1
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Pinto D, Schmitt FC. Immunohistochemistry Applied to Breast Cytological Material. Pathobiology 2022; 89:343-358. [PMID: 35367980 DOI: 10.1159/000522542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/08/2022] [Indexed: 12/19/2022] Open
Abstract
Fine-needle aspiration biopsies (FNABs) of the breast are minimally invasive procedures enabling the diagnosis of suspicious breast lesions. Unfortunately, they are often perceived as inferior to core-needle biopsies, namely because they are supposedly unable to differentiate between high-grade ductal carcinoma in situ and invasive carcinoma or provide material for ancillary testing. Several studies have shown, however, that FNAB samples, when handled properly, are indeed capable of providing sufficient and adequate material for ancillary testing, namely immunocytochemistry (ICC). We reviewed the published literature regarding the use of ICC for both diagnostic and theranostic uses in the different types of cytological samples obtained from FNABs of the breast, including smears, liquid-based cytology samples, and cellblocks. We found that p63 and 34βE12 show promise in aiding in the differential diagnosis between in situ and invasive lesions and that most other diagnostic markers may be used as in tissue. Regarding theranostic ICC markers, results vary between publications, but with care, these can successfully be performed in cytological samples. Air-dried smears should be avoided, and cellblocks are overall more versatile than cytology slides, enabling the evaluation of not only hormonal receptors and HER2 by ICC, but also of Ki-67. Particular attention should be paid to fixation and antigen retrieval procedures in all cases. We recommend that laboratories without experience perform short validation runs before adopting these techniques into clinical practice.
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Affiliation(s)
- Daniel Pinto
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal.,NOVA Medical School, Lisboa, Portugal.,IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Fernando C Schmitt
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,RISE (Health Research Network) @ CINTESIS (Center for Health Technology and Services Research), Porto, Portugal
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2
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Bannon M, Marak C, Ashraf A, Smith C, Nunley M, Guddati AK, Kaushik P. Unusual presentation of a small cell lung cancer with bilateral breast metastases: Case report and a brief review of the literature. Respir Med Case Rep 2022; 38:101693. [PMID: 35799863 PMCID: PMC9254160 DOI: 10.1016/j.rmcr.2022.101693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Small cell lung cancer (SCLC) is a smoker's disease and occurs almost exclusively in smokers. SCLC is a high-grade neuroendocrine tumor and commonly presents as a central tumor with bulky mediastinal adenopathy. It is notorious for causing widespread disease and paraneoplastic syndromes. The usual sites of metastasis include the liver, brain, bone, and adrenals. SCLC presenting with breast metastasis is unusual; however, there are reports of unilateral and bilateral breast metastases. SCLC with bilateral breast metastases is extremely rare, with only five previously reported cases available in the literature. We are taking this opportunity to report and add to the growing literature on the unusual presentation of a small cell lung cancer with bilateral breast metastases.
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3
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Tandon A, Patel T, Kaur K, Shah M, Trivedi P. Role of FNAC in Extramammary Tumors Metastatic to the Breast. J Cytol 2020; 37:159-165. [PMID: 33776254 PMCID: PMC7984515 DOI: 10.4103/joc.joc_99_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/12/2020] [Indexed: 11/04/2022] Open
Abstract
Background Metastasis to the breast of an extra-mammary origin is very rare. FNAC plays an important role in differentiating non-mammary breast metastasis from primary malignancy. This study aimed to analyze the cytomorphological criteria and its pitfalls in differentiating metastatic lesion of the breast from primary malignancy. Methodology Retrospective analysis of 891 FNACs of the breast was performed for a time span of 3 years. A total of 12 cases were diagnosed on FNAC as secondary neoplasms to the breast. Clinical and radiological data, along with Pap and MGG stained smears of each case were examined and correlated with the histopathology of the primary tumor. Statistical analysis was carried out. All cases of primary breast malignancies were excluded from our study. Results In 10 out of 12 cases, primary malignancies were identified as Plasma cell myeloma (one case), B-acute lymphoblastic leukemia (two cases), acute myeloid leukemia (one case); chronic myeloid leukemia (one case), Burkitt's lymphoma of the ovary (one case), Diffuse large B-cell lymphoma (one case), esophageal squamous cell carcinoma (one case), spindle cell sarcoma (one case) and squamous cell carcinoma of the cervix (one case). The remaining two cases in our study were misdiagnosed on cytology as metastasis and turned out to be breast primaries on histopathology. Conclusion Our case series highlights the importance of FNAC to differentiate secondary lesions from primary breast malignancy and thus helps to avoid unnecessary surgery to the patient. It emphasizes on the need to keep in mind the possibility of metastatic breast neoplasms in the presence of unusual cytological features on FNAC.
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Affiliation(s)
- Arshi Tandon
- Department of Oncopathology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Trupti Patel
- Department of Oncopathology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Kanwalpreet Kaur
- Department of Oncopathology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Majal Shah
- Department of Oncopathology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Department of Oncopathology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
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4
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Economopoulou P, Chrysikopoulou A, Goula K, Papiri I, Psyrri A, Kotsantis I, Arkadopoulos N, Michalopoulos NV. Breast Metastasis from Neuroendocrine Carcinoma of the Lung: A Case Report and Review of the Literature. Case Rep Oncol 2020; 13:1281-1284. [PMID: 34191931 PMCID: PMC7649700 DOI: 10.1159/000510936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022] Open
Abstract
Breast metastasis originating from non-mammary tumors is an uncommon event accounting for 0.5-6.6% of all breast neoplasms. The primary malignancies that reportedly metastasize to the breast most frequently are hematologic malignancies, such as leukemia and lymphoma and malignant melanoma. Breast cancer metastasis resulting from a primary lung neoplasm is significantly less commonly described in the literature. Herein, we present the unusual case of a patient with metastatic disease to the breast from a primary lung tumor.
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Affiliation(s)
- Panagiota Economopoulou
- Section of Medical Oncology, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Athena Chrysikopoulou
- Fourth Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Kalliroi Goula
- Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ilectra Papiri
- Fourth Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Amanda Psyrri
- Section of Medical Oncology, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ioannis Kotsantis
- Section of Medical Oncology, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos Arkadopoulos
- Fourth Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos V Michalopoulos
- Fourth Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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5
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Sharma A, Das AK, Pal S, Bhattacharyya S. Fine-needle aspiration cytology of granulocytic sarcoma presenting as a breast lump - Report of a rare case with a comprehensive literature search. J Lab Physicians 2018; 10:113-115. [PMID: 29403218 PMCID: PMC5784281 DOI: 10.4103/jlp.jlp_114_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Myeloid sarcoma is a neoplasm of myeloid cells that can arise before or concurrent with or may follow acute myeloid leukemia. Very rarely, it can present as an isolated breast lump. We have diagnosed a case of myeloid sarcoma by fine-needle aspiration cytology (FNAC), in a 52-year-old woman who presented with the right-sided breast lump. FNAC showed hypercellular smears with immature myeloid cells few neutrophils and many large round cells with high nuclear-cytoplasmic ratio, prominent nucleoli and a moderate amount of granular cytoplasm. The blast cells were myeloperoxidase positive and complete blood count, and peripheral blood examination were normal. We report this case for its rarity and as a note of caution to a pathologist to consider myeloid sarcoma in the differential diagnosis of breast lump to provide the correct diagnosis and avoid incorrect treatment of a curable disease.
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Affiliation(s)
- Abhishek Sharma
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Anjan Kr Das
- Department of Pathology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Subrata Pal
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Subodh Bhattacharyya
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
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6
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Famà F, Barresi V, Giuffrè G, Todaro P, Mazzei S, Vindigni A, Gioffrè-Florio M. An Unusual Presentation of Secondary Involvement of B-Cell Chronic Lymphocytic Leukemia. A Case Report. TUMORI JOURNAL 2018; 94:617-20. [DOI: 10.1177/030089160809400431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extramammary tumors rarely metastasize to the breast. The commonest tumors to metastasize in breast tissue are lymphoproliferative diseases, melanoma, lung cancer and gynecological malignancies. Primary breast lymphoma has been reported in the literature with a maximum percentage of about 0.5% of all breast malignancies, while secondary localizations of lymphomas in the breast are less well studied in the literature than primary ones. The authors report a rare case of a secondary localization of B-cell chronic lymphocytic leukemia to the breast in which the diagnosis was obtained by histopathology and immunohistochemistry and further confirmed by molecular data. This occurrence must be considered in the differential diagnosis of a breast lump so that the primary hematological disease can be adequately treated and the correct type of breast surgery performed.
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Affiliation(s)
- Fausto Famà
- Division of General Surgery, Department of Human Pathology, University of Messina, Italy
| | - Valeria Barresi
- Division of Diagnostic Cytopathology, Department of Human Pathology, University of Messina, Italy
| | - Giuseppe Giuffrè
- Division of Diagnostic Cytopathology, Department of Human Pathology, University of Messina, Italy
| | - Paolo Todaro
- Division of Diagnostic Cytopathology, Department of Human Pathology, University of Messina, Italy
| | - Sergio Mazzei
- Division of General Surgery, Department of Human Pathology, University of Messina, Italy
| | - Angelo Vindigni
- Division of General Surgery, Department of Human Pathology, University of Messina, Italy
| | - Maria Gioffrè-Florio
- Division of General Surgery, Department of Human Pathology, University of Messina, Italy
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7
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Longo R, Melgar E, Campitiello M, Plastino F, Eid N, Quirin I, Hennequin L, Grignon Y, Gunther M, Quétin P. Breast metastasis from squamous cell carcinoma of the oropharynx: a case report. J Med Case Rep 2017; 11:355. [PMID: 29268777 PMCID: PMC5740581 DOI: 10.1186/s13256-017-1500-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/25/2017] [Indexed: 11/25/2022] Open
Abstract
Background Breast metastases from extramammary tumors are extremely rare, the most common primary tumors being contralateral breast carcinoma, followed by lung, gynecological, gastrointestinal, melanoma, and hematological cancers. Only a few cases deriving from head and neck squamous cell carcinoma have been reported in the literature to date. Case presentation We report a case of a 47-year-old Caucasian woman who presented to our hospital with a solitary breast lesion in the right upper external quadrant associated with multiple bone and visceral metastases. Two years before, she had undergone radical resection of a squamous cell carcinoma of the oropharynx (stage pT2, pN1), which was followed by adjuvant radiotherapy. Breast ultrasound showed a hypoechogenic tumor lesion of 4 cm in the right upper external quadrant that was associated with multiple axillary and infra-/supraclavicular adenopathies. A positron emission tomographic scan documented multiple visceral and bone metastases with a single hypermetabolic lesion of the right breast. The results of histology and immunohistochemistry were consistent with a metastasis from a squamous cell carcinoma. The patient died of acute respiratory insufficiency 1 month after her breast metastasis diagnosis and before starting any systemic antitumoral treatment. Conclusions Although breast metastases are extremely rare, they should be considered in any patient with a history of cancer and confirmed by histology and immunohistochemistry because they are very difficult to distinguish from other primary breast tumors based only on clinical and radiological features. There are no standardized treatment guidelines for breast metastasis management. Surgery and radiotherapy can play a role in symptom palliation, but they do not have any relevant impact on survival, the prognosis being poor, with an estimated overall survival less than 1 year from diagnosis.
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Affiliation(s)
- Raffaele Longo
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France.
| | - Emmanuelle Melgar
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Marco Campitiello
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Francesca Plastino
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Nada Eid
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Isabelle Quirin
- Division of Radiology, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Laurent Hennequin
- Division of Radiology, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Yves Grignon
- Division of Pathology, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Michel Gunther
- Division of Gynecology, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Philippe Quétin
- Division of Radiotherapy, Centre Hospitalier Régional (CHR) Metz-Thionville, 1 Allée du Château, 57085, Ars-Laquenexy, France
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8
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Ali RH, Taraboanta C, Mohammad T, Hayes MM, Ionescu DN. Metastatic non-small cell lung carcinoma a mimic of primary breast carcinoma-case series and literature review. Virchows Arch 2017; 472:771-777. [PMID: 29105026 DOI: 10.1007/s00428-017-2262-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/09/2017] [Accepted: 10/26/2017] [Indexed: 12/22/2022]
Abstract
Metastatic tumors to the breast are rare but constitute a major diagnostic dilemma. Of these, non-mammary carcinomatous metastases to the breast are particularly challenging and, without a clinical history, may be extremely difficult to distinguish from primary breast carcinoma (PBC). We specifically studied metastatic tumors of pulmonary origin, as the lung is one of the major primary sites for carcinomatous metastasis to breast. Sixteen metastatic lung tumors to the breast were identified in our archives between 1996 and 2017 including 12 non-small cell lung carcinomas (NSCLC), one large-cell neuroendocrine, one atypical carcinoid, and two small-cell carcinomas. Adenocarcinoma was the most frequent amongst the NSCLCs (11/14). We retrieved the clinical information of these cases and reviewed the pathological characteristics to provide practical tools for pathologists to aid in their identification. Even in the absence of a clinical history of lung cancer, metastatic pulmonary adenocarcinoma to the breast should be considered in at least one of the following scenarios: (1) single or multiple well-circumscribed lesions of the breast that lack an in situ component and that are accompanied by distant metastases but negative axillary lymph nodes, (2) breast tumors that are triple negative yet not high-grade, or (3) breast tumors presenting as stage 4 disease and/or having an unusually aggressive clinical course on standard breast therapy. Accurate and timely diagnosis of these tumors is mandatory because of treatment and prognostic implications.
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Affiliation(s)
- Rola H Ali
- Pathology Department, Health Sciences Center, Kuwait University, Kuwait, Kuwait
| | - Catalin Taraboanta
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tareq Mohammad
- Department of Pathology, University of California, Los Angeles, CA, USA
| | - Malcolm M Hayes
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Pathology Department, British Columbia Cancer Agency (BCCA), 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Diana N Ionescu
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada. .,Pathology Department, British Columbia Cancer Agency (BCCA), 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada.
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9
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Buisman FE, van Gelder L, Menke-Pluijmers MBE, Bisschops BHC, Plaisier PW, Westenend PJ. Non-primary breast malignancies: a single institution's experience of a diagnostic challenge with important therapeutic consequences-a retrospective study. World J Surg Oncol 2016; 14:166. [PMID: 27337944 PMCID: PMC4918012 DOI: 10.1186/s12957-016-0915-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 06/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background Breast cancer is a common malignancy, but metastases to the breast of extramammary malignancies are very rare. Treatment and prognosis are different. The aim of the study is to report the incidence of lymphomas and metastases to the breast of extramammary malignancies in our 30-year archive. Methods The pathology database of a single institute was reviewed for all breast neoplasms which were coded in our system as a metastasis in the period 1985–2014. Metastatic tumors from primary breast carcinoma were excluded. Results A total of 47 patients were included (7 men/40 women, mean age 63 years). The majority originated from lymphoma (n = 18) and primary melanoma (n = 11). Other primary tumor sites included the ovary (n = 6), lung (n = 6), colon (n = 3), kidney (n = 1), stomach (n = 1), and chorion (n = 1). In 24/47 patients (51 %), metastasis was the first sign of the specific malignant disease. In seven patients (15 %) surgery was performed, the diagnosis of metastatic disease was adjusted in four patients (9 %) postoperatively. Conclusions It is important to distinguish lymphomas and metastases to the breast from common primary breast carcinoma for proper treatment and prognosis. Therefore, we emphasize the need for a histological or cytopathological diagnosis before any treatment is commenced. The pathologist plays a key role in considering the diagnosis of metastasis if the histological features are unusual for a primary breast carcinoma. The pathologist should therefore be properly informed by the clinical physician although lymphomas and metastases to the breast are the first presentation of malignant disease in half the cases.
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Affiliation(s)
- Florian E Buisman
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands. .,Department of Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Linda van Gelder
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Bob H C Bisschops
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Pieter J Westenend
- Laboratory of Pathology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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10
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Wang L, Wang SL, Shen HH, Niu FT, Niu Y. Breast metastasis from lung cancer: a report of two cases and literature review. Cancer Biol Med 2014; 11:208-15. [PMID: 25364582 PMCID: PMC4197421 DOI: 10.7497/j.issn.2095-3941.2014.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/13/2014] [Indexed: 01/14/2023] Open
Abstract
Breast metastasis from extra-mammary malignancy is rare. An incidence of 0.4% to 1.3% has been reported in literature. The primary malignancies that most commonly metastasize to the breast are leukemia, lymphoma, and malignant melanoma. In this report, two cases of pulmonary metastasis to the breast were presented. A 40-year-old female manifested a right breast mass of 2-month duration. After physical examination was performed, a poorly defined mass was noted in the upper outer quadrant of the right breast. Another 49-year-old female manifested right breast mass of 5-day duration. A poorly defined mass was noted in the lower inner quadrant of the right breast. Mammography results also revealed breast cancer. The patients underwent local excision. After histological and immunohistochemical analyses were conducted, a primary lung carcinoma that metastasized to the breast was diagnosed. An accurate differentiation of metastasis to the breast from primary breast cancer is very important because the treatment and prognosis of the two differ significantly.
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Affiliation(s)
- Li Wang
- Department of Breast Cancer Pathology and Research Laboratory; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 30060, China
| | - Shu-Ling Wang
- Department of Breast Cancer Pathology and Research Laboratory; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 30060, China
| | - Hong-Hong Shen
- Department of Breast Cancer Pathology and Research Laboratory; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 30060, China
| | - Feng-Ting Niu
- Department of Breast Cancer Pathology and Research Laboratory; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 30060, China
| | - Yun Niu
- Department of Breast Cancer Pathology and Research Laboratory; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 30060, China
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11
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Koch A, Richter-Marot A, Wissler M, Baratte A, Mathelin C. Métastases mammaires de cancers d’origine extra-mammaire : état des lieux et difficultés diagnostiques. ACTA ACUST UNITED AC 2013; 41:653-9. [DOI: 10.1016/j.gyobfe.2013.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Indexed: 10/26/2022]
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12
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DeLair DF, Corben AD, Catalano JP, Vallejo CE, Brogi E, Tan LK. Non-mammary metastases to the breast and axilla: a study of 85 cases. Mod Pathol 2013; 26:343-9. [PMID: 23174933 DOI: 10.1038/modpathol.2012.191] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Non-mammary metastases to the breast and axilla are rare occurrences. However, they are important diagnostic considerations as their treatment and prognosis differ significantly from primary breast cancer. Between 1990 and 2010, we identified a total of 85 patients, 72 women and 13 men, with non-mammary malignancies involving the breast, axilla, or both. The tumor types consisted of carcinoma (58%), melanoma (22%) and sarcoma (20%). Ovary was the most common site of origin for carcinoma, and metastatic high-grade ovarian serous carcinoma was most frequently misdiagnosed as a primary breast carcinoma. Melanoma was the single most common non-carcinomatous tumor type to involve the breast and/or axilla, and uterine leiomyosarcoma was the most common type of sarcoma. Most patients (77%) had other metastases at the time of diagnosis of the tumor, but in 11% the breast or axillary lesion was the first presentation. Without a clinical history, non-mammary metastases were difficult to diagnose because the majority of cases presented with a solitary nodule and lacked pathognomonic pathologic features. There were, however, certain recurrent histological findings identified, such as the often relatively well-circumscribed growth pattern of the metastatic lesion surrounded by a fibrous pseudocapsule, and the absence of an in situ carcinoma. Overall, these patients had poor survival; 96% of patients with follow-up available are dead of disease, with a median survival of 15 months after the diagnosis of the breast or axillary lesion. This finding emphasizes the need to accurately identify these tumors as metastases in order to avoid unnecessary procedures and treatments in these patients.
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Affiliation(s)
- Deborah F DeLair
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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13
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D'Angelo P, Carli M, Ferrari A, Manzitti C, Mura R, Miglionico L, Di Cataldo A, Grigoli A, Cecchetto G, Bisogno G. Breast metastases in children and adolescents with rhabdomyosarcoma: Experience of the Italian Soft Tissue Sarcoma Committee. Pediatr Blood Cancer 2010; 55:1306-9. [PMID: 20730885 DOI: 10.1002/pbc.22729] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 06/03/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Breast metastasis from rhabdomyosarcoma (RMS) is an uncommon event but may be problematic in treatment decision-making. Aim of the study was to evaluate clinical characteristics, treatment, and subsequent outcome, of patients with RMS metastasis in the breast, enrolled in four consecutive Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP) Soft Tissue Sarcoma Committee protocols during the last 20 years, in order to obtain information to establish a more adequate diagnostic and therapeutic approach. PROCEDURES Data were derived from the AIEOP STSC database and reviewed for the purpose of this study. RESULTS From 1988 to 2008, among 189 patients with metastatic RMS, we identified 7 (3.7%) patients with RMS with breast involvement at diagnosis. All patients were females, aged 13-17 years with alveolar histology and multiple metastasis sites (2-5). The primary tumor was located in the extremities in 3/7 patients. In spite of intensive treatment no patient survived. The cause of treatment failure was distant relapse in six patients, including two on the mammary region. Treatment data analysis revealed that local measures to control breast lesions were used in only two patients. CONCLUSIONS Our data suggest that investigations of the mammary region should be part of the usual diagnostic workup in adolescent girls with alveolar RMS, especially if the primary tumor arises in the extremities. New and more effective strategies are needed to improve the outcome of these patients including aggressive local measures to control breast disease.
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Affiliation(s)
- Paolo D'Angelo
- Pediatric Hematology and Oncology Unit, G. Di Cristina Children's Hospital, Palermo, Italy.
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Rodríguez-Gil Y, Pérez-Barrios A, Alberti-Masgrau N, Garzón A, de Agustín P. Fine-needle aspiration cytology diagnosis of metastatic nonhaematological neoplasms of the breast: a series of seven cases. Diagn Cytopathol 2010; 40:297-304. [PMID: 22431317 DOI: 10.1002/dc.21559] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 09/02/2010] [Indexed: 11/11/2022]
Abstract
Metastatic neoplasms of the breast are rare. Mammary metastases as the initial presentation are even more infrequent and can simulate a primary malignancy clinically and radiologically. Recognition of metastatic tumors in the breast is important because it would prevent unnecessary mutilating surgery and would lead to appropriate treatment of the primary tumor. There is a broad variety of cytological appearances reported about primary tumors and few reports about secondary breast malignancies, specially diagnosed by FNAC. This study was carried out to examine the clinical and cytomorphologic features of metastatic breast tumors found in 12 de Octubre University Hospital during a period of 20 years. It confirms the utility of FNAC and describes findings that can help in the differential diagnosis that sometimes can be very difficult. Seven cases of nonhematological metastatic neoplasms of the breast were identified from the files of the Department of Pathology of the 12 de Octubre University Hospital from a total of 64,000 aspirates. We included only metastatic tumors from extramammary nonhematological neoplasms. There were nine cases of hematological metastatic neoplasm that were excluded. They were diagnosed with FNAC and confirmed by histopathology, with at least three years of follow up. The breast lump was the first manifestation of malignancy in one case of synovial sarcoma. The other six cases had been previously diagnosed of cancer. These included one malignant melanoma, one alveolar rhabdomyosarcoma, one mixed müllerian tumor, one medullary carcinoma of thyroid, one colonic adenocarcinoma, and one gastric adenocarcinoma. The period of time between primary tumor and metastases ranged from one month to eight years. An accurate cytologic diagnosis was made in all the cases. Immunocytochemistry was available but diagnosis could be made with cytomorphology alone in the seven cases. Fine-needle aspiration cytology is an excellent first line diagnostic modality that is particularly informative when clinical previous data are known. If metastatic disease is suspected, the material obtained by FNAC may provide a definitive diagnosis and prevent open surgical biopsy or mastectomy. We concur with previous reports that FNAC is a reliable, rapid, secure, and cost-effective approach to the diagnosis of palpable metastatic breast tumors.
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Affiliation(s)
- Yolanda Rodríguez-Gil
- Department of Pathology, Hospital Universitario 12 de Octubre, Avda de Córdoba S/N, Madrid, Spain.
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15
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Sauer T. Fine-needle aspiration cytology of extra mammary metastatic lesions in the breast: A retrospective study of 36 cases diagnosed during 18 years. Cytojournal 2010; 7:10. [PMID: 20806071 PMCID: PMC2924528 DOI: 10.4103/1742-6413.65056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 02/19/2010] [Indexed: 11/26/2022] Open
Abstract
Background: Metastatic tumors in the breast require treatment according to origin and type of tumor. It is important to recognize these lesions in fine-needle aspiration cytology (FNAC) in order to avoid unnecessary mastectomy or non-relevant chemotherapy. The aim of this study was to evaluate the cytological features of metastatic tumors and possible criteria that could alert us as to the possibility of a metastasis from an extra mammary malignancy. Methods: The material included 36 confirmed or suspected metastases in the breast registered in the pathology files at Oslo University Hospital, Ulleval, during 1990–2007. There were a total of 6,325 cases of malignant breast FNAC, representing 30 men and 6,295 women. Smears were evaluated for the amount of material, presence or absence of myoepithelial cells, microcalcifications, mitoses and necrotic material. All carcinomas were graded. Results: There were seven men (7/30 = 23.3%) and 29 women (29/6,295 = 0.46%). The primary tumor was known in 22 cases (22/36 = 61.1%). No other primary tumor was known and metastatic lesion was not initially suspected in 14 cases (14/36 = 38.9%). The most common origin was lung (15/36 = 41.7%). In five cases (5/36 = 13.9%), the origin remained uncertain. Conclusions: Metastases from extra mammary sites are (relatively) common in males (23.3%). In women, metastatic lesions are rare (0.46%). A large proportion of them (88%) are high-grade adenocarcinomas and poorly differentiated carcinomas that may resemble grade 3 ductal carcinomas. Unusual clinical and/or radiological presentation in combination with high-grade malignant cells should alert us to consider the possibility of a metastasis.
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Affiliation(s)
- Torill Sauer
- Department of Pathology, Faculty Division of Clinical Medicine, Oslo University Hospital, Ulleval, N-0407 Oslo, Norway
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16
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Mehdi G, Ansari HA, Sherwani RK, Bhargava R. Small Cell Carcinoma in the Mammary Gland: Primary or Metastatic? A Diagnostic Challenge. World J Oncol 2010; 1:97-100. [PMID: 29147188 PMCID: PMC5649912 DOI: 10.4021/wjon2010.04.207w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2010] [Indexed: 11/24/2022] Open
Abstract
Metastatic tumours to the mammary gland are relatively uncommon as compared to primary breast malignancies. Such lesions can pose diagnostic dilemmas for both the clinician and the pathologist because it is often difficult to categorize the tumour as primary or secondary and to determine the site of origin. We present the case of a thirty year old female who was diagnosed with small cell neuro-endocrine carcinoma in the mammary gland, probably of pulmonary origin. The diagnostic challenges posed by such a case are highlighted.
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Affiliation(s)
- Ghazala Mehdi
- Departments of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Hena A Ansari
- Departments of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rana K Sherwani
- Departments of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rakesh Bhargava
- Departments of Tuberculosis and Chest Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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17
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Doval DC, Pande SB, Sharma JB, Khatri S, Khurana AK, Vaid AK, Chaturvedi AK, Hazarika D. Metastatic Signet-Ring Cell Gastric Carcinoma Masquerading as Breast Primary. Case Rep Gastroenterol 2009; 3:21-25. [PMID: 20651960 PMCID: PMC2895171 DOI: 10.1159/000203648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Metastasis to the breast from an extra-mammary primary is a rare phenomenon; metastasis from gastric carcinoma to the breast is extremely so. We report a case who initially presented as mucin-secreting and signet-ring cell tumor of the ovary, and after an interval of 8 months with breast and chest wall metastatic nodules. The covert gastric primary eluded the oncologists at both presentations.
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Affiliation(s)
- Dinesh Chandra Doval
- Departments of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
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18
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Uludag M, Citgez B, Ozkaya O, Sakiz D. In-transit metastasis of the breast region from malignant melanoma of the trunk. BMJ Case Rep 2009; 2009:bcr07.2008.0433. [PMID: 21686814 DOI: 10.1136/bcr.07.2008.0433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Extramammarian cancer metastases to the breast are rare. Melanoma is one of the malignancies that can metastasise to the breast. The distinction between a primary breast carcinoma and a metastatic neoplasm is crucial because surgical and therapeutic treatment options will vary accordingly. The present report concerns a case of breast metastasis from melanoma of the trunk. A 50-year-old man with a self-detected left breast lump who had previously undergone wide local excision and axillary dissection for melanoma was admitted to our department. Ultrasonography showed an 0.8 cm hypoechoic nodule with silent margins. The palpable mass was excised. Surgical pathology revealed metastatic melanoma.
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Affiliation(s)
- Mehmet Uludag
- Sisli Etfal Training and Research Hospital, 2nd General Surgery, Etfal Sok. No. 1, Istanbul, 34360, Turkey
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19
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Wood B, Sterrett G, Frost F, Swarbrick N. Diagnosis of extramammary malignancy metastatic to the breast by fine needle biopsy. Pathology 2008; 40:345-51. [PMID: 18446623 DOI: 10.1080/00313020801911520] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS To review and illustrate the findings in fine needle biopsy (FNB) of extramammary malignancies presenting with breast metastases (MMB). METHODS We reviewed 32 cases of MMB diagnosed on breast FNB. The clinical data, with particular attention to the history of a known primary malignancy, previous systemic metastatic disease in other sites and presentation with extramammary disease in addition to a breast mass were examined. The morphological appearances were reviewed and are illustrated, focusing on those features which allow the pathologist to recognise the possibility of metastatic disease and undertake appropriate steps to investigate this. RESULTS The 32 cases included metastases from a wide range of sites, including cutaneous melanoma (10), lung (8), non-Hodgkin's lymphoma (5), soft tissue (4), colon (2), endometrium, ovary and bladder. There was a history of extramammary malignancy in 26, while in six patients the breast mass was detected at initial presentation with malignant disease. Of the latter six patients, four had evidence of widespread metastases, while one presented with multiple breast masses. In 16 cases the cytological features allowed the possibility of metastases to be recognised without clinical data, while in the other 16 there was sufficient overlap with primary mammary carcinoma that the possibility of metastases could be missed. Only one case was initially mistaken for a primary tumour, in this case the history of prior malignancy with systemic metastases was not provided to the reporting pathologist. CONCLUSION The majority (81%) of cases of MMB have a history of primary malignancy, although only a minority have a history of systemic metastases at other sites. Of those patients without known prior malignancy, the majority present with systemic disease or multiple breast lesions. The cytological features allow metastatic disease to be suspected in half of the cases, although in the others, particularly patients with metastatic adenocarcinoma, diagnosis without recourse to immunohistochemistry is difficult or impossible. A combination of complete clinical history, attention to the cytological features and suspicion in cases with metastatic disease beyond the axilla should allow most cases of MMB to be suspected, and suitable material for ancillary confirmatory testing to be obtained.
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Affiliation(s)
- Benjamin Wood
- PathWest Laboratory Medicine WA, QEII Medical Centre and School of Surgery and Pathology, The University of Western Australia, Perth, Western Australia, Australia.
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20
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Charfi S, Makni SK, Khanfir A, Abbes K, Gouiaa N, Fakhfakh I, Guermazi M, Daoud J, Frikha M, Sellami-Boudawara T. Les métastases mammaires : étude anatomoclinique de six cas. ACTA ACUST UNITED AC 2008; 37:346-52. [DOI: 10.1016/j.jgyn.2008.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2007] [Revised: 01/24/2008] [Accepted: 02/19/2008] [Indexed: 11/27/2022]
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21
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Luh SP, Kuo C, Tsao TCY. Breast metastasis from small cell lung carcinoma. J Zhejiang Univ Sci B 2008; 9:39-43. [PMID: 18196611 PMCID: PMC2170467 DOI: 10.1631/jzus.b072258] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Accepted: 12/03/2007] [Indexed: 11/11/2022]
Abstract
Breast metastases from extramammary neoplasms are very rare. We presented a 66 year-old female with metastasis of small cell lung carcinoma to the breast. She presented with consolidation over the left upper lobe of her lung undetermined after endobronchial or video-assisted thoracoscopic surgery (VATS) biopsy, and this was treated effectively after antibiotic therapy at initial stage. The left breast lumps were noted 4 months later, and she underwent a modified radical mastectomy under the impression of primary breast carcinoma. However, the subsequent chest imaging revealed re-growing mass over the left mediastinum and hilum, and cells with the same morphological and staining features were found from specimens of transbronchial brushing and biopsy. An accurate diagnosis to distinguish a primary breast carcinoma from metastatic one is very important because the therapeutic planning and the outcome between them are different.
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Affiliation(s)
- Shi-ping Luh
- Department of Surgery, Chia-Yi Christian Hospital and Chung-Shan Medical University and Hospital, Taichung 402, Taiwan, China.
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22
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Fulciniti F, Losito S, Botti G, Di Mattia D, La Mura A, Pisano C, Pignata S. Metastases to the breast: role of fine needle cytology samples. Our experience with nine cases in 2 years. Ann Oncol 2007; 19:682-7. [PMID: 18048381 DOI: 10.1093/annonc/mdm546] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The increased survival due to the introduction of effective antineoplastic regimens has caused a modification of the natural history of numerous malignancies. Follow-up of neoplastic patients often includes the evaluation of masses in various body sites by fine needle cytology (FNC) in order to rule out cancer recurrence. Besides primary neoplasms, the breast can host a number of metastases: these rarely do have a typical presentation, so FNC is requested for their cytomorphological assessment. PATIENTS AND METHODS This report describes nine consecutive cases in which a cytopathological diagnosis of metastasis to the breast was carried out on FNC samples. RESULTS Primary sites were identified on cytomorphological and immunocytochemical bases and were represented by the ovary (three cases), melanoma (two cases), endocervix (one case), endometrium (one case), lung (one case) and prostate (one case). CONCLUSION The cytopathological diagnosis of metastatic neoplasms to the breast is not always straightforward, especially in the absence of a clinical history of cancer. The usage of improved cytopathological criteria combined with immunocytochemistry may be of great diagnostic help in the identification of breast metastases.
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Affiliation(s)
- F Fulciniti
- Section of Pathology, Cytopathology Service, National Cancer Center, Fondazione G. Pascale, Via Mariano Semmola 1, I-80131 Naples, Italy.
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23
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Omeroglu G, Ersşahin C, Potkul RK, Booth CN. FNA diagnosis of retroperitoneal leiomyosarcoma metastasizing to the breast. Diagn Cytopathol 2007; 35:508-11. [PMID: 17636496 DOI: 10.1002/dc.20664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fine-needle aspiration (FNA) biopsy is one of the first-line investigations in any breast lump, and hence cytomorphological recognition of nonmammary metastatic tumors to the breast and their distinction from primary tumors is important. Breast metastasis from extra-mammary malignancy is rare, constituting 2% of breast tumors; even rarer are metastatic leiomyosarcomas. Our patient presented with a breast lump 2 years after operative removal of a retroperitoneal leiomyosarcoma. The breast lump was confirmed to be a metastasis from the earlier primary. Herein, we report the first case of a retroperitoneal leiomyosarcoma metastatic to the breast diagnosed by Fine Needle Aspiration.
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Affiliation(s)
- Gulbeyaz Omeroglu
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
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24
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Charfi S, Ayadi L, Khanfir A, Ben Mahfoudh K, Khabir A, Bahri I, Gouiaa N, Makni S, Mnif Z, Frikha M, Sellami-Boudawara T. Métastase mammaire d’un choriocarcinome. IMAGERIE DE LA FEMME 2007. [DOI: 10.1016/s1776-9817(07)88743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Racz MM, Pommier RF, Troxell ML. Fine-needle aspiration cytology of medullary breast carcinoma: report of two cases and review of the literature with emphasis on differential diagnosis. Diagn Cytopathol 2007; 35:313-8. [PMID: 17497662 DOI: 10.1002/dc.20639] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Melinda M Racz
- Department of Pathology, Oregon Health & Science University, Portland, Oregon 97239, USA
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26
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Abstract
PURPOSE OF REVIEW Fine needle aspiration has been used for many years as a diagnostic tool for breast lesions, with high sensitivity and specificity. There is controversy as to whether this technique should be replaced by other diagnostic procedures such as core biopsy. This review aims to re-evaluate the usefulness of breast fine needle aspiration. RECENT FINDINGS During the past 10 years many institutions have replaced fine needle aspiration by core biopsy and related techniques such as vacuum-assisted core biopsy and advanced breast biopsy instrument action. Other institutions continue to use fine needle aspiration as a first line of investigation for breast lesions. This technique is especially useful in radiologically benign lesions and when combined with image guidance. The use of the 'triple test' (combined cytologic, clinical and radiologic findings) decreases false-negative and false-positive results. SUMMARY Fine needle aspiration continues to be an acceptable and reliable procedure for the preoperative diagnosis of breast lesions, particularly in developing countries, and when used as part of the 'triple test'. Accurate diagnosis requires experience in both aspiration technique and specimen interpretation. Clinicians should be mindful of the limitations of the technique. The choice between fine needle aspiration and core biopsy should be individualized for the patient.
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Affiliation(s)
- Benjaporn Chaiwun
- Department of Pathology, Chiang Mai University, Chiang Mai, Thailand.
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27
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Iyengar P, Reid-Nicholson M, Moreira AL. Pregnancy-associated anaplastic large-cell lymphoma of the breast: a rare mimic of ductal carcinoma. Diagn Cytopathol 2006; 34:298-302. [PMID: 16544330 DOI: 10.1002/dc.20442] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Anaplastic large-cell lymphoma (ALCL) is a rare T-cell lymphoma typically seen in children and young adults. It has been described in numerous sites; however, the breast is one of the least common locations. We herein report a case of ALCL arising in the breast of a 36-yr-old pregnant woman. To our knowledge this is the second such case in the English literature. We would like to highlight the cytologic and histologic features of ALCL, as this case was initially misdiagnosed as a ductal carcinoma. Differential diagnosis with other tumors is also discussed. This case serves to emphasize the importance of the triple test, and the need for correlation of fine-needle aspiration findings with core biopsy findings in breast tumor management.
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Affiliation(s)
- P Iyengar
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
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