Pleomorphic lobular carcinoma in a male breast: a case report with review of the literature

Invasive lobular carcinoma (ILC) is a distinct type of breast carcinoma and represents 5-15% of invasive breast carcinomas in female. However, the occurrence of ILC is exceptional in male breast, and the incidence is 1.5-1.9% of male breast carcinomas. Herein, we report a case of pleomorphic lobular carcinoma in a male breast. A 76-year-old Japanese male with a history of treatment with a progestational agent for prostate cancer presented with a right breast tumor. Magnetic resonance imaging showed gynecomastia of bilateral breasts and an irregular-shaped nodule in his right breast. Histopathological study revealed infiltrative neoplastic growth of discohesive tumor cells arranged in single-filed linear cords or trabeculae. These neoplastic cells had variable-sized large nuclei containing occasional nucleoli. Immunohistochemically, these tumor cells lacked E-cadherin expression. Accordingly, an ultimate diagnosis of pleomorphic lobular carcinoma was made. This is the third documented case of pleomorphic lobular carcinoma of male breast. Our analyses of the clinicopathological features of this type of tumor revealed that patients were middle-aged or elderly men, and all cases were free from lymph node metastases or recurrence. Gynecomastia and a history of hormonal agent intake were present only in the current case. The most commonly proposed risk factor for the development of male breast cancer is elevated level of estrogen, and a possible link between the development of male breast cancer and estrogen therapy for prostate cancer has been suggested. The clinicopathological features of ILC of male breast remains unclear; therefore, additional studies are needed to clarify them.     

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.     

Adenoid cystic carcinoma of the breast diagnosed by fine-needle aspiration

Fine-needle aspiration cytology remains a useful tool for preoperative diagnosis of breast lesions. We describe a case of adenoid cystic carcinoma (ACC) of the breast detected by ultrasound-guided fine-needle aspiration (FNA). Subsequent histopathology corroborated the diagnosis. ACC is a rare but distinctive neoplasm of the breast that can be accurately diagnosed by FNA. Its infrequent presentation, favorable prognosis, and relatively conservative management in the breast prompt us to reinforce its features.     

Metastatic granular cell tumor to the breast diagnosed by fine needle aspiration cytology: A case report with review of the literature

Granular cell tumors (GCT) are mesenchymal neoplasms of Schwann cell/neural origin. Malignant granular cell tumors (MGCTs) represent <1‐2% of all GCT and defined as tumors demonstrating metastases or destructive local growth. Other clinical parameters suggestive of malignancy include rapid growth, size > 4 cm and necrosis. An apparently inconsistent set of histological features have been described in MGCT. Although the histologic parameters of a GCT are not always predictive of biologic behavior, the presence of atypical features may be indicative of an aggressive clinical behavior (recurrence and metastases). A preoperative estimate of features suggestive of malignancy is important for treatment and prognostication. Diagnosis and prognostication from preoperative fine needle aspiration (FNA) cytology is hampered by the fact that only a few case reports on cytologic features of malignant GCT have been published. We report a case of metastatic MGCT to breast and compare cytologic features to that of primary breast GCT and apocrine/histiocytoid variants of breast carcinoma.     

Papillary thyroid carcinoma with an adenoid cystic pattern: report of a case with fine-needle aspiration cytology and immunocytochemistry

Although fine-needle aspiration (FNA) cytologic features of conventional papillary thyroid carcinoma (PTC) and some of its variants have been documented in the literature, PTC with an adenoid cystic pattern has not so far been described. A 35-year-old woman presented with solitary cold nodule in the right lobe of thyroid. FNA smears from the nodule showed features of PTC such as papilliform clusters, monolayered sheets, psammoma bodies, increased frequency of nuclear grooves, and intranuclear cytoplasmic inclusions. In addition, there were areas of follicular formation and light-pink to deep-purple hyaline globules with a laminated appearance and surrounded by neoplastic cells, reminiscent of adenoid cystic carcinoma. These globules were present in 53% of the follicles. Immunocytochemical staining for thyroglobulin yielded positive cytoplasmic reaction in the neoplastic cells. Histopathology of the thyroidectomy specimen confirmed the cytodiagnosis of PTC. The hyaline globules were present focally and were light pink to deep purple with a laminated appearance resembling psamomma bodies. The colloid and follicular cells were positive for thyroglobulin but the hyaline globules were negative. Von Kossa staining for calcium revealed positive reaction in the psamomma bodies and some of the hyaline globules, indicating that the globules may be the beginning of psammoma bodies. Thus, FNA cytology was useful in diagnosing an unusual variant of PTC.     

Phosphaturic mesenchymal tumor diagnosed by fine-needle aspiration and core biopsy: a case report and review of literature

Oncogenic (tumor-induced) osteomalacia is a rare paraneoplastic syndrome of phosphate wasting that is frequently associated with phosphaturic mesenchymal tumor (PMT). As the cytologic features of this tumor apparently have not been reported, we describe the fine-needle aspiration (FNA) findings for PMT that arose from the gluteal soft tissue in a patient with hypophosphatemia and multiple fractures secondary to osteomalacia. Smears from the computerized tomography (CT)-guided FNA showed groups of spindle cells having elongated nuclei, fine to moderately coarsely granular chromatin, inconspicuous nucleoli, and delicate cytoplasm. Marked nuclear atypia, mitotic figures, and necrosis were absent. The differential diagnosis included a variety of benign and malignant spindle cell neoplasms such as monophasic synovial sarcoma, leiomyoma, peripheral nerve sheath tumor, fibrosarcoma, and, less likely, metastatic melanoma and sarcomatoid carcinoma. The bland-appearing cytologic features of a spindle cell tumor in a patient with osteomalacia should suggest the diagnosis of PMT.     

Metastatic breast carcinoma involving the thyroid gland diagnosed by fine-needle aspiration: a case report

Secondary involvement of the thyroid gland from a remote primary malignancy is uncommon. The distinction of metastatic carcinoma (MC) or sarcoma from a primary thyroid malignancy is important because the treatment is different. We discuss a case of a 64-yr-old female with a history of breast carcinoma, who presented with pain and swelling in her neck 5 yrs after being diagnosed with breast cancer. She had undergone mastectomy with subsequent chemotherapy and radiation for infiltrating mammary carcinoma. During the 5-yr interval, she had been free of clinically evident metastatic disease. Subsequent work-up revealed two distinct nodules in the left lobe of her thyroid gland as well as a subcutaneous mass in her right shoulder. A fine-needle aspiration (FNA) of the larger thyroid nodule showed malignant epithelial cells with features consistent with breast carcinoma in a background of benign thyroid epithelial cells and colloid. The case was signed out as metastatic breast carcinoma. Subsequent FNA and biopsy of her right shoulder lesion also revealed metastatic breast carcinoma with similar morphology to the material in the thyroid FNA.     

Fine-needle aspiration biopsy of invasive micropapillary carcinoma of the breast: a report of five cases

Invasive micropapillary carcinoma of the breast is an uncommon variant of infiltrating ductal carcinoma. Observing its distinctive cytologic appearance and aggressive behavior is important for early diagnosis by fine-needle aspiration cytology (FNAC). There are only a few reported cases in the literature. Five women presented with breast masses. FNAC showed malignant epithelial tumors, and mastectomy materials showed invasive micropapillary carcinoma for all of them. Three patients had axillary lymph node metastases. Invasive micropapillary carcinoma, with its angulated papillary clusters lacking a fibrovascular core, and irregular crowded nuclei, has a distinctive cytologic appearance which correlates with its histological features. A differential diagnosis from other primary or metastatic papillary lesions of the breast may be possible using immunohistochemistry and some cytologic features. The limited experience with invasive micropapillary carcinoma should not discourage others from undertaking further studies.     

Fine-needle aspiration cytology of glycogen-rich carcinoma of breast: report of a case and review of literature

Glycogen-rich carcinoma (GRC) of the breast is a rare histological subtype of breast cancer having a poor prognosis. There are very few case reports describing the cytological features of GRC on fine-needle aspiration cytology (FNAC). In this report we present the case of a 34-yr-old woman who underwent FNAC of a clinically palpable breast lump. The aspirate was cellular showing tumor cells in groups, clusters and lying singly. The tumor cells had abundant eosinophilic, finely granular to vacuolated cytoplasm with moderate to marked nuclear pleomorphism. With a cytological diagnosis of carcinoma, a wide local excision was performed. On histology a diagnosis of GRC was made with the tumor cells showing abundant glycogen. The presence of cells with abundant granular to finely vacuolated cytoplasm in a case of breast carcinoma, should point toward the possibility of GRC and other clear cell tumors of the breast. Demonstration of glycogen is required to make a definite diagnosis on cytology.     

Dirofilariasis of breast: report of two cases diagnosed by fine-needle aspiration biopsy.

We report on 2 cases of dirofilariasis of the breast occurring in adult Chinese females residing in Hong Kong. The diagnosis was made by fine-needle aspiration biopsies. The direct smears contained numerous acute inflammatory cells, including eosinophils. A partially necrotic adult nematode of about 400-450 microm in diameter was identified in the cell-block sections of each case. The worm was characterized by a thick cuticle with longitudinal cuticular ridges and fine transverse surface striations, abundant somatic muscle, an intestine, and a reproductive tube or uterus. The morphologic features of this round worm were most compatible with those of Dirofilaria repens. While the clinical and radiologic findings of dirofilariasis of the breast are nonspecific and mimic those of breast neoplasms or inflammatory conditions, a definitive diagnosis is possible with fine-needle aspiration biopsy. A correct diagnosis of dirofilariasis may help to spare patients from unnecessary medical and surgical interventions.     

Medullary thyroid carcinoma metastatic to breast diagnosed by fine-needle aspiration biopsy

We report a patient with a 22-yr history of medullary thyroid carcinoma in whom fine-needle aspiration biopsy of a breast mass, clinically suspected of being a primary mammary carcinoma, established the diagnosis of metastasis. This article demonstrates the importance of the use of immunocytochemical methods on fine-needle aspirates to diagnose metastases to the breast.     

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.     

Plasmablastic lymphoma involving breast: a case diagnosed by fine-needle aspiration and core needle biopsy

Plasmablastic lymphoma (PBL) is a rare lymphoma originating from B-cells with terminal differentiation. Most common anatomic site involved by PBL is the oral cavity. Involvement of other body sites has only rarely been reported. Herein, we report a rare case of EBV-negative PBL involving the breast of an HIV positive 47-year-old woman. The patient presented with decreased vision and photophobia. During physical examination, she was found to have bilateral breast masses and multiple lymphadenopathy. Fine-needle aspiration of one of the breast masses showed large malignant cells with plasmacytoid features. Immunohistochemical studies performed on the core biopsy showed that the tumor cells were positive for common leukocyte antigen CD45 and plasma cell marker CD138, but negative for the pan-B cell markers CD20 and CD79a. Molecular genetic studies showed clonal rearrangement of the immunoglobulin kappa light chain gene. This is the first case of PBL involving the breast reported in English cytological literature.     

Invasive mammary carcinoma with osteoclast-like giant cells diagnosed by fine-needle aspiration biopsy: review of the cytologic literature and distinction from other mammary lesions containing giant cells

Invasive carcinoma with osteoclast-like giant cells is an unusual type of mammary adenocarcinoma with few cases reported in the cytology literature. We present the cytologic findings in a case of invasive cribriform carcinoma of the breast containing osteoclast-like giant cells diagnosed by fine-needle aspiration biopsy. The smears displayed three-dimensional cohesive cluster cells of uniform epithelial cells admixed with numerous multinucleated giant cells that morphologically resembled osteoclasts. Core biopsy confirmed the cytologic diagnosis. Immunohistochemical studies indicated that the multinucleated giant cells were of histocytic origin. Knowledge of the bland cytologic pattern and the admixture of giant cells seen in invasive cribriform carcinoma with osteoclast-like giant cells should avoid making a false negative diagnosis on aspiration biopsy.     

Metaplastic breast carcinoma with chondrosarcomatous differentiation: fine-needle aspiration cytology findings. A case report

Metaplastic carcinoma (carcinoma with pseudosarcomatous metaplasia) of the breast are high-grade carcinomas in which much of the tumor undergoes metaplastic change producing a pseudosarcomatous pattern. We report a case of metaplastic breast carcinoma (MBC) in whom fine-needle aspiration (FNA) cytology was performed with later histological confirmation. The lesion affected a 68-yr-old woman, with a tumor measuring 6.4 x 5.3 cm well demarcated mass located in the upper outer quadrant of the right breast. FNA cytology revealed a variety of markedly atypical cells, mainly spindle-shaped, and mitotic figures sporadically distributed against a severely necrotic background. Atypical chondrocytes were observed against a background of myxomatous substance that displayed metachromasia with May-Giemsa stain that resembled chondrosarcoma cells. Clusters of markedly atypical carcinoma cells that exhibited epithelial junctions were also seen, and immunostaining confirmed the presence of both mesenchyme-marker-positive sarcomatous and epithelial-marker-positive carcinoma cells. Careful attention to the precise cellular composition such as sarcomatous cells, chondrosarcomatous cells and carcinoma cells should allow the recognition of these neoplasms. Therefore, MBC seems to be very a characteristic tumor in which accurate cellular diagnosis may be achieved by FNA cytology.     

Sclerosing mucoepidermoid carcinoma with eosinophilia of thyroid gland in a male patient: a case report and literature review

Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) was first described by Chan et al in 1991. It is characterized by nest or strands of epidermoid tumor cells with squamous differentiation, rare mucous cells, prominent sclerotic stroma, eosinophilic and lymphoplasmacytic infiltration, and a background of chronic lymphocytic thyroiditis in the non-neoplastic thyroid gland. It is important to recognize SMECE of thyroid and differentiate it from squamous cell carcinoma or other neoplasms with squamous differentiation/metaplasia. In published cases, the SMECE of thyroid gland predominantly occurs in women. We report a case of SMECE of thyroid in a 45-year-old male patient. All cases in male patients were Caucasian described in English literature, and our case is the first one in Asian.     

乳腺嗜酸性细胞癌1例及文献复习

目的;探讨乳腺嗜酸性细胞癌的诊断及鉴别诊断。方法：通过ＨＥ、免疫组化染色及电镜观察１例女性乳腺嗜酸性细胞癌,并复习文献,结果：癌细胞呈圆形到多边表,胞浆丰富,胞冻内见弥漫２的强嗜酸性颗粒,细胞核呈轻一中度异型,核仁明显,癌细胞呈巢状排列伴有腺管及乳头形态。电镜下胞浆内充满了无极性分布的线粒体。无分泌颗粒。免疫组化染色显示癌细胞不表达肌动蛋白、Ｓ－１００蛋白及嗜铬素Ａ。ＰＡＳ染色阴性。结论：嗜酸性细     

Paratesticular congenital malignant rhabdoid tumor diagnosed by fine-needle aspiration cytology. a case report

We report the FNA features of a congenital malignant extrarenal rhabdoid tumor (MERT) located in the right paratesticular area of a newborn full-term boy (39 wk gestation), with disseminated metastases in the liver and right parietal region. The diagnosis was suggested two days after birth by fine-needle aspiration biopsy (FNAB) of the parietal mass, which demonstrated an atypical large cell proliferation with vesicular nuclei, prominent nucleoli, and abundant cytoplasm exhibiting paranuclear dense inclusions. The diagnosis was confirmed by histopathologic and immunohistochemical examination of the primary paratesticular tumor. To the best of our knowledge, this is the third MERT reported in the paratesticular region, one of the few congenital extrarenal non-central nervous system cases, and the third congenital case (renal or extrarenal) primarily diagnosed by FNAB. We emphasize the characteristic cytologic features of a congenital rhabdoid tumor, which must be known by pathologists because of the clinical and prognostic implications. Diagn. Cytopathol. 2004;30:46-50.     

Ovarian carcinoma presenting with axillary lymph node metastasis: a case diagnosed by fine-needle aspiration and brief review of the literature

Ovarian carcinoma is a lethal disease and a main cause of morbidity and mortality among gynecological malignancies. Metastatic ovarian carcinoma to the axillary node is an exceptionally infrequent pathological entity. We report a case of ovarian carcinoma, which presented with axillary lymph node metastasis and review the previously documented cases. A 63-year-old woman with a medical history of stage IIIb ovarian carcinoma was admitted to our hospital complaining of a mass in her right axilla. Fine-needle aspiration (FNA) biopsy was performed. Cytological examination revealed a poorly differentiated carcinoma with immunocytochemical features consistent with metastatic ovarian carcinoma. This case illustrates a rare presentation of ovarian carcinoma and underlines the need to consider it in the differential diagnosis of axillary lesions.     

Synchronous papillary thyroid carcinoma and follicular thyroid carcinoma: case report and review of literature

Collision tumor is a term denoting two histologically distinct tumor types occuring at the same anatomic site, which is a rare clinical entity. In the thyroid gland, collision tumors are rare. Here we report a case of the synchronous occurrence of follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC). The current case report describes a 40-year-old woman with synchronous FTC and PTC. Pathologists and surgeons should be aware of collision tumors to avoid possible misdiagnosis.