Lui Philip C W, Tse Gary M K, Tan Puay Hoon, Jayaram Gita, Putti Thomas C, Chaiwun Benjaporn, Chan Norman H L, Lau Patrick P L, Mak Kong Ling, Khin Aye T
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
J Clin Pathol. 2007 May;60(5):529-33. doi: 10.1136/jcp.2006.039412. Epub 2006 Jun 23.
Metaplastic carcinoma of the breast encompasses a heterogeneous group of tumours with variable components of sarcomatoid, squamous or poorly differentiated carcinomas.
To review a series of 19 cytological preparations of metaplastic carcinomas to assess diagnostic cytological features.
17 cases of fine-needle aspirates of histologically proven metaplastic carcinomas (4 monophasic spindle cell carcinomas, 4 squamous cell carcinomas and 11 biphasic tumours) were reviewed, with an emphasis on the presence of poorly differentiated carcinoma, squamous cell carcinoma, atypical spindle cells, benign stromal fragments and necrosis.
All cases were diagnosed as malignant, with 68% of cases showing moderate to high cellularity, and 47% showing necrosis. If the tumours were analysed according to the constituting components histologically, 7, 15 and 8 cases, respectively, possess poorly differentiated carcinoma cells, sarcomatoid malignant cells and squamous carcinoma cells, whereas these components were cytologically identified in 11, 10 and 7 cases, respectively. Dual tumour populations were identified in only 5 of the 11 biphasic carcinomas in the cytological preparations; and the stromal material was cytologically identified in the only case with chondroid stroma.
Identification of metaplastic carcinoma in cytology remains problematic. There seems to be morphological overlap between various components. The identification of dual components, unequivocal squamous carcinoma cells and chondroid stroma is helpful for diagnosis, but it is uncommon. The presence of poorly differentiated carcinoma cells with a suggestion of focal spindle morphology is another clue to the suggestion of metaplastic carcinoma.
乳腺化生性癌包含一组异质性肿瘤，具有肉瘤样、鳞状或低分化癌的不同成分。
回顾19例化生性癌的细胞学涂片，评估其诊断性细胞学特征。
回顾17例经组织学证实的化生性癌细针穿刺抽吸物（4例单相梭形细胞癌、4例鳞状细胞癌和11例双相肿瘤），重点关注低分化癌、鳞状细胞癌、非典型梭形细胞、良性间质碎片和坏死的存在情况。
所有病例均诊断为恶性，68%的病例细胞丰富度为中度至高，47%的病例有坏死。若根据组织学构成成分分析肿瘤，分别有7例、15例和8例具有低分化癌细胞、肉瘤样恶性细胞和鳞状癌细胞，而这些成分在细胞学检查中分别在11例、10例和7例中被识别。在细胞学涂片中，11例双相癌中仅5例识别出双肿瘤群体；仅在1例有软骨样间质的病例中细胞学识别出间质成分。
在细胞学中识别化生性癌仍存在问题。各种成分之间似乎存在形态学重叠。识别双成分、明确的鳞状癌细胞和软骨样间质有助于诊断，但并不常见。存在提示局灶性梭形形态的低分化癌细胞是化生性癌的另一个诊断线索。
