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

Dipartimento di Scienze Biomorfologiche e Funzionali, Sezione di Citopatologia, Naples, Italy.
Diagnostic Cytopathology (Impact Factor: 1.12). 09/2005; 33(3):205-9. DOI: 10.1002/dc.20340
Source: PubMed


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.

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    • "Owing to the wide histopathologic variation, MBC poses a diagnostic challenge and is often confused with benign and other malignant entities [13] [14]. Furthermore , MBCs are very frequently misdiagnosed in aspiration samples because they show a myriad of cytomorphologic patterns [13] [15] [16]. Therefore, combining findings derived from both cytology and histopathology and potentially immunohistochemistry (IHC), best allows for the proper diagnosis and management [12] [14]. "
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    ABSTRACT: Metaplastic breast carcinoma (MBC) is a rare malignancy comprised of ductal, squamous and/or mesenchymal elements with problematic diagnosis. This study analyses MBC identifying its cytologic and histologic features and emphasizing the combined role of FNAC, histopathology and immunohistochemistry (IHC) in its diagnosis. Cytology and histopathology files search yielded 21 cases identified as MBC from January 2005 to December 2010. FNAC and the histopathology slides were re-examined for the presence and frequency of various elements. Cytological and histopathological diagnoses were made and the cases subtyped according to WHO classification. Cytokeratin and vimenten IHC were used to confirm diagnosis when required. On FNAC, 52.4% were diagnosed as malignant, 9.5% as suspicious for malignancy and 38.1% as benign lesions. Most frequent cytologic findings were squamous and spindle cell elements (52.4% each). Histopathology revealed 76.2% pure epithelial tumors and 23.8% mixed epithelial-mesenchymal tumors. Squamous cell carcinoma was the most frequent histological subtype (33.3%). Carcinosarcomas were dimorphic on IHC& spindle cell carcinomas were positive for both cytokeratin and vimentin. Presence of dual components, squamous, spindle elements, mesenchymal fragments and necrosis in moderate to high cellularity breast FNAC provides clues for the diagnosis of MBC. FNAC; histopathology and IHC complement for diagnosis.
    Breast disease 09/2013; 34(2):67-75. DOI:10.3233/BD-130353
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    • "Therefore, the pathologist commonly must settle for suboptimal sampling -- too few passes, or perhaps sampling areas representing less than 50% or even 25% of the lesion. Also, metaplastic carcinomas not uncommonly reveal prominent cystic or necrotic areas, contributing to further complications in the identification of an additional cell population, especially when less than optimal sampling has occurred [9]. "
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    ABSTRACT: Because metaplastic carcinoma of the breast encompasses a great variety of histopathology, diagnostic challenges abound, especially within the realm of cytology. The authors compiled and studied an eight-case series comprised of metaplastic breast carcinomas and lesions initially suspicious cytologically for metaplastic carcinoma in order to assess the degree of cytologic-histologic correlation and to identify recurring problematic themes surrounding the cytology-based diagnosis of this neoplasm. The cytologic and histologic slides from eight cases suspicious for metaplastic breast carcinoma diagnosed by fine needle aspiration (FNA) were collected and analyzed through a seven-year retrospective search of case files at our institution. Based on cytologic characteristics, the cases were separated into three groups. Group 1 consisted of three cases presenting with poorly differentiated adenocarcinoma and squamoid components on FNA. Group 2 was composed of two cases that featured a monophasic, malignant ductal cell population on cytology, while the cytologic specimens for the third group of cases presented with a mesenchymal component with or without a malignant glandular constituent. Cytologic-histologic correlation was present in two of three cases demonstrating a mesenchymal component, and there was 100% sensitivity in the cytologic detection of those mesenchymal elements. However, in only one of three cases was there an accurate cytologic diagnosis of metaplastic carcinoma when squamoid changes were present on FNA. Both cases demonstrating only malignant glandular elements on cytologic specimens revealed an additional component of malignant squamous differentiation upon the examination of mastectomy-derived tissue. These results indicate that squamous-like changes identified on FNA should be interpreted with caution and that sampling error remains a problematic recurrence in cytology. Regardless, there appears to be promise concerning the accurate cytologic diagnosis of metaplastic carcinoma when the lesion is characterized by a mesenchymal component. A study implementing a larger case number is essential in determining the significance of these findings.
    Diagnostic Pathology 01/2011; 6(1):7. DOI:10.1186/1746-1596-6-7 · 2.60 Impact Factor
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    ABSTRACT: Introduction Carcinosarcoma is a rare neoplasm in the breast generally associated with an adverse prognosis. Materials and methods we report a case of breast carcinosarcoma in a male breast. Results identification of malignant heterologous elements is the key to use this designation. Conclusions Carcinosarcomas are very aggressive tumours with a worse prognosis compared with ductal adenocarcinomas in the same stage. There are no image and clinical criteria to make an early diagnosis. Histological diagnosis will be definitive.
    07/2006; 39(3):180–182. DOI:10.1016/S1699-8855(06)70035-6
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