Abstract
Fibroadenomas are common benign breast tumours that display a characteristic pathological morphology, although several epithelial and stromal variations exist. A very rare histological finding is the presence of multinucleated giant cells throughout the stroma of a benign fibroadenoma. Cells of this type, which are more commonly found incidentally within the interlobular stroma of breast tissue, are benign and should not be mistaken for malignant cells on microscopic examination. Unfortunately a lack of awareness of this pathological entity can lead to diagnostic confusion amongst pathologists resulting in the multinucleate giant cells being mistaken for highly mitotic cells and consequently the fibroadenoma being mistaken for a malignant lesion. This may have serious implications for the subsequent management of the patient. The presence of this unusual cell type in the stroma does not alter the prognosis of otherwise benign lesion. We encountered two such cases at our institution in a six month period recently. We present their histories along with relevant radiological, microscopic and immunohistochemical features, followed by a discussion of this unusual pathological entity.
Highlights
A 42 year old female was referred to the Breast Clinic for assessment of a palpable right breast lump
In 1979 Rosen first described the presence of Multinucleated Stromal Giant Cells (MSGCs) in the breast, as an incidental finding in breast specimens from 14 patients with breast carcinoma [1]
The tissue foci containing these atypical MSGCs were located in otherwise normal areas of the mammary gland and were usually distinct from the carcinomata
Summary
In 1979 Rosen first described the presence of Multinucleated Stromal Giant Cells (MSGCs) in the breast, as an incidental finding in breast specimens from 14 patients with breast carcinoma [1]. In a recent review of literature published by Cai G regarding the presence of osteoclast-like multinucleated giant cells in mammary carcinomas [10], the occurrence of MSGCs in a variety of malignant tumours was described This report noted their presence in a spectrum of invasive and in-situ breast carcinomas and referred to their original description in malignant breast lesions by Rosen [1]. Hamartomas are breast lesions with varying amounts of benign epithelial elements, fibrous tissue, and fat and in rare cases the occurrence of giant cells has been noted They lack a distinctive pathological appearance most authors agree on a general characteristic pattern of interlobular fibrosis, which is defined as the presence of lobules within a fibrotic stroma, which surrounds and extends to between individual lobules and obliterates the usual interlobular specialised loose stroma [22]. A complete triple assessment of these lesions is warranted to formulate the correct diagnosis, including correlation of the clinical impression with the radiologically distinct imaging findings and the above pathological features
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