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Case 03

View the images and select the correct diagnosis from the list below.

Breast bugaboo

FNA of the left breast from a 40-year-old woman (submitted air-dried smears were stained with May-Grunwald-Giemsa stain):

 

 

 

 

 

Select the correct diagnosis:

You answered: Low grade duct cell carcinoma with osteoclast-like giant cells and mucinous features
CORRECT!!



CYTOPATHOLOGY:

  • The fine needle aspiration of left breast is a cellular specimen that shows single and cohesive atypical duct epithelial cells and many multinucleate osteoclast-like giant cells in a background of mucin. Bipolar naked nuclei were not prominent. Definite myoepithelial cells could not be identified in the cohesive groups.
  • These findings are suspicious for low-grade duct cell carcinoma with mucinous features.

DISCUSSION:

  • Examination of a core biopsy of the breast revealed an invasive grade 1/3 ductal carcinoma with numerous osteoclast-like giant cells and cellular stroma. Increased mucin was not noted although the sampled material is limited and may not be entirely representative of the whole tumour.
  • Multinucleated osteoclast-like giant cells as a component of breast carcinoma are uncommon.
  • About two-thirds of patients with carcinoma with osteoclast-like giant cells are less than 50 years old.
  • The histogenesis of the giant cells is controversial. Studies utilising immunohistochemistry and electron microscopy have demonstrated both epithelial origin and histiocytic origin. Most authors favour the latter.
  • Osteoclast-like giant cells may be associated with metaplastic carcinoma and malignant fibrous histiocytoma.
  • Benign mutlinucleated giant cells that may be atypical may be seen in the stroma of fibroadenoma but other features of fibroadenoma including cohesive branching fragments of benign duct and myoepithelial cells, hypocellular fibrous stroma and background bipolar naked nulei should be present.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Gupta RK, Holloway LJ, Wakefield SJ, Fauck RJ. Fine needle aspiration cytology, immunocytochemistry and electron microscopy in a rare case of carcinoma of the breast with malignant epithelial giant cells. Acta Cytologica. 1991;35(4):412-6.



Shabb NS, Tawil A, Mufarrij A, Obeid S, Halabi J. Mammary carcinoma with osteoclastlike giant cells cytologically mimicking benign breast disease. A case report. Acta Cytologica. 1997;41(4 Suppl):1284-8.



Stewart CJ, Mutch AF. Breast carcinoma with osteoclast-like giant cells. Cytopathology. 1991;2(4):215-9.



Phillipson J, Ostrzega N. Fine needle aspiration of invasive cribriform carcinoma with benign osteoclast-like giant cells of histiocytic origin. A case report. Acta Cytologica. 1994;38(3):479-82.



Nielsen BB, Kiaer HW. Carcinoma of the breast with stromal multinucleated giant cells. Histopathology. 1985;9(2):183-93.



Nielsen BB, Ladefoged C. Fibroadenoma of the female breast with multinucleated giant cells. Pathology, Research & Practice. 1985;180(6):721-6.



Berean K, Tron VA, Churg A, Clement PB. Mammary fibroadenoma with multinucleated stromal giant cells. American Journal of Surgical Pathology. 1986;10(11):823-7

You answered: Mucinous atypical ductal hyperplasia
Sorry, that is INCORRECT



The correct answer is: Low grade duct cell carcinoma with osteoclast-like giant cells and mucinous features



CYTOPATHOLOGY:

  • The fine needle aspiration of left breast is a cellular specimen that shows single and cohesive atypical duct epithelial cells and many multinucleate osteoclast-like giant cells in a background of mucin. Bipolar naked nuclei were not prominent. Definite myoepithelial cells could not be identified in the cohesive groups.
  • These findings are suspicious for low-grade duct cell carcinoma with mucinous features.

DISCUSSION:

  • Examination of a core biopsy of the breast revealed an invasive grade 1/3 ductal carcinoma with numerous osteoclast-like giant cells and cellular stroma. Increased mucin was not noted although the sampled material is limited and may not be entirely representative of the whole tumour.
  • Multinucleated osteoclast-like giant cells as a component of breast carcinoma are uncommon.
  • About two-thirds of patients with carcinoma with osteoclast-like giant cells are less than 50 years old.
  • The histogenesis of the giant cells is controversial. Studies utilising immunohistochemistry and electron microscopy have demonstrated both epithelial origin and histiocytic origin. Most authors favour the latter.
  • Osteoclast-like giant cells may be associated with metaplastic carcinoma and malignant fibrous histiocytoma.
  • Benign mutlinucleated giant cells that may be atypical may be seen in the stroma of fibroadenoma but other features of fibroadenoma including cohesive branching fragments of benign duct and myoepithelial cells, hypocellular fibrous stroma and background bipolar naked nulei should be present.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Gupta RK, Holloway LJ, Wakefield SJ, Fauck RJ. Fine needle aspiration cytology, immunocytochemistry and electron microscopy in a rare case of carcinoma of the breast with malignant epithelial giant cells. Acta Cytologica. 1991;35(4):412-6.



Shabb NS, Tawil A, Mufarrij A, Obeid S, Halabi J. Mammary carcinoma with osteoclastlike giant cells cytologically mimicking benign breast disease. A case report. Acta Cytologica. 1997;41(4 Suppl):1284-8.



Stewart CJ, Mutch AF. Breast carcinoma with osteoclast-like giant cells. Cytopathology. 1991;2(4):215-9.



Phillipson J, Ostrzega N. Fine needle aspiration of invasive cribriform carcinoma with benign osteoclast-like giant cells of histiocytic origin. A case report. Acta Cytologica. 1994;38(3):479-82.



Nielsen BB, Kiaer HW. Carcinoma of the breast with stromal multinucleated giant cells. Histopathology. 1985;9(2):183-93.



Nielsen BB, Ladefoged C. Fibroadenoma of the female breast with multinucleated giant cells. Pathology, Research & Practice. 1985;180(6):721-6.



Berean K, Tron VA, Churg A, Clement PB. Mammary fibroadenoma with multinucleated stromal giant cells. American Journal of Surgical Pathology. 1986;10(11):823-7

You answered: Metaplastic carcinoma with osteoclast-like giant cells
Sorry, that is INCORRECT



The correct answer is: Low grade duct cell carcinoma with osteoclast-like giant cells and mucinous features



CYTOPATHOLOGY:

  • The fine needle aspiration of left breast is a cellular specimen that shows single and cohesive atypical duct epithelial cells and many multinucleate osteoclast-like giant cells in a background of mucin. Bipolar naked nuclei were not prominent. Definite myoepithelial cells could not be identified in the cohesive groups.
  • These findings are suspicious for low-grade duct cell carcinoma with mucinous features.

DISCUSSION:

  • Examination of a core biopsy of the breast revealed an invasive grade 1/3 ductal carcinoma with numerous osteoclast-like giant cells and cellular stroma. Increased mucin was not noted although the sampled material is limited and may not be entirely representative of the whole tumour.
  • Multinucleated osteoclast-like giant cells as a component of breast carcinoma are uncommon.
  • About two-thirds of patients with carcinoma with osteoclast-like giant cells are less than 50 years old.
  • The histogenesis of the giant cells is controversial. Studies utilising immunohistochemistry and electron microscopy have demonstrated both epithelial origin and histiocytic origin. Most authors favour the latter.
  • Osteoclast-like giant cells may be associated with metaplastic carcinoma and malignant fibrous histiocytoma.
  • Benign mutlinucleated giant cells that may be atypical may be seen in the stroma of fibroadenoma but other features of fibroadenoma including cohesive branching fragments of benign duct and myoepithelial cells, hypocellular fibrous stroma and background bipolar naked nulei should be present.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Gupta RK, Holloway LJ, Wakefield SJ, Fauck RJ. Fine needle aspiration cytology, immunocytochemistry and electron microscopy in a rare case of carcinoma of the breast with malignant epithelial giant cells. Acta Cytologica. 1991;35(4):412-6.



Shabb NS, Tawil A, Mufarrij A, Obeid S, Halabi J. Mammary carcinoma with osteoclastlike giant cells cytologically mimicking benign breast disease. A case report. Acta Cytologica. 1997;41(4 Suppl):1284-8.



Stewart CJ, Mutch AF. Breast carcinoma with osteoclast-like giant cells. Cytopathology. 1991;2(4):215-9.



Phillipson J, Ostrzega N. Fine needle aspiration of invasive cribriform carcinoma with benign osteoclast-like giant cells of histiocytic origin. A case report. Acta Cytologica. 1994;38(3):479-82.



Nielsen BB, Kiaer HW. Carcinoma of the breast with stromal multinucleated giant cells. Histopathology. 1985;9(2):183-93.



Nielsen BB, Ladefoged C. Fibroadenoma of the female breast with multinucleated giant cells. Pathology, Research & Practice. 1985;180(6):721-6.



Berean K, Tron VA, Churg A, Clement PB. Mammary fibroadenoma with multinucleated stromal giant cells. American Journal of Surgical Pathology. 1986;10(11):823-7

You answered: Fibroadenoma with multinucleate giant cells and mucinous degeneration
Sorry, that is INCORRECT



The correct answer is: Low grade duct cell carcinoma with osteoclast-like giant cells and mucinous features



CYTOPATHOLOGY:

  • The fine needle aspiration of left breast is a cellular specimen that shows single and cohesive atypical duct epithelial cells and many multinucleate osteoclast-like giant cells in a background of mucin. Bipolar naked nuclei were not prominent. Definite myoepithelial cells could not be identified in the cohesive groups.
  • These findings are suspicious for low-grade duct cell carcinoma with mucinous features.

DISCUSSION:

  • Examination of a core biopsy of the breast revealed an invasive grade 1/3 ductal carcinoma with numerous osteoclast-like giant cells and cellular stroma. Increased mucin was not noted although the sampled material is limited and may not be entirely representative of the whole tumour.
  • Multinucleated osteoclast-like giant cells as a component of breast carcinoma are uncommon.
  • About two-thirds of patients with carcinoma with osteoclast-like giant cells are less than 50 years old.
  • The histogenesis of the giant cells is controversial. Studies utilising immunohistochemistry and electron microscopy have demonstrated both epithelial origin and histiocytic origin. Most authors favour the latter.
  • Osteoclast-like giant cells may be associated with metaplastic carcinoma and malignant fibrous histiocytoma.
  • Benign mutlinucleated giant cells that may be atypical may be seen in the stroma of fibroadenoma but other features of fibroadenoma including cohesive branching fragments of benign duct and myoepithelial cells, hypocellular fibrous stroma and background bipolar naked nulei should be present.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Gupta RK, Holloway LJ, Wakefield SJ, Fauck RJ. Fine needle aspiration cytology, immunocytochemistry and electron microscopy in a rare case of carcinoma of the breast with malignant epithelial giant cells. Acta Cytologica. 1991;35(4):412-6.



Shabb NS, Tawil A, Mufarrij A, Obeid S, Halabi J. Mammary carcinoma with osteoclastlike giant cells cytologically mimicking benign breast disease. A case report. Acta Cytologica. 1997;41(4 Suppl):1284-8.



Stewart CJ, Mutch AF. Breast carcinoma with osteoclast-like giant cells. Cytopathology. 1991;2(4):215-9.



Phillipson J, Ostrzega N. Fine needle aspiration of invasive cribriform carcinoma with benign osteoclast-like giant cells of histiocytic origin. A case report. Acta Cytologica. 1994;38(3):479-82.



Nielsen BB, Kiaer HW. Carcinoma of the breast with stromal multinucleated giant cells. Histopathology. 1985;9(2):183-93.



Nielsen BB, Ladefoged C. Fibroadenoma of the female breast with multinucleated giant cells. Pathology, Research & Practice. 1985;180(6):721-6.



Berean K, Tron VA, Churg A, Clement PB. Mammary fibroadenoma with multinucleated stromal giant cells. American Journal of Surgical Pathology. 1986;10(11):823-7

From the Cytopathology files of the BC Cancer Agency
Submitted by: Brenda Smith, BSc and Tom Thomson, MD
Special thanks to Dr. Malcolm Hayes for his assistance with this case.
SOURCE: Case 03 ( )
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