Tsilimigras Diamantis I, Ntanasis-Stathopoulos Ioannis, Schizas Dimitrios, Bakopoulos Anargyros, Moris Demetrios, Stanc Gabriela-Monica, Tentolouris Anastasios, Nassar Soumphi, Salla Charitini
School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
In Vivo. 2017 Jul-Aug;31(4):737-740. doi: 10.21873/invivo.11123.
Due to its heterogeneity, metaplastic breast carcinoma (MBC) poses diagnostic dilemmas, leading to delayed treatment, thereby aggravating the prognosis. Over the years, there has been controversy regarding the role of fine-needle aspiration (FNA) cytology in timely diagnosis.
A 54-year-old woman presented with a palpable mass in the upper outer quadrant of her right breast with corresponding mammographic findings and FNA was performed. The smears revealed small- and medium-sized cohesive clusters of malignant cells with atypical nuclei. Sporadically, there was a pleomorphic population of notably large mononuclear cells, with disturbance of nuclear/cytoplasmic ratio, and binucleated or multinucleated malignant cells. The presence of chondromyxoid substance with focally embedded cells in a magenta-colored substrate was predominant in the background. These features, along with the corresponding mammographic findings, allowed for high preoperative suspicion of MBC. Surgical resection followed immediately without neoadjuvant chemotherapy; the pathology report led to the definite diagnosis of MBC.
MBC is a rare clinical entity with unfavorable prognosis, thus early diagnosis is imperative regarding its management. The effectiveness of FNA in the diagnostic algorithm has been questioned, with data from literature being rather contradictory. FNA seems to provide valuable information, which should always be interpreted in correlation with the clinical and mammographic findings.
High preoperative suspicion of MBC with the combination of mammography and FNA cytology necessitated the surgical excision of the lesion as the principal treatment approach. Although the role of FNA in the diagnosis of MBC is debatable, its combination with clinical presentation and corresponding mammographic findings may prevent the administration of neoadjuvant chemotherapy in patients with ambiguous indications, given the poor response rate of this cancer subtype.
由于其异质性，化生性乳腺癌（MBC）带来了诊断难题，导致治疗延迟，进而使预后恶化。多年来，细针穿刺（FNA）细胞学检查在及时诊断中的作用一直存在争议。
一名54岁女性，右乳外上象限可触及肿块，乳腺X线摄影有相应表现，遂进行FNA检查。涂片显示有中等大小的恶性细胞凝聚性簇，细胞核不典型。偶见多形性的显著大单核细胞群，核质比例失调，还有双核或多核恶性细胞。背景中主要是在品红色基质中有局灶性嵌入细胞的软骨黏液样物质。这些特征，连同相应的乳腺X线摄影表现，使得术前高度怀疑为MBC。随即进行手术切除，未进行新辅助化疗；病理报告确诊为MBC。
MBC是一种临床罕见且预后不良的疾病，因此早期诊断对其治疗至关重要。FNA在诊断流程中的有效性受到质疑，文献数据相当矛盾。FNA似乎能提供有价值的信息，应始终结合临床和乳腺X线摄影表现进行解读。
乳腺X线摄影和FNA细胞学检查相结合，术前高度怀疑为MBC，因此手术切除病变作为主要治疗方法是必要的。尽管FNA在MBC诊断中的作用存在争议，但鉴于该癌症亚型反应率低，其与临床表现及相应乳腺X线摄影表现相结合，可能避免对适应证不明确的患者进行新辅助化疗。
