Ding Gabriel Teck Yong, Hwang Jacqueline Siok Gek, Tan Puay Hoon
Department of Pathology, Singapore General Hospital, Singapore, Singapore.
Acta Cytol. 2007 May-Jun;51(3):451-5. doi: 10.1159/000325765.
Tumors metastatic to the breast are a rare occurrence. The correct identification is essential as there are divergent management implications. Fine needle aspiration cytology (FNAC) is an effective method of diagnosis when coupled with the judicious use of immunocytochemistry.
A 50-year-old Indian woman presented with a palpable right breast lump that was clinically suspicious for malignancy. There were no contralateral breast masses or palpable axillary lymphadenopathy. There was a history of nephrectomy carried out several years earlier for renal cell carcinoma (RCC). FNAC of the right breast lump yielded malignant epithelioid and occasionally spindled cells within an inflamed background, while immunocytochemistry showed positive reactivity of tumor cellsfor CD10, with negative staining for CK7. The cytologic diagnosis favored a tumor of renal origin. The patient underwent wide central excision of the right breast lump, whereby the diagnosis of metastatic RCC with sarcomatoid features was confirmed. On follow-up, she developed metastases to multiple organ sites and died.
A high index of suspicion is required in the diagnosis of disease metastatic to the breast. FNAC is a reliable diagnostic tool in the distinction of metastasis from primary malignancy of the breast.
转移性乳腺癌较为罕见。由于治疗方法存在差异，正确识别至关重要。细针穿刺细胞学检查（FNAC）结合合理使用免疫细胞化学是一种有效的诊断方法。
一名50岁的印度女性，右乳可触及肿块，临床怀疑为恶性肿瘤。对侧乳房无肿块，腋窝未触及肿大淋巴结。患者数年前因肾细胞癌（RCC）行肾切除术。右乳肿块的FNAC检查显示，在炎症背景中有恶性上皮样细胞，偶尔可见梭形细胞，免疫细胞化学显示肿瘤细胞对CD10呈阳性反应，CK7呈阴性染色。细胞学诊断倾向于肾源性肿瘤。患者接受了右乳肿块广泛中央切除术，病理证实为具有肉瘤样特征的转移性RCC。随访期间，她出现多器官转移并死亡。
诊断转移性乳腺癌需要高度怀疑。FNAC是区分乳腺转移瘤与原发性恶性肿瘤的可靠诊断工具。
