could be used as an additional marker useful for decision making, especially in those tumors with questionable histology.