Ribu D L, Shield P W, Bligh J F
Department of Cytology, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia.
Cytopathology. 2012 Aug;23(4):256-62. doi: 10.1111/j.1365-2303.2011.00883.x. Epub 2011 Jul 18.
To identify cytomorphological patterns of metastatic melanoma (MM) in breast fine needle aspiration (FNA) specimens and highlight the differential diagnoses and features most useful in identifying MM.
The clinical, radiological and FNA findings of 16 cases were reviewed. Cytological features evaluated related to cell arrangement, size and shape of cells, nuclear and cytoplasmic features, and the presence or absence of necrosis.
The series consisted of 14 females and two males, ranging in age from 24 to 83 years (mean = 50 years). A previous history of melanoma was available in 12/16 (75%) cases at the time of FNA reporting; however the clinical/radiological impression in 4/16 cases was of a breast cyst. The cases were classified into six morphological variants: classical (8/16), pseudopapillary (3/16), spindle-cell (1/16), melanin-rich (1/16), pleomorphic (2/16) and lymphoma-like (1/16). The varying patterns raised a wide range of differential diagnoses; however, discohesion, binucleation and granular cytoplasm were the major features seen in 94% of all cases. In 14/16 cases (88%), plasmacytoid cells, prominent nucleoli and cytoplasmic vacuolation were identified. Melanin and multinucleation were detected in 44% of cases and intranuclear cytoplasmic invaginations in 63%. Necrosis was present in more than half of the cases (56%).
MM should be considered in the differential diagnosis of breast FNA specimens when atypical cells are seen that present as plasmacytoid cells in a dispersed or pseudopapillary pattern, or as spindle, pleomorphic or pigmented cells. These features, combined with clinical history and immunocytochemistry, may assist in correctly identifying MM and directing optimal treatment.
识别乳腺细针穿刺（FNA）标本中转移性黑色素瘤（MM）的细胞形态学模式，并突出鉴别诊断以及对识别MM最有用的特征。
回顾了16例患者的临床、放射学和FNA检查结果。评估的细胞学特征包括细胞排列、细胞大小和形状、细胞核和细胞质特征以及有无坏死。
该系列包括14名女性和2名男性，年龄在24至83岁之间（平均50岁）。在FNA报告时，16例中有12例（75%）有黑色素瘤病史；然而，16例中有4例的临床/放射学印象为乳腺囊肿。这些病例被分为六种形态学变体：经典型（8/16）、假乳头状型（3/16）、梭形细胞型（1/16）、富含黑色素型（1/16）、多形性型（2/16）和淋巴瘤样型（1/16）。这些不同的模式引发了广泛的鉴别诊断；然而，细胞解离、双核化和颗粒状细胞质是所有病例中94%可见的主要特征。在16例中的14例（88%）中，识别出浆细胞样细胞、明显的核仁和细胞质空泡化。44%的病例中检测到黑色素和多核化，63%的病例中检测到核内细胞质内陷。超过一半的病例（56%）存在坏死。
当在乳腺FNA标本中看到非典型细胞时，应考虑MM的鉴别诊断，这些细胞表现为分散或假乳头状模式的浆细胞样细胞，或梭形、多形性或色素沉着细胞。这些特征，结合临床病史和免疫细胞化学，可能有助于正确识别MM并指导最佳治疗。
