Fine-needle aspiration cytology of metastatic ovarian carcinoma to the breast

Metastatic ovarian carcinoma to the breast is rare. It represents a diagnostic challenge to the cytologist. It usually signifies a progressive widespread metastatic ovarian tumor with a poor prognosis. This report evaluates the breast fine-needle aspiration (FNA) cytomorphologic features of six cases of metastatic ovarian carcinoma and compares them to those reported in the literature. The cytologic features included hypercellularity, abundant papillary fragments, and necrotic background. The tumor cells showed high nuclear/cytoplasmic ratio, anisonucleosis, prominent nucleoli, and psammoma bodies in cases of serous papillary carcinoma. In addition, the clear-cell carcinoma had prominent finely vacuolated and clear cytoplasm, multinucleated giant cells, and papillary fragments with hobnail nuclei. Recognition of these unusual patterns in a breast FNA cytology should raise the suspicion of a metastatic ovarian tumor. Direct comparison between the breast FNA cytology and the original primary ovarian tumor should confirm the diagnosis. The proper diagnosis of metastatic ovarian cancer to the breast will prevent unnecessary surgical treatment and ensure the appropriate therapy. Diagn Cytopathol 1996;15:1–6. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of a minimal carcinoma of the breast with neuroendocrine features

A case of breast carcinoma with neuroendocrine features is described in a 62-year-old nulliparous female, in which the fine-needle aspiration cytodiagnosis was of a breast carcinoma. Carcinoma of the breast with neuroendocrine features is an unusual variant which may be observed in several histologic types of mammary carcinoma. An awareness of this tumor is essential in view of the increasing use of fine-needle aspiration cytology as a minimally invasive, first line of investigation of a breast abnormality. The case presented here is also of interest since the tumor was only 5 mm in diameter (a minimal carcinoma). Diagn. Cytopathol. 1998;19:107–109. © 1998 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of spindle-cell argyrophilic mucin-producing carcinoma of the breast

An unusual breast carcinoma with prominent spindle cells, intracytoplasmic mucin, and argyrophilia in an 82-yr-old woman was sampled preoperatively by fine-needle aspiration (FNA). The smears contained highly cellular sheets and fragments of uniform spindle cells with abundant vacuolated cytoplasm. The cells were mucicarmine positive and contained many cytoplasmic argyrophilic granules. The findings were confirmed by histologic examination of the excised tumor, which was also studied with a panel of immunohistochemical stains. A review of the literature indicated that spindle-cell argyrophilic mucin-producing carcinoma (SCAMPC) of the breast is a very rare neoplasm presenting primarily in elderly patients. The FNA cytologic features seem to be unique and should allow distinction from other primary breast lesions. Diagn Cytopathol 1996;14:238–242. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration of inflammatory carcinoma of the breast

Inflammatory carcinoma of the breast is an uncommon clinicopathologic entity which is characterized by a distinctive clinical appearance and poor prognosis. Histopathologically, it is characterized by plugging of dermal lymphatics with tumor emboli. Because this lesion usually does not form a discrete palpable mass, it is not as amenable to diagnosis by fine-needle aspiration (FNA) as other breast lesions. In the following, we report our experience with establishing the diagnosis of inflammatory carcinoma by FNA. Three patients underwent FNA for confirmation of clinically suspected inflammatory carcinoma. All aspirations were performed by a cytopathologist and required multiple passes to obtain diagnostic material. Aspirates were paucicellular and contained fragments of fibrous or adipose tissue. Malignant cells were predominantly distributed in tight, three-dimensional clusters and were identifiable as tumor cells based on large size, nuclear irregularity, and increased nuclear to cytoplasmic ratio. Unlike aspirates from conventional breast carcinoma, individual dispersed cells and cellular discohesiveness were not prominent features. Subsequent histologic material from these patients revealed the characteristic tumor emboli plugging dermal lymphatics. We conclude that in the appropriate setting, the diagnosis of inflammatory carcinoma can be established by FNA. Diagn Cytopathol 1996;15:363–366. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration cytodiagnosis of adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (ACC) of the breast is a rare breast cancer with a good prognosis. Its morphology is identical to its counterpart in the salivary glands. In this brief report, two cases of ACC of the breast are presented in which the diagnosis was established on a fine-needle aspiration cytology (FNAC) and correlated with subsequent examination of cell blocks of aspirate and tissue. The cytodiagnostic criteria for ACC of the breast are discussed. Diagn Cytopathol 1996;14:328–330. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration of low grade adenosquamous carcinoma of the breast

Low-grade adenosquamous carcinoma is an unusual variant of mammary carcinoma. This malignancy generally presents as a palpable mass without mammographic microcalcifications, and fine-needle aspiration may be the initial technique selected for diagnosis. To our knowledge, the cytologic findings associated with this neoplasm have not been reported. We report a case of low-grade adenosquamous carcinoma of the breast in a 57-yr-old woman, initially studied by fine-needle aspiration cytology and confirmed by excisional biopsy. The aspiration biopsy smears were characterized by low cellularity and small disoriented clusters containing uniform cells of small to medium size. Bipolar cells were not seen in the background. The diagnostic features and differential diagnosis of this unusual neoplasm are reviewed. Diagn Cytopathol 1996;14:321–324. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration cytodiagnosis of recurrent carcinoma of the breast in operative scars

Recurrence of carcinoma in scars following surgical treatment of breast carcinoma is a frequent problem. An early diagnosis of recurrent lesions is essential to enable timely management. In this study, the role of fine-needle aspiration cytology (FNAC) in the diagnosis of scar lesions was evaluated in 156 women seen over a period of 12½ yr. Ninety-eight of these on FNAC showed features of a recurrent carcinoma, and in six samples, the FNAC showed suspicious features. In all the six suspicious cases, a subsequent biopsy confirmed a recurrent breast carcinoma. The remaining 52 cases on repeated FNAC were diagnosed as benign, and this was confirmed on a subsequent biopsy. The sensitivity, specificity, and predictive value for cytologic findings were 94.2, 100, and 100%, respectively. It was concluded that FNAC clearly has a role as a first line of investigation for distinguishing between recurrent malignant and benign lesions in scars in women which have been surgically treated for a breast carcinoma. Diagn. Cytopathol. 16:14–16, 1997. © 1997 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of a subareolar abscess of the male breast

We report on the fine-needle aspiration (FNA) cytology of a subareolar abscess of the breast in a 45-yr-old man. The patient presented with a 1.5-cm mass in the subareolar region. FNA cytology demonstrated the presence of numerous anucleated squamous cells and a few small nucleated squamous cells as well as numerous neutrophils and some lymphocytes in the background. Histiocytes were also present, including some multinucleated foreign-body-type giant cells. No organisms were identified either with special stains or microbiologic cultures. The differential diagnosis of FNA of the male breast is presented, along with other lesions that can potentially contain either benign or malignant squamous cells in the aspirate. The correct FNA diagnosis of this unusual benign lesion involving the male breast should lead to the appropriate treatment. To the best of our knowledge, this is the first published report of FNA cytology of a subareolar abscess of the male breast. Diagn. Cytopathol. 1998;18:441–444. © 1998 Wiley-Liss, Inc.     

Fine-needle aspiration of metastatic renal-cell carcinoma masquerading as primary breast carcinoma

This report details a fine-needle aspiration biopsy performed in the investigation of two right breast nodules in a patient with previous history of lumpectomy for infiltrating ductal carcinoma in the same breast 3 years before. Because the cytology was atypical for a mammary carcinoma and cells did not match the morphology of the previous breast carcinoma, a tissue biopsy was recommended, revealing the presence of metastasis from a previously silent primary renal-cell carcinoma. This report illustrates not only how metastatic lesions in the breast can masquerade clinically as a primary carcinoma but also the necessity for the cautious approach to interpreting the fine-needle aspiration biopsy of these lesions. Furthermore, essential guidelines necessary to distinguish primary from metastatic lesions in the breast are presented. Diagn. Cytopathol. 1998;18:343–345. © 1998 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of mammary fibromatosis: Report of two cases

The purpose of this study is to evaluate cytologically two cases of mammary fibromatosis (MF). Prior to FNAC, clinical and mammographic suspicion of carcinoma and fibroadenoma were present. In both cases cytology disclosed the presence of numerous spindle cells admixed with epithelial cells. In the first case, carcinoma was excluded and the diagnosis of “spindle-cell proliferative lesion” was established. The second case was erroneously diagnosed as “cellular fibroadenoma” due to the presence of monolayered ductal epithelial groups and stromal tissue. In both cases local excision of the lesion was recommended. Although in a strict sense fibromatosis is a pure stromal lesion, the frequent presence of epithelial groups in the smears should raise a differential diagnosis with other more frequent mixed (epithelial and stromal) lesions such as fibroadenoma, cystosarcoma phyllodes, and metaplastic carcinoma. Due to the fact that clinically and mamographically MF is frequently confused with malignancy, preoperative recognition is essential since in many cases it would avoid unnecessary radical surgery. In this sense cytology offers very important preoperative information. Diagn. Cytopathol. 1997;17:363–368. © 1997 Wiley-Liss, Inc.     

Fine-needle aspiration of well differentiated small-cell duct carcinoma of the breast

Historically, fine-needle aspiration of the female breast has been accepted as a useful modality in the diagnosis of ductal as well as other types of breast carcinoma. However, cases of well differentiated small-cell duct carcinoma can be problematic. The differential diagnoses include fibrocystic disease, papillary neoplasia, fibroadenoma, and lobular carcinoma. Retrospectively, 16 cases of well differentiated small-cell duct carcinoma have been identified in the case files of Truman Medical Center/University of Missouri-Kansas City. Patient's ages ranged from 29–81 yr, with the mean being 56.2 yr. The overall cytologic features consisted predominately of a hypercellular specimen with cohesive and rarely discohesive cells with no demonstrable nuclear atypia. For well differentiated small-cell duct carcinoma, the mean nuclear diameter was greater than that of a red cell (6–8 μm). For the well differentiated small-cell duct carcinoma group, the mean nuclear diameter was 9.86 μm; for fibrocystic disease, 12.86 μm; for papillomas, 8.28 μm; for fibroadenomas, 9.48 μm; and for lobular carcinoma, 11.88 μm. From our data, it appears that specific attention to the clinical presentation, cytologic pattern, and nuclear diameters are useful discriminators for well differentiated small-cell duct carcinoma. Diagn. Cytopathol. 16:226–229, 1997. © 1997 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of medullary breast carcinoma: report of two cases and review of the literature with emphasis on differential diagnosis

Medullary carcinoma is a rare variant of breast carcinoma with a relatively good clinical prognosis as strictly defined. Characteristic features on fine-needle aspiration cytology (FNAC) allow medullary carcinoma to be considered in the cytologic differential diagnosis. We present two FNAC cases with such features, including high cellularity with clusters and single intact malignant cells, bizarre stripped nuclei with prominent nucleoli in a lymphoplasmacytic background, and illustrate one case in liquid-based preparation. Surgical excision revealed that one patient had medullary carcinoma, while the second patient had high-grade infiltrating ductal carcinoma. Breast FNAC samples with syncytial fragments, bizarre nuclei with prominent nucleoli, and a chronic inflammatory infiltrate should raise the possibility of medullary carcinoma. However, the differential diagnosis also includes high-grade ductal carcinoma, lymphoma, or metastasis to breast or intramammary lymph nodes; thus, histopathologic analysis is required for definitive diagnosis.     

Ductal carcinoma-in-situ of the breast: Fine-needle aspiration cytology of 12 cases

Aspiration specimens from 12 patients with histologically documented ductal carcinoma-in-situ (DCIS) of the breast (seven patients) or DCIS with minute foci of stromal invasion (five) were evaluated. Five patients presented with palpable masses, 1.5–4.0 cm, and four patients presented with localized thickening, associated with nipple erosion and discharge in two of them. One patient had nipple inversion, and one patient had bilateral nipple discharge. In one patient, no apparent abnormality of the breast was present. Mammography was either suspicious for or strongly suggestive of carcinoma in 10 patients and negative in two. Aspirates from all patients were composed of fragments of atypical ductal epithelium and numerous single epithelial cells. In nine cases, the smears were hypercellular and similar to aspirates of typical invasive ductal carcinoma. Calcifications were present in six cases. In four of these, associated tumor necrosis was evident. Cytologic features separating DCIS patients from those showing minimal stromal invasion or common types of invasive ductal carcinoma (IDC) were not identified. We conclude that fine-needle aspiration cytology of DCIS is identical to that of IDC. If preoperative radiotherapy or chemotherapy is considered in the management of invasive breast carcinoma, cutting-needle biopsy for confirmation of tumor invasion is necessary.     

A case of matrix-producing metaplastic carcinoma of the breast exhibiting similarities to pleomorphic adenoma on fine-needle aspiration cytology

The distinction between matrix-producing metaplastic carcinoma (MPMC) and pleomorphic adenoma (PA) is sometimes unclear in breast pathology, especially on core needle biopsy. Herein, we presented a 66-year-old woman with MPMC of the breast that looked like PA on fine-needle aspiration cytology (FNAC). On FNAC, the appearance of abundant myxoid matrix along with cellular clusters composed of monotonous cellular populations looked like salivary PA, which we were familiar with owing to the frequency in routine pathological practice. Thus, the possibility of breast PA, the counterpart of salivary PA, was considered. However, the tumor location was different from where breast PA frequently occurs, i.e. the retroareolar region. Therefore, we eliminated the possibility of breast PA and avoided the erroneous cytological diagnosis. It is should be kept in mind that MPMC can look like PA on FNAC.     

Fine-needle aspiration cytology of lobular carcinoma in situ

Fine-needle aspiration cytology (FNAC) plays a key role in the preoperative diagnosis of breast carcinoma but is less reliable in the diagnosis of in situ lesions. The objective of the present study was to investigate the cytological features of lobular carcinoma in situ (LCIS), regarding which little data is available to date. Cytological features of FNAC of the breast from 21 patients with histology-proven LCIS were described and compared with surgical specimens. Aspirates from 8/21 cases had cell groups diagnostic for or compatible with LCIS. Aspirates from an additional two cases demonstrated hypercellular, dissociated, and more pleomorphic tumor cells, which were originally diagnosed as invasive lobular carcinoma (ILC). The remaining 11 aspirates were diagnosed as benign or nondiagnostic. FNAC from the eight diagnostic specimens were characterized by loosely cohesive cell groups composed of uniform cells with occasional intracytoplasmic lumina, slightly irregular and eccentric nuclei. We conclude that the main difficulty in diagnosing LCIS by FNAC is sampling rather than recognition of the lesions. However, one should be aware of the cytological features of LCIS in order to reach a correct diagnosis. There are no reliable cytological criteria that help in differentiating pleomorphic and dissociated LCIS from ILC.     

Mucinous carcinoma of breast with abundant psammoma bodies in fine-needle aspiration cytology: a case report

Fine-needle aspiration (FNA) cytology plays an important role in the diagnosis of various pathologic conditions in the breast. Microcalcification can be observed in benign and malignant breast lesions, but psammoma bodies (PBs) are rarely reported in breast lesions and are a feature of papillary neoplasms. However, we have observed PBs in large numbers in a mucinous carcinoma of breast, which is not previously reported in FNA of breast lesions. A 65-yr-old postmenopausal woman underwent FNA of a palpable mass. The aspirate revealed mucinous carcinoma cells associated with plenty of PBs. This case report of mucinous carcinoma of the breast with abundant PBs highlights the cytodiagnostic pattern of the lesion and formation of PBs.     

Fine-needle aspiration cytology of extranodal lymphoma

The assessment of lymphoproliferative disorders using fine-needle aspriation (FNA) cytology may be problematic particularly when organs other than lymph node are involved. In this report we have reviewed 26 consecutive FNA specimens from superficial extranodal sites which were reported as diagnostic or suggestive of malignant lymphoma. The aspirates were obtained from skin or subcutaneous tissue (ten cases), thyroid (five cases), salivary gland (five cases), breast (four cases), neck, and pharynx (one case each). Ancillary studies including immunocytochemistry, in situ hybridisation to detect immunoglobulin light chain mRNA expression, and polymerase chain reaction for analysis of immunoglobulin heavy chain gene rearrangement were performed in 20, 12, and 7 cases, respectively. Clinicopathologic correlation confirmed the diagnosis of lymphoma in 25/26 aspirates. Nine of the 14 patients whose initial presentation was with an extranodal mass were considered to have primary lymphomas of mucosa-associated lymphoid tissue (MALT) type. In contrast, ten of 11 patients with recurrent extranodal disease had primary nodal type lymphomas. There was one false-positive diagnosis, a neck mass misinterpreted cytologically as B-cell lymphoma which was ultimately shown to be a branchial cyst. FNA cytology supported by appropriate ancillary investigations provides accurate diagnosis in most cases of extranodal lymphoma. Diagn. Cytopathol. 1998;19:260–266. © 1998 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of metastatic small cell carcinoma of the colon: A report of three cases

Small cell carcinoma of the large intestine is a rare, extremely aggressive malignancy often associated with an overlying adenoma. We report three cases of metastatic small cell carcinoma of the colon diagnosed by fine-needle aspiration (FNA) biopsy. Two of the patients were women (ages 33 and 46 yr old) and one was a man (69 yr old). FNA biopsy established the diagnosis of metastatic small cell carcinoma involving the liver (2 cases) and soft tissue of the scapular region (1 case). In one patient, the FNA diagnosis of hepatic metastases preceded identification of the primary site. Subsequently, the patient was found to have a small cell carcinoma subadjacent to a colonic villous adenoma, illustrating the importance of investigating villous lesions of the colon in patients with metastatic small cell carcinoma of unknown primary origin (especially in non-smokers). All three cases showed the characteristic cytologic features of small cell carcinoma. Ancillary studies performed on aspirated material confirmed the diagnosis of small cell carcinoma in one case. Immunocytochemical studies revealed punctate cytokeratin and diffuse neuron-specific enolase (NSE) positivity of the malignant cells. Ultrastructurally neurosecretory granules were evident. To the best of our knowledge, this is the first FNA cytologic report of metastatic small cell carcinoma of the large intestine. This FNA report also demonstrates when a small cell carcinoma is detected in a metastatic site in a patient lacking a lung primary, a likely primary site could be adjacent or beneath a polypoid lesion of the colon. Diagn Cytopathol 1996;15:54–59. © 1996 Wiley-Liss, Inc.