Bilateral carcinoid tumor of the breast. Report of a case with diagnosis by fine needle aspiration cytology.

A case of bilateral carcinoid tumors of the breast was studied by cytology, histology, immunohistochemistry and electron microscopy. The preoperative aspiration cytologic findings strongly suggested a carcinoid tumor of the breast. The differential diagnosis with fine needle aspiration cytology of other breast lesions, the bilaterality of the condition and terminology are discussed.     

A follow-up study of 105 women with breast cancer following reduction mammaplasty.

Reduction mammaplasty is one of the most common procedures performed by plastic surgeons in Canada. In a recent study of 27,500 women in the province of Ontario who underwent breast reduction surgery, 105 women were identified who developed breast cancer after reduction mammaplasty. The purpose of this study was to compare women who had breast cancer and had a previous breast reduction with women who had breast cancer but did not have a breast reduction. Specifically, we wanted to document patient demographics, cancer type, surgical and nonsurgical treatment, and eventual outcome. A comparison group of non-breast reduction women was taken from the cohort of breast cancer patients in the province of Ontario, and the two groups were matched for age, year of diagnosis, and place of diagnosis. It was found that (1) the average age at diagnosis of breast cancer is significantly younger for women who have had previous breast reduction surgery than for those who have not; (2) the median interval between breast reduction and cancer is 5 years; (3) the type, location, and side of breast cancers are similar in the two groups of women; (4) breast reduction does not significantly increase or decrease survival rate from breast cancer; and (5) women who have had breast reduction receive the same treatment for their breast cancer as women who have not had reduction mammaplasty.     

Pseudosarcomatous fasciitis of the breast. Cytologic and histologic features

A rare case of pseudosarcomatous fasciitis of the breast is presented. Both the clinical examination and the mammographic findings led us to expect a malignant lesion. Fine needle aspiration biopsy cytology, however, was negative, with the cells observed indicating a benign lesion. The benignity was proven by histologic examination of the extirpated nodule. The usefulness of aspiration cytology in the diagnosis of this entity and the need for a combined methodology in the diagnosis of breast tumors are emphasized.     

Secretory carcinoma of the breast. Report of a case with fine needle aspiration biopsy

A case of secretory carcinoma of the breast in a 48-year-old woman studied by fine needle aspiration (FNA) cytology is presented. The prominent intracytoplasmic vacuolization and numerous signet-ring forms and the presence of sheets of neoplastic cells with large intercellular spaces should permit its diagnosis in FNA specimens. The differential diagnosis of this rare lesion from other breast neoplasms that show similar features is discussed.     

Pleomorphic lobular carcinoma of the breast. A case report

BACKGROUND: Pleomorphic lobular carcinoma of the breast is associated with aggressive behavior. CASE: Fine needle aspiration cytology was performed on a breast lump in a 55-year-old woman. The aspirates showed highly pleomorphic, large cells in a dyscohesive pattern, with a tendency of few cells to aggregate in small groups. A diagnosis of ductal carcinoma was made on cytology. On histology, the paraffin sections showed features of pleomorphic lobular carcinoma of the breast. CONCLUSION: The cytologic features of pleomorphic lobular carcinoma overlap with those of infiltrating ductal carcinoma. It is very difficult to make a diagnosis of pleomorphic lobular carcinoma prospectively on cytology. However, if Indian file arrangement and cytoplasmic vacuolation are present, pleomorphic lobular carcinoma must at least be suggested for the differential diagnosis as it has different clinical implications.     

Extramedullary plasmacytoma presenting as a primary mass in the breast. A case report

BACKGROUND: Extramedullary plasmacytoma (EMP) of the breast is extremely rare, especially that not associated with multiple myeloma. CASE: A case of plasmacytoma of the breast in a 73-year-old man was diagnosed by fine needle aspiration cytology (FNAC). Aspiration smears revealed a dispersed population of plasmacytoid cells at various stages of maturation. The tumor was excised, and the histologic sections confirmed the cytologic diagnosis. CONCLUSION: FNAC diagnosis of plasmacytoma of the breast offers the opportunity to distinguish these neoplasms from primary mammary tumors and avoid unnecessary surgery.     

Fine needle aspiration biopsy of neuroendocrine breast carcinoma metastatic to the thyroid. A case report

BACKGROUND: Tumors showing neuroendocrine differentiation arise in a wide range of organs, and metastatic neuroendocrine tumors may be difficult to differentiate from primary tumors. This report describes an unusual case of metastatic breast carcinoma with neuroendocrine differentiation that presented as a solitary thyroid nodule. The diagnosis was made by fine needle aspiration biopsy (FNAB). CASE: A 52-year-old woman presented with a thyroid nodule and bilateral enlarged supraclavicular fossa lymph nodes. FNAB revealed a neuroendocrine carcinoma. Further questioning revealed that the patient had had a breast carcinoma resected eight years previously. The diagnosis of metastatic neuroendocrine breast carcinoma was established by immunocytochemistry. The patient received antiestrogen therapy but subsequently developed skeletal metastases. CONCLUSION: Neuroendocrine carcinomas from various sites show similar cytologic features. In this case, a diagnosis of breast carcinoma metastatic to the thyroid was suggested by the clinical history and confirmed by FNAB with immunocytochemistry.     

Fine needle aspiration cytology of dermatofibrosarcoma protuberans presenting as a breast mass. A case report

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous soft tissue neoplasm with a tendency to recur but rarely metastasize. It occurs at almost any site but usually in the trunk and extremities. DFSP mimicking a primary breast lesion has not been reported before. CASE: A 30-year-old female presented with an eight-month history of a breast mass that was aspirated, revealing a spindle cell neoplasm. The diagnosis of DFSP was made on excisional biopsy. CONCLUSION: The diagnosis of DFSP may be problematic, especially when it presents clinically as a primary breast lesion.     

Idiopathic granulomatous mastitis. Report of a case diagnosed with fine needle aspiration cytology.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a benign, inflammatory breast disease of unknown etiology. Although it is rare, it frequently presents in a manner similar to that of breast carcinoma. CASE: A 41-year-old female developed unilateral idiopathic granulomatous mastitis, diagnosed by fine needle aspiration cytology. The clinical presentation and mammographic findings were suspicious for carcinoma. Fine needle aspiration cytology showed granulomatous inflammation. Histopathologic examination revealed a noncaseating, granulomatous lesion. Further clinical, radiologic and laboratory investigations disclosed no etiology. Therefore, we considered the case to be idiopathic granulomatous mastitis. CONCLUSION: Cytologically it may be difficult to distinguish IGM from carcinoma of the breast. Typical cytologic findings of the lesion are helpful to rule out cancer. In the differential diagnosis, all known causes of granulomatous changes have to be excluded before a diagnosis of idiopathic granulomatous mastitis is made.     

Fine needle aspiration of Actinomyces infection of the breast. A novel presentation of thoracopleural actinomycosis.

A case of Actinomyces infection of the breast secondary to thoracopleural disease was initially diagnosed by fine needle aspiration biopsy. The tender, hard, swollen left breast was clinically suspected of harboring an inflammatory carcinoma. Cell block sections of the aspirate showed polymorphonuclear leukocytes surrounding a typical "sulphur granule" composed of branching filaments. The diagnosis was confirmed by culture of material obtained at subsequent surgery.     

Malignant fibrous histiocytoma,giant cell type,of the breast mimicking metaplastic carcinoma. A case report

BACKGROUND: We report a case of malignant fibrous histiocytoma, giant cell type (MFHGC), of the breast. A review of the literature failed to reveal cytology-based reports on this entity. The cytologic similarity of breast MFHGC on fine needle aspiration biopsy (FNAB) to other malignant breast neoplasms, including carcinoma with osteoclastlike giant cells, metaplastic carcinoma and breast sarcomas, as well as benign reactive processes, makes the recognition of this tumor challenging. CASE: A 72-year-old woman presented with a 5-month history of an enlarging breast mass. FNAB of the mass showed a hypercellular smear composed of cohesive, branching clusters of spindle cells with ovoid, focally hyperchromatic nuclei and inconspicuous nucleoli. Interspersed osteoclastlike giant cells, some associated with clusters of spindle cells, were uniformly seen throughout the smear. The background was hemorrhagic, with cellular debris and occasional spindle cells and lymphocytes. No ductal epithelial or myoepithelial cells were seen. An incisional biopsy was performed, followed by radical mastectomy. The histologic examination was diagnostic of MFHGC. The diagnosis was supported by immunohistochemical and electron microscopic studies. CONCLUSION: MFHGC, also called primary giant cell tumor of soft tissues, is composed of a mixture of histiocytes, fibroblasts and bland-appearing osteoclastlike giant cells with a multinodular growth pattern. Although MFHGC rarely occurs in the breast and the definitive diagnosis is difficult based on cytology alone, the diagnosis can be considered when a cytologic examination reveals a hypercellular, spindle cell smear with osteoclastlike giant cells in the absence of ductal epithelial or myoepithelial cells.     

Fine needle aspiration of breast masses. An analysis of 276 aspirates

A study of 276 consecutive fine needle aspirations (FNAs) of the breast in 240 cases is presented. Of these cases, 108 underwent subsequent biopsy of the breast; correlations between the FNA cytology and the surgical pathology findings revealed that FNA had a sensitivity of 79.4%, a specificity of 100% and a predictive value of a positive diagnosis of 100%. The overall diagnostic accuracy was 92.4%. These results are compared with those in other published series, and the pitfalls in and methods of improvement of breast FNA are discussed.     

Granulomatous angiopanniculitis of the breast. A case report

BACKGROUND: Granulomatous angiopanniculitis (GAP) is a rare benign condition of the breast of unknown etiology. Clinically and by fine needle examination, GAP may simulate breast carcinoma. The cytologic characteristics have not been described before. CASE: A 63-year-old female exhibited a palpable mass in her left breast. The fine needle aspirate contained both epithelioid and stromal elements. The epithelioid component consisted of dissociated individual cells and small groups and clusters of atypical cells. The stromal component showed a uniform, not-atypical pattern. The lumpectomy specimen showed nonnecrotizing granulomatous panniculitis and lymphoid angiitis without involvement of ducts or lobules. CONCLUSION: Granulomatous lesions should be borne in mind in the differential diagnosis of breast cancer in fine needle aspiration cytology. GAP must be histopathologically distinguished from granulomatous inflammation in the breast of autoimmune or infectious origin as specific medical therapy may be available for these latter diseases.     

Value of fine needle aspiration cytology of the breast, with an emphasis on the cytodiagnosis of colloid carcinoma.

The fine needle aspiration (FNA) cytologic evaluation of 6,941 lesions of the breast was reviewed, with an emphasis on the cytodiagnosis of colloid carcinoma. The most common benign breast diseases in this series were fibroadenomas, cysts and fibrocystic conditions. All cases with an FNA diagnosis of suspicious were biopsied; a number of these were found to be carcinoma of the breast. In cases with an FNA diagnosis of carcinoma of the breast, a plan of management was immediately adopted on the basis of that diagnosis. Thirteen cases of colloid (mucinous) carcinoma of the breast were diagnosed by FNA cytology; in all, the cytodiagnosis was confirmed by the subsequent histologic diagnosis. The distinctive cytologic criteria that may be useful for making an FNA diagnosis of colloid carcinoma of the breast are discussed, and the FNA differences between the pure and mixed types of colloid carcinoma are noted.     

Adverse life events and breast cancer: case-control study.

OBJECTIVE--To investigate the strength of association between past life events and the development of breast cancer. DESIGN--Case-control study. A standardised life events interview and rating was administered before a definitive diagnosis. SETTING--Breast Cancer Screening Assessment Unit and surgical outpatient clinics at King''s College Hospital, London. SUBJECTS--119 consecutive women aged 20-70 who were referred for biopsy of a suspicious breast lesion. MAIN OUTCOME MEASURES--Odds ratio of the risk of developing breast cancer after life events in the preceding five years after adjustment for confounders. RESULTS--41 women were diagnosed as having malignant disease while the remainder had benign conditions. Severe life events increased the risk of breast cancer. The crude odds ratio was 3.2 (95% confidence interval 1.35 to 7.6). After adjustment for age and the menopause and other potential confounders this rose to 11.6 (3.1 to 43.7). Multiple logistic regression analysis showed that all severe events and coping with the stress of adverse events by confronting them and focusing on the problems significantly predicted a diagnosis of breast cancer. Non-severe life events and long term difficulties had no significant association. CONCLUSION--These findings suggest an aetiological association between life stress and breast cancer.     

Relation between age of mothers with breast cancer and sex of their children.

In a consecutive series of 150 women with breast cancer 122 had borne one or more children. Sixty-two patients were aged below 55 years at diagnosis (group A) and 60 were 55 years or older (group B). In group A 91 out of 153 children (59%) were boys compared with 48 out of 141 (34%) in group B (p=0.000007). In group A 54 of the 62 patients (87%) had given birth to one or more boys compared with 35 of the 60 (58%) in group B (p=0.0003). The mean age at diagnosis in mothers of two or more boys was 49.0 years, in those of one boy 55.2 years, and in those of only girls 61.0 years. The differences between each of the mean ages was significant. The mean age at diagnosis in 28 nulliparous patients was 57.7 years. There was no significant correlation between the number of female pregnancies and age at diagnosis. These results suggest that in women liable to develop breast cancer male pregnancies are associated with an early onset of the disease.     

Fine needle aspiration cytology in the management of male breast masses. Nineteen years of experience.

OBJECTIVE: To determine the utility and accuracy of fine needle aspiration cytology (FNAC) as well as its sensitivity, specificity and predictive value in the diagnosis of male breast masses. STUDY DESIGN: Data on male breast FNAC done between 1978 and 1997 were retrieved from the records of the cytopathology laboratory. FNAC diagnoses were categorized as positive, negative, inconclusive or unsatisfactory. Cytohistologic correlation was done with data from histopathology records. Sensitivity, specificity, diagnostic accuracy and predictive values of FNAC were calculated using standard statistical methods. RESULTS: Five hundred seven of 13,175 patients undergoing breast FNAC were males. Of them, 393/507 had satisfactory aspirates. Of these, 70 were positive (13.8%), 295 were negative (58%), and 29 were inconclusive (5.7%). A total of 114 FNACs (22.5%) were unsatisfactory. Histopathology was available in 97/507 cases. There were no false positive or false negative diagnoses. FNAC had a sensitivity, specificity and diagnostic accuracy of 100% for male breast lesions. CONCLUSION: This large study shows that FNAC is a very accurate tool for diagnosis of male breast lesions. It is highly sensitive and specific, with good cytohistologic correlation. FNAC should therefore be an integral part of the primary assessment of breast lumps in males.     

Breast carcinoma with tumor giant cells. Report of a case with fine needle aspiration cytology

A 31-year-old woman presented with a cystic mass in the left breast. At fine needle aspiration (FNA), the mass felt gritty, and a firm mass remained after drainage of the cyst. Cytologic examination of the aspirate showed mononucleated malignant cells and an array of bizarre malignant multinucleated giant cells. A diagnosis of carcinoma of breast with malignant giant cells was made. Subsequent histologic study of the lesion showed a central cystic cavity lined by bizarre tumor giant cells. Immunocytochemistry and lectin cytochemistry confirmed the epithelial nature of the malignant giant cells. The entities that may yield giant cells on FNA of breast masses are discussed.     

Value of the history in the office diagnosis of breast cancer.

A review of the histories of 1059 patients with breast problems seen consecutively in office consultation revealed an incidence of breast cancer of 13%. Patients over 50 years of age or whose mother or sister had had breast cancer had a substantially greater likelihood of having breast cancer. The finding of the problem on routine examination, a family history of breast cancer in a relative other than the mother or a sister, or prominent breast pain or nipple discharge made the diagnosis of cancer less likely. Menstrual status, a history of previous benign disease, nulliparity, current hormone therapy and duration of symptoms did not help identify the patient likely to have breast cancer. Much time could be saved for both doctor and patient in taking the history from patients with breast disorders. Only the patient''s age and the history of the mother and sisters with regard to breast cancer will help identify the "high-risk" patient. Other historical findings are either valueless or should be used to reassure these usually anxious women.     

Extraskeletal myxoid chondrosarcoma of the chest wall masquerading as a breast tumor. A case report

BACKGROUND: Extraskeletal myxoid chondrosarcoma is a rare tumor that usually occurs in the soft tissues of extremities. Cytologic features of chondrosarcoma arising from a rib and presenting as a breast mass were reported by Molyneux et al in 1995. However, to the best of our knowledge, the cytology of extraskeletal myxoid chondrosarcoma of the chest wall presenting as a breast mass has not been documented before. CASE: A 30-year-old female presented with left-sided chest pain and a hard lump in the breast of two months' duration. Fine needle aspiration cytology was done, and a possible diagnosis of mucinous carcinoma or mixed tumor of the breast was suggested, with advice to prepare a frozen section before undertaking a radical procedure. On imprint cytology and frozen section a diagnosis of extraskeletal myxoid chondrosarcoma was made and confirmed by histopathology and immunohistochemistry. CONCLUSION: It is rare for extraskeletal myxoid chondrosarcoma to occur in the chest wall. This problem is compounded by the fact that cells of extraskeletal myxoid chondrosarcoma which resemble epithelial cells, can very closely mimic some malignant breast tumors.