Abstract
A mammary nodular lesion was recognized one month before the surgery in the right upper breast of a 55-year-old female. The fine needle aspiration cytology specimens contained many individual bizarre, multi-nucleated, and/or giant cells having hyperchromatic pleomorphic nuclei, prominent nucleoli, and relatively abundant cytoplasm, admixed with numerous mitotic figures in a hemorrhagic or inflammatory background. A small amount of sheet-like or three-dimensional clusters of malignant cells coexisted. We first interpreted it as high-grade malignancy, such as invasive carcinoma, not otherwise specified. A right breast-conserving surgery was performed, and gross examination revealed a cystic cavity-formed and solid tumor lesion, measuring 35 × 35 × 25 mm and looking gray-yellowish to -whitish. On microscopic examination, the tumor was composed of a diffuse proliferation of highly atypical cells devoid of adhesive characteristics, including many multi-nucleated giant bizarre cells, in a haphazard fashion with stromal invasion, alternating with sarcomatoid features of spindle tumor cells. The cystic cavity was surrounded by hemorrhagic and inflammatory granulation tissue and lined by mostly denuded but atypical tumor cells or bland-looking flattened epithelial cells. Immunohistochemically, these tumor cells are specifically positive for all epithelial markers. Therefore, we made a conclusive diagnosis of pleomorphic carcinoma of the breast with cyst formation. We should be aware that, owing to its characteristic findings, cytopathologists can diagnose correctly, based on careful cytological examination of adequate samplings.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9290689448998782
Highlights
An entity of mammary pleomorphic carcinoma (PC) was first established based on the following criteria, as previously described by Silver and Tavassoli in 2000 [1]: ≥50% of the tumor manifested a pleomorphic cell population, and tumors of lobular origin were excluded out
Based on all these features, we indicated that these tumor cells were characteristic of epithelial differentiation, and made a diagnosis of PC of the breast associated with cyst formation
The prognosis of the current PC patient might unusually appear better than that reported by Silver and Tavassoli [1], since it is likely that the final diagnosis was made at a relatively earlier stage of the tumors; even though follow-up period was not too long in this limited case report
Summary
An entity of mammary pleomorphic carcinoma (PC) was first established based on the following criteria, as previously described by Silver and Tavassoli in 2000 [1]: ≥50% of the tumor manifested a pleomorphic cell population, and tumors of lobular origin were excluded out. Corresponding to most invasive ductal carcinomas of the breast, PC could be seen at any age, but tend to occur in the perimenopausal period [1,3], as in the present case. We recently have seen no series of large detailed studies regarding with cytological findings in PCs of the breast, except for few case reports previously published [6,7,8]. It is critical to establish an accurate preoperative diagnosis by fine needle aspiration cytology
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