Department of Pathology, Albert Einstein College of Medicine at Long Island Jewish Medical Center, New Hyde Park, New York, USA.
Diagn Pathol. 2011 Jan 18;6:7. doi: 10.1186/1746-1596-6-7.
Because metaplastic carcinoma of the breast encompasses a great variety of histopathology, diagnostic challenges abound, especially within the realm of cytology. The authors compiled and studied an eight-case series comprised of metaplastic breast carcinomas and lesions initially suspicious cytologically for metaplastic carcinoma in order to assess the degree of cytologic-histologic correlation and to identify recurring problematic themes surrounding the cytology-based diagnosis of this neoplasm. The cytologic and histologic slides from eight cases suspicious for metaplastic breast carcinoma diagnosed by fine needle aspiration (FNA) were collected and analyzed through a seven-year retrospective search of case files at our institution. Based on cytologic characteristics, the cases were separated into three groups. Group 1 consisted of three cases presenting with poorly differentiated adenocarcinoma and squamoid components on FNA. Group 2 was composed of two cases that featured a monophasic, malignant ductal cell population on cytology, while the cytologic specimens for the third group of cases presented with a mesenchymal component with or without a malignant glandular constituent. Cytologic-histologic correlation was present in two of three cases demonstrating a mesenchymal component, and there was 100% sensitivity in the cytologic detection of those mesenchymal elements. However, in only one of three cases was there an accurate cytologic diagnosis of metaplastic carcinoma when squamoid changes were present on FNA. Both cases demonstrating only malignant glandular elements on cytologic specimens revealed an additional component of malignant squamous differentiation upon the examination of mastectomy-derived tissue.These results indicate that squamous-like changes identified on FNA should be interpreted with caution and that sampling error remains a problematic recurrence in cytology. Regardless, there appears to be promise concerning the accurate cytologic diagnosis of metaplastic carcinoma when the lesion is characterized by a mesenchymal component. A study implementing a larger case number is essential in determining the significance of these findings.
因为乳腺的化生癌包含了各种各样的组织病理学，所以诊断极具挑战性，尤其是在细胞学领域。作者收集并研究了一个包含 8 例乳腺化生癌和最初细胞学上怀疑为化生癌的病变的病例系列，以评估细胞学与组织学相关性的程度，并确定围绕这种肿瘤的细胞学诊断中反复出现的问题主题。通过对我们机构的病例文件进行七年的回顾性搜索，收集并分析了 8 例通过细针抽吸（FNA）诊断为化生性乳腺癌的可疑细胞学和组织学切片。根据细胞学特征，将这些病例分为三组。第一组包括 3 例 FNA 表现为低分化腺癌和鳞癌成分的病例。第二组由 2 例细胞学上表现为单相、恶性导管细胞群的病例组成，而第三组病例的细胞学标本则表现为伴或不伴恶性腺成分的间充质成分。在表现为间充质成分的 2 例病例中存在细胞学-组织学相关性，并且在细胞学检测这些间充质成分时具有 100%的敏感性。然而，当 FNA 上出现鳞癌样改变时，只有 3 例中的 1 例有化生癌的准确细胞学诊断。仅在细胞学标本上显示恶性腺成分的 2 例病例在检查乳房切除术衍生组织时显示出恶性鳞状分化的额外成分。这些结果表明，在 FNA 上识别出的鳞状样改变应谨慎解释，并且取样误差仍然是细胞学中的一个问题。无论如何，当病变具有间充质成分时，似乎有希望进行化生癌的准确细胞学诊断。实施更大病例数的研究对于确定这些发现的意义至关重要。
