Kobayashi G, Cobb C
Cytopathology and FNA Services, Los Angeles County and University of Southern California Healthcare Network, Los Angeles 90033, USA.
Diagn Cytopathol. 2000 Apr;22(4):246-9. doi: 10.1002/(sici)1097-0339(200004)22:4<246::aid-dc10>3.0.co;2-q.
Metastatic neoplasms to the breast are relatively rare. Spindle-cell lesions of the breast are also uncommon. Here we present a case of fine-needle aspiration (FNA) of an amelanotic, spindle-cell melanoma metastatic to the breast and axillary lymph node. The patient was a 47-yr-old female who presented with a right breast mass, left axillary adenopathy, and a pigmented skin lesion on the back. FNA of the right breast and left axilla showed malignant, nonpigmented spindle cells that were weakly positive for HMB-45 on immunocytochemistry. The skin biopsy showed a pigmented malignant melanoma with epithelioid features, and also weak positivity for HMB-45. Although malignant melanoma is one of the more common tumors to metastasize to the breast, this is the first known case that showed exclusive spindle-cell morphology. History and physical examination were crucial in making the correct FNA diagnosis. The cytologic differential diagnosis of spindle-cell tumors of breast and the discordant morphology between the primary and metastatic melanotic lesions observed in this case are discussed.
乳腺转移性肿瘤相对少见。乳腺的梭形细胞病变也不常见。在此，我们报告一例细针穿刺抽吸（FNA）诊断为乳腺及腋窝淋巴结转移的无色素性梭形细胞黑色素瘤病例。患者为一名47岁女性，表现为右乳肿块、左腋窝淋巴结肿大及背部色素沉着性皮肤病变。右乳及左腋窝的FNA显示恶性、无色素性梭形细胞，免疫细胞化学检测HMB-45弱阳性。皮肤活检显示为具有上皮样特征的色素性恶性黑色素瘤，HMB-45也呈弱阳性。尽管恶性黑色素瘤是较常见的转移至乳腺的肿瘤之一，但这是首例已知的仅表现为梭形细胞形态的病例。病史和体格检查对做出正确的FNA诊断至关重要。本文讨论了乳腺梭形细胞肿瘤的细胞鉴别诊断以及该病例中观察到的原发性和转移性黑色素病变之间不一致的形态学表现。
