Das Dilip K, Pathan Shahed K, Sheikh Zafar A, Mallik Mrinmay K, John Bency, Mothaffer Fatma
Department of Pathology, Faculty of Medicine, Kuwait University, and Cytology and Histopathology Units, Mubarak Al-Kabeer Hospital, Kuwait.
J Cytol. 2020 Apr-Jun;37(2):99-107. doi: 10.4103/JOC.JOC_15_20. Epub 2020 Apr 14.
Infiltration of tumors by dendritic reticulum cells (DRC) reflects the host immune defense mechanism. We observed three breast carcinomas cases with dense tumor-infiltrating DRC and lymphocytes in fine-needle aspiration (FNA) smears, leading to cytodiagnosis or differential diagnosis of dendritic reticulum cell sarcoma (DRCS). An attempt was made to find out the reason behind such an erroneous interpretation.
Between 2009 and 2014, two cases were diagnosed as DRCS of the female breast by FNA cytology and in one case possibility of DRCS was considered along with medullary breast carcinoma (MBC). We compare and contrast the cytomorphological features of these three cases with those of nine cytologically diagnosed MBC.
Cases diagnosed as DRCS or MBC showed singly dispersed tumor cells, nuclear pleomorphism, bare nuclei, prominent nucleoli, and presence of lymphocytes. There was no significant difference between the two groups for discohesive clusters, syncytial clusters, plasma cells, neutrophils, foamy histiocytes, and necrosis. However, there was significant difference for presence of cohesive clusters (0% DRCS and 100% MBC, = 0.00485), severe degree (+++) of pleomorphism (100% DRCS vs. 11.1% MBC, = 0.01818), +++ DRC ( = 0.04697), and DRC with ++ to +++ enlarged nuclei ( = 0.03333), and pleomorphic nuclei ( = 0.00833). Two of the three cytologically diagnosed DRCS cases proved to be MBC or MBC-like and one as invasive ductal carcinoma. Six of nine cytologically diagnosed MBC cases with histology proved to be invasive breast carcinomas.
Criteria for cytodiagnosis MBC need a fresh look. Cases with numerous dendritic cells possibly represent MBC.
树突状网状细胞（DRC）浸润肿瘤反映了宿主免疫防御机制。我们在细针穿刺（FNA）涂片检查中观察到3例乳腺癌病例，其肿瘤内有密集的DRC和淋巴细胞浸润，导致细胞诊断为树突状网状细胞肉瘤（DRCS）或进行鉴别诊断。我们试图找出这种错误解读背后的原因。
2009年至2014年期间，2例经FNA细胞学诊断为女性乳腺DRCS，1例除考虑髓样乳腺癌（MBC）外还考虑了DRCS的可能性。我们将这3例病例的细胞形态学特征与9例经细胞学诊断为MBC的病例进行比较和对比。
诊断为DRCS或MBC的病例显示肿瘤细胞单个散在、核多形性、裸核、核仁突出以及淋巴细胞存在。两组在松散聚集物、合体细胞聚集物、浆细胞、中性粒细胞、泡沫状组织细胞和坏死方面无显著差异。然而，在紧密聚集物的存在（DRCS为0%，MBC为100%，P = 0.00485）、多形性严重程度（+++）（DRCS为100%，MBC为11.1%，P = 0.01818）、+++ DRC（P = 0.04697）以及核增大为++至+++的DRC（P = 0.03333）和多形性核（P = 0.00833）方面存在显著差异。3例经细胞学诊断为DRCS的病例中，2例被证明为MBC或类似MBC，1例为浸润性导管癌。9例经细胞学诊断为MBC的病例中，6例经组织学证实为浸润性乳腺癌。
MBC的细胞诊断标准需要重新审视。有大量树突状细胞的病例可能代表MBC。
