Kleer C G, Michael C W
Department of Pathology, University of Michigan Medical Center, Ann Arbor 48109-0054, USA.
Diagn Cytopathol. 2000 Jul;23(1):39-42. doi: 10.1002/1097-0339(200007)23:1<39::aid-dc9>3.0.co;2-#.
Carcinomas of the breast with prominent lymphoplasmacytic background are commonly encountered in cytology. The aim of this study was to assess the prevalence of different types of carcinomas that share this common feature, identify possible distinguishing cytologic features, and evaluate the diagnostic pitfalls in this group of tumors. Eighteen fine-needle aspirations (FNAs) of breast carcinomas with heavy lymphoplasmacytic background were reviewed. Histologic follow-up was reviewed in all cases. Of 18 cases, there were 9 invasive ductal carcinomas (IDC), and 9 medullary carcinomas (6 typical and 3 atypical). FNAs from typical medullary carcinomas (TMC) showed more severe nuclear atypia and macronucleoli than the cases of IDC and atypical medullary carcinomas (AMC). Gland formation was absent in the TMC but was common in IDC and AMC. No cytologic differences were noted between IDC and AMC. Nucleoli were larger in TMC (mean 4, microm) than in AMC (mean, 2 microm) and IDC (mean, 1.5 microm). We conclude that lymphocytes and plasma cells may be seen in different types of breast carcinomas and should not be considered a diagnostic feature of TMC. Features potentially helpful in the cytologic differential diagnosis of a carcinoma with prominent lymphoplasmacytic background are nucleolar size (4 microm in MC, vs. 1.5 and 2 microm in IDC and AMC, respectively) and the degree of nuclear atypia. Lymphocytosis may be part of the carcinoma or may originate from a lymph node involved by metastases. In rare cases, a prominent neutrophilic infiltrate may also be present.
细胞学检查中常见具有显著淋巴浆细胞背景的乳腺癌。本研究的目的是评估具有这一共同特征的不同类型癌的患病率，识别可能的鉴别细胞学特征，并评估这组肿瘤的诊断陷阱。回顾了18例具有重度淋巴浆细胞背景的乳腺癌细针穿刺抽吸（FNA）病例。所有病例均进行了组织学随访。18例病例中，有9例浸润性导管癌（IDC）和9例髓样癌（6例典型和3例非典型）。典型髓样癌（TMC）的FNA显示出比IDC和非典型髓样癌（AMC）病例更严重的核异型性和大核仁。TMC中无腺管形成，但在IDC和AMC中常见。IDC和AMC之间未观察到细胞学差异。TMC中的核仁（平均4微米）比AMC（平均2微米）和IDC（平均1.5微米）中的核仁大。我们得出结论，淋巴细胞和浆细胞可见于不同类型的乳腺癌，不应被视为TMC的诊断特征。对具有显著淋巴浆细胞背景的癌进行细胞学鉴别诊断可能有帮助的特征是核仁大小（髓样癌中为4微米，而IDC和AMC中分别为1.5微米和2微米）和核异型程度。淋巴细胞增多可能是癌的一部分，也可能源于转移累及的淋巴结。在罕见情况下，也可能出现显著的中性粒细胞浸润。
