Metaplastic breast carcinoma with melanocytic differentiation

Metaplastic carcinoma of the breast is a rare heterogeneous malignancy, accounting for <1% of all invasive breast carcinomas, in which adenocarcinoma is found to coexist with an admixture of spindle, squamous, chondroid or bone-forming neoplastic cells. Metaplastic breast carcinoma composed of both epithelial and melanocytic elements is rare, and only seven cases have been reported so far. Reported herein is the case of a 38-year-old woman with a nodular mass in her left breast suspicious of malignancy, discovered during routine ultrasound examination. After histological and immunohistochemical examination of the resected tumor mass, initial diagnosis was collision tumor: ductal invasive carcinoma and metastatic melanoma. The patient underwent quadrantectomy, chemotherapy and radiotherapy. At 6 years follow up the patient was alive and healthy, without local recurrence or metastases. After revising slides and the literature, in addition to patient follow up, it was concluded that this case represents metaplastic carcinoma with melanocytic differentiation.     

Metaplastic breast carcinoma on fine-needle cytology samples: a report of three cases

Metaplastic breast carcinoma (MBC) may have a varied presentation on fine-needle cytology samples. We herewith describe three cases of MBC found in our series. One of these cases showed a peculiar mixture of malignant ductal, apocrine type, and squamous epithelial cells with fascicles of spindle cells with variable degree of atypia and was diagnosed as metaplastic carcinoma of the carcino-sarcomatous type. The other two lesions were characterized by an abundant chondroid extracellular matrix to which were variably admixed carcinomatous and chondroid-type cells, with variable degree of atypia. Both these latter cases were defined as matrix-producing metaplastic carcinomas. Because of the various presentation of MBC on fine-needle cytology samples and the possible influence of needle "sampling" on the cytological specimen, the spectrum of differential diagnoses to be considered may encompass a number of benign and malignant entities, like keratinous subareolar cysts, malignant fibroepithelial lesions with myxo-chondroid stroma, and true sarcomas of the breast, with cartilaginous metaplasia. It is the Authors' feeling that, with optimal samples, the cytomorphological findings of this rare variant of breast carcinoma permit its accurate pre-operative diagnosis.     

Comparison of fine-needle aspiration cytology and core biopsy for diagnosis of breast cancer

Both fine-needle aspiration (FNA) cytology and core biopsy are useful in the diagnosis of breast cancer. In order to compare the sensitivities of these procedures, we reviewed 209 patients with breast cancer who had either FNA, core biopsy, or both, and also either mastectomy or lumpectomy. Sensitivities for FNA and core biopsies for diagnosing breast cancer were calculated and compared. Sensitivity for FNA or core biopsies interpreted as either atypical or malignant was 93.8% for FNA and 90.1% for core biopsy (P > 0.05). Sensitivity for FNA or core biopsies interpreted as malignant was 65.4% for FNA and 88.7% for core biopsy (P < 0.0001). Sensitivities of FNA interpreted as either atypical or malignant were 92.4% for FNA performed by pathologists and 100% for FNA by nonpathologists (P > 0.05). Sensitivities of FNA interpreted as malignant were 75.8% for FNA by pathologists and 20.0% for FNA by nonpathologists (P < 0.00001). Both FNA and core biopsies are sensitive procedures for the detection of breast cancer. There was no significant difference between sensitivity of FNA and core biopsies interpreted as either atypia or malignancy, although the sensitivity of core biopsies interpreted as unequivocal malignancy was greater than that of FNA. FNAs performed by pathologists were more sensitive than FNAs performed by nonpathologists in making an unequivocal diagnosis of breast cancer.     

Plasmacytoma of the larynx diagnosed by fine-needle aspiration cytology: a case report

Extramedullary plasmacytoma is a rare lesion. The use of fine-needle aspiration for diagnosis of plasmacytoma has been described in a few sporadic reports. To the best of our knowledge, none of these reports described the cytologic findings from plasmacytoma of the larynx. We report on a case of laryngeal plasmacytoma in a 79-yr-old man diagnosed by fine-needle aspiration cytology. The patient had a history of a plasmacytoma involving the sixth thoracic vertebra diagnosed in 1996, which progressed to multiple myeloma in 1997. He received treatment in the form of local radiation to the skeletal vertebrae and chemotherapy. Two years later, the patient presented with a large neck mass. Computed tomography (CT) was done at an outside facility, and the radiologic impression was of a large right glottic carcinoma with invasion into the right thyroid cartilage. Because of the history of multiple myeloma, a fine-needle aspiration (FNA) biopsy was performed of the laryngeal mass. Cytologic examination demonstrated atypical plasma cells arranged in a dissociative fashion, consistent with a plasmacytoma. Although there are previous surgical pathology reports of laryngeal plasmacytoma, to the best of our knowledge, this is the first report of plasmacytoma of the larynx diagnosed by FNA cytology.     

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.     

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.     

Primary pure squamous cell carcinoma of the breast diagnosed by fine-needle aspiration cytology: a case study using liquid-based cytology

Pure primary squamous cell carcinoma (SCC) is an extremely rare type of breast tumor. We report one of such cases in a 32-year-old woman, diagnosed by fine-needle aspiration cytology (FNAC). Aspiration smears were characterized by squamous cells, both isolated and in aggregates, at various stages of maturation. The tumor was excised, and the histologic sections confirmed the cytologic diagnosis. Pure primary SCC of the breast has a distinctive cytomorphologic appearance, and diagnosis of this tumor by FNAC is possible. For its diagnosis, the exclusion of SCC of local cutaneous structures and metastasis of distant squamous carcinoma are mandatory.     

Mixed metaplastic carcinoma of the breast associated with pregnancy: Diagnostic dilemmas in fine‐needle aspiration cytology

Metaplastic carcinoma of the breast represents a rare entity characterized by the simultaneous presence of ductal, squamous, and/or mesenchymal components in several proportions. There are limitations in fine‐needle aspiration diagnosis due to its pathological heterogeneity. When it develops under pregnancy and lactation influence, the cytologic evaluation appears to be more difficult and accurate diagnosis often proves challenging. We describe a case of mixed metaplastic carcinoma with dominant areas of squamous metaplasia, sarcomatoid stroma with spindle cells, and a minor component of cartilaginous metaplasia. We notify our experience in diagnostic approach of this entity focusing on differential diagnosis. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Cytodiagnostic patterns of metaplastic breast carcinoma in aspiration samples: A study of 14 cases

Metaplastic breast carcinomas (MBCs) are not only uncommon neoplasms but also show a myriad of cytomorphologic patterns in aspiration samples. These tumors comprise less than 5% of breast malignancies and have an uncertain prognosis. In this study, the fine‐needle aspiration cytologic features of 14 MBCs with the identification of two distinct malignant cell populations are presented, based on which a definitive diagnosis was possible in 12 of the 14 cases. In the remaining 2 cases the diagnosis of MBC was substantiated after study of cell blocks from the aspirate, which were made in all the cases. Furthermore, the diagnosis of MBC was also confirmed subsequently on tissue examination. The various combinations of patterns included malignant ductal, squamous, and sarcomatous (including heterologous) elements and multinucleated osteoclastic giant cells. As a result of this study, it was felt that if malignant breast aspirates on careful examination show two or more distinct neoplastic elements, the diagnosis of MBC may be possible. Diagn. Cytopathol. 1999;20:10–12. © 1999 Wiley‐Liss, Inc.     

Fine needle aspiration cytology of solid neuroendocrine carcinoma of the breast: a case report

We report a case of neuroendcrine (NE) carcinoma in the right breast of a 67-year-old female, ultrasonography revealed a lesion composed of irregular hypoechoic masses and mammography showed asymmetric breast tissue. Histopathologic examination of the surgical sample showed a solid to nested proliferation of plasmacytoid cells that showed immunocytochemical positivity for chromogranin A, synaptophysin, CD56, and estrogen receptor. Our case was diagnosed as solid NE carcinoma. Though the findings of fine needle aspiration cytology reflected the histological features, we were not able to cytopathologic grounds only to predict the NE nature of this tumor. We performed immunocytochemistry using Chromogranin A, Synaptophysin, and CD56 on our cytologic smear retrospectively with positive results for all of the markers. When the cytopathologic examination of a given breast neoplasm is suggestive of NE differentiation, immunocytochemical staining for NE markers is generally useful for a correct preoperative diagnosis. An acurate preoperative diagnosis of NE carcinoma on FNAC can be achieved based on its distinctive cytomorphologic and immunocytochemical features.     

Matrix-producing carcinoma of the breast: Case report with radiographical and cytopathological features

A case of matrix-producing carcinoma (MPC), which is a unique variant of breast cancer, is described with cytopathological and radiographical findings. A 75-year-old female presented with a palpable mass in her right breast. After confirmation of the cytopathological diagnosis, the patient received a right mastectomy with ipsilateral axillary lymph node dissection. The histopathological examination revealed MPC. The Union Internationalis Contra Cancrum postoperative clinical stage was IIB. The patient is well and without disease 18 months after the surgery.     

Metaplastic breast carcinoma: a case report and systematic review of the literature

A 78‐year‐old retired woman was diagnosed with metaplastic breast carcinoma (MBC), a rare tumor, in our hospital. We reviewed 15 articles with a total of 1328 patients to determine the epidemiology, clinical features, biomarkers, histology, management and outcome of patients with this tumor. The mean age at presentation is 58.5 years (range 32–83). Eighty‐one percent of patients presented either with a breast mass or abnormal mammographic finding. Twenty‐three percent of patients had a family history of breast cancer. Estrogen receptors were only found in 12%, progesterone receptors in 10% and HER2 in 6% of patients. The main method of treatment was mastectomy (66.9%) in combination with chemotherapy (57%) and radiotherapy (47%). Five‐year disease‐free survival ranged between 40% and 84% and 5‐year overall survival ranged between 64 and 83%. We have further reviewed the nature of this disease in the light of advancement in genetics, such as microarray gene expression profiling. The relationship of MBC with triple‐negative tumor and basal‐like tumor is discussed. It is hoped that advances in genetics and biomarkers will bring forward the era of personalized medicine in the treatment of breast carcinoma.     

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.     

Intramammary lymph nodes: Cytologic findings and implications for fine-needle aspiration cytology diagnosis of breast nodules

The recognition of intramammary lymphoid proliferations is important because smears of these proliferations would be judged as insufficient by several of the published criteria for specimen adequacy. Alternatively, some might be confused with medullary carcinoma of the breast or adenocarcinomas with a “single-cell” pattern. We found 19 intramammary lymphoid proliferations in a series of 887 fine-needle aspirates of palpable breast nodules. Six were lymphomas and 13 were benign intramammary lymph nodes. Smear cellularity ranged from scant to high, but in all cases, lymphocytes dominated the cell population. The cytology of intramammary lymph nodes and lymphoma did not differ from those occurring at other sites. Diagn. Cytopathol. 1997;17:223–229. © 1997 Wiley-Liss, Inc.     

Aggressive papillary male breast carcinoma on fine-needle cytology sample

Papillary carcinoma (PC) is a histological variant of breast carcinoma that is more frequently observed in males than in females, showing the same cytological features in both sexes. PC is characterized by a low grade of malignancy and a generally favorable course. We describe a case of male breast PC (MPC) diagnosed by fine-needle cytology (FNC) in which some aggressive morphologically detectable features were associated with bland cytologic features of the tumor. FNC was performed on a 3 cm palpable mass of the left breast of a 55-yr-old male. FNC yielded abundant bloody material. Two smears were Diff-Quik and Papanicolaou stained, others were used for immunocytochemical assessment of estrogen, progesterone, c-erbB-2, and Ki-67; another was Feulgen stained for DNA ploidy. Smears were highly cellular, showing isolated cells and papillary structures. Cells showed tall and well-defined cytoplasm with a columnar aspect, light anisonucleosis, coarse chromatin, and small nucleoli. Immunoperoxidase staining demonstrated positivity for estrogen (50%), negativity for progesterone, intense positivity for c-erbB-2, with specific membrane staining and positivity for Ki-67 in more than 20% of the cells. DNA-ploidy showed an aneuploid histogram with 5c exceeding rate (5cER) of 59% and 2c deviation index (2cDI) of 29%. Subsequent surgical pathology examination confirmed the cytological diagnosis of papillary carcinoma; moreover, it revealed neoplastic endolymphatic thrombi and infiltrative border of the tumor that reached the thoracic wall. Cytological features can suggest diagnosis of MPC on FNC samples. Immunocytochemical evaluation of c-erbB-2 and Ki-67 and DNA ploidy evaluation on cytological smears might reveal a biological aggressiveness of PC despite the bland microscopic features of the tumor and this should influence the therapeutic procedure.     

Fine-needle aspiration cytology findings in a case of aggressive angiomyxoma: A case report and review of the literature

Aggressive angiomyxomas are uncommon but distinct soft-tissue neoplasms occurring predominantly in the pelvis and peritoneum of females, but they have occasionally been reported in association with inguinal hernias in males. Histologically, these neoplasms are characterized by a proliferation of spindle- or stellate-shaped cells widely separated by loose myxoid stroma in which is dispersed a prominent vascular component. The vascular component is comprised of large, thick-walled vessels that generally do not show an arborizing pattern. Mitotic activity has been exceedingly low in the cases reported. Because of their occurrence within the groin, these lesions may undergo fine-needle aspiration (FNA). Cytologic examination of this material will reveal hypocellular smears containing scattered spindle cells with bipolar cytoplasmic processes, as well as bland stellate cells. The nuclei are fusiform to oval with a bland chromatin pattern. The stromal cells lie in a background of watery myxoid material. While specific diagnosis by FNA is not possible, the recognition of this cytologic appearance should exclude lymphoproliferative processes as well as metastatic disease from the differential diagnosis. Careful attention to cytologic detail should also help exclude certain other myxoid neoplasms, especially myxoid liposarcoma. Once the myxoid stromal nature of the proliferation is recognized, a differential diagnosis of myxoid lesions can be considered along with a recommendation for open biopsy to establish the definitive diagnosis. Diagn. Cytopathol. 16:425–429, 1997. © 1997 Wiley-Liss, Inc.     

Acquired gluteal myospherulosis secondary to intramuscular injections of petrolatum-based hormones: a case report diagnosed by fine-needle aspiration cytology

A case of acquired myospherulosis of the right gluteal region diagnosed by FNA cytology is reported in a woman who had received a series of intramuscular injections of petrolatum-based hormones. The lesion is characterized by inflammatory pseudocystic nodules containing saccular formations with erythrocytes or "bags of marbles." It results from a physical process similar to the emulsion phenomenon between nonresorbent oily material and plasma. This process gives rise to sequestration of blood corpuscles by oily materials and thus development of foreign body granulomas.     

Metaplastic carcinoma of the breast arising within complex sclerosing lesion: a report of five cases

AIMS: This study presents a series of five cases in which metaplastic carcinoma, predominantly low-grade adenosquamous carcinoma, of the breast is seen arising within a background of a complex sclerosing lesion. This association has been recognized previously but has not been documented in detail. This study describes the characteristics of the components present in each case and discusses the existing literature. This observation adds further evidence to support an association between some types of invasive breast carcinoma and sclerosing lesions of the breast. METHODS AND RESULTS: Four of these cases were received as referral cases for opinion. The fifth was received as part of the routine surgical workload within our own institution. Two patients presented following mammographic screening and three symptomatically; their mean age was 62 years (range 49-68). The mean lesion size was 16 mm (range 7-24). All five lesions showed features of a complex sclerosing lesion/radial scar in the form of central sclerosis with elastosis and radiating benign entrapped tubules. One had associated benign papillary structures and two had focal benign squamous metaplasia. Four cases showed coexisting but distinct areas of low-grade adenosquamous carcinoma with glandular and squamous epithelial differentiation in a spindle cell background. One case had associated undifferentiated spindle cell carcinoma. Detailed immunophenotypic characteristics of two cases are presented. CONCLUSIONS: This series illustrates a postulated but previously unconfirmed association between an unusual form of metaplastic breast carcinoma (adenosquamous carcinoma) and complex sclerosing lesions. The mechanisms of induction of breast carcinoma are poorly understood but these observations further emphasize the potential for sclerosing lesion of the breast to be associated with, and possibly give rise to, invasive carcinoma of different types. The precise nature of the interaction between the pathological processes remains unclear.     

Paired ductal lavage and fine-needle aspiration specimens from patients with breast carcinoma

Ductal lavage (DL) is a new procedure for sampling of the mammary epithelium, but experience with this technique remains limited. We compared the findings in paired DL and fine-needle aspiration (FNA) specimens obtained from patients with breast carcinoma. Four reviewers evaluated all DL samples. Two reviewers also examined the FNA material and compared cellular composition and morphologic findings in paired samples. DL and FNA samples from six patients were satisfactory for evaluation. Two DL samples showed marked atypia, one showed mild atypia, and two were benign; there was no agreement in one case (mild atypia vs. benign). Overall, the atypical cells in DL samples resembled those in the paired FNA material, but low degree of cytologic atypia and relative paucity of atypical cells limited their correct identification. The interpretation of DL samples is more challenging than that of FNA material, but similar criteria apply. To increase the sensitivity of DL, the number of epithelial cells required for a satisfactory sample should be higher than previously set.