Pettinato G, Manivel J C, Petrella G, De Chiara A, Calí A
Department of Pathology, 2nd Medical School, University of Naples, Italy.
Acta Cytol. 1989 Sep-Oct;33(5):620-6.
Pleomorphic spindle cells, osteoclastlike giant cells and plaques of osteoidlike material were the cytologic features observed in fine needle aspirates of the breast tumors from two patients. This cytologic pattern suggested a diagnosis of osteogenic sarcoma, a rare neoplasm in the breast. Immunoperoxidase staining performed on the original smears showed reactivity for vimentin in both cases. One tumor was also positive for epithelial membrane antigen (EMA); reactivity for this marker revealed the metaplastic nature of the sarcomatous cells in this tumor, suggesting a diagnosis of metaplastic carcinoma. Histologically, both tumors showed a sarcomatous pattern, with osteoid and chondroid formation, with no evidence of epithelial differentiation. Polyclonal and monoclonal antibodies against epithelial and mesenchymal markers used in tissue sections confirmed the immunophenotypes identified cytologically. Based on the immunochemical findings, the final diagnoses were osteogenic sarcoma of the breast in one case and osteogenic metaplastic carcinoma of the breast in the second case. Both patients died of metastatic disease within one year. These cases (1) show the reliability and accuracy of the immunoperoxidase method in making a differential diagnosis of ambiguous cytologic patterns in fine needle aspirates, (2) support the occurrence of a true osteogenic sarcoma of the breast (comparable to its skeletal counterpart) and (3) demonstrate that metaplastic carcinomas may closely simulate sarcomas of the breast, morphologically as well as biologically. Immunochemical staining techniques play an important role in the differential diagnosis of these neoplasms.
在两名患者乳腺肿瘤的细针穿刺抽吸物中观察到多形性梭形细胞、破骨细胞样巨细胞和类骨质样物质斑块。这种细胞学模式提示诊断为骨肉瘤，这是一种乳腺罕见肿瘤。对原始涂片进行免疫过氧化物酶染色显示，两例均对波形蛋白有反应。其中一个肿瘤上皮膜抗原（EMA）也呈阳性；该标志物的反应性揭示了该肿瘤肉瘤细胞的化生性质，提示诊断为化生性癌。组织学上，两个肿瘤均呈肉瘤样模式，有类骨质和类软骨形成，无上皮分化证据。组织切片中使用的针对上皮和间充质标志物的多克隆和单克隆抗体证实了细胞学鉴定的免疫表型。根据免疫化学结果，最终诊断一例为乳腺骨肉瘤，另一例为乳腺骨化生性癌。两名患者均在一年内死于转移性疾病。这些病例（1）显示了免疫过氧化物酶法在鉴别细针穿刺抽吸物中模糊细胞学模式时的可靠性和准确性，（2）支持乳腺真性骨肉瘤（与其骨骼对应物相似）的发生，（3）表明化生性癌在形态学和生物学上可能与乳腺肉瘤密切相似。免疫化学染色技术在这些肿瘤的鉴别诊断中起重要作用。
