Department of Pathology, University Hospital La Princesa, Madrid, Spain,
Department of Pathology, University Hospital La Princesa, Madrid, Spain.
Acta Cytol. 2021;65(3):272-275. doi: 10.1159/000513982. Epub 2021 Mar 11.
Multinucleated giant cells (MGC) are a rare finding when evaluating axillary sentinel lymph nodes. Some are described as foreign body-type MGC accompanied by foamy macrophages. They have been rarely reported in nodes from patients in which a previous breast biopsy was performed. The tissue damage induced by biopsy results in secondary changes including fat necrosis and hemorrhage that can migrate to axillary nodes. In this report, we illustrate a lipogranulomatous reaction in cytologic samples obtained during a sentinel lymph node examination of a woman previously biopsied because of breast carcinoma. We have found no previous cytologic descriptions and consider it an interesting finding that should be known to avoid diagnostic misinterpretations.
A 51-year-old woman underwent mastectomy of the right breast with a sentinel lymph node biopsy at our medical center. One month before, a control mammography revealed suspicious microcalcifications and a vacuum-assisted breast biopsy resulted in a diagnosis of high-grade intraductal carcinoma with comedonecrosis. Surgery with a sentinel lymph node biopsy was performed. The sentinel node was processed as an intraoperative consultation. Frozen sections and air-dried Diff-Quik stained samples were obtained. They showed abundant lymphocytes with MGC and tumoral cells. MGC showed ample cytoplasm with evident vacuoles of variable size. Occasional hemosiderin-laden macrophages were also present. The complete histologic analysis and immunohistochemical studies revealed no malignant cells. Histologic analysis showed, in subcapsular location, occasional MGC phagocyting lipid droplets. Hemosiderin-laden macrophages were a common finding.
Lipogranulomas may appear at axillary sentinel lymph nodes because of fat necrosis induced by previous breast biopsy. The most important consideration is not confounding MGC with epithelial cell clusters. This can occur with not well-processed samples, especially if unmounted.
在评估腋窝前哨淋巴结时，多核巨细胞（MGC）是一种罕见的发现。有些被描述为伴有泡沫状巨噬细胞的异物型 MGC。它们在先前进行过乳腺活检的患者的淋巴结中很少见。活检引起的组织损伤导致继发性变化，包括脂肪坏死和出血，这些变化可以迁移到腋窝淋巴结。在本报告中，我们展示了一例在因乳腺癌进行前哨淋巴结检查时获得的细胞学样本中出现的脂肪肉芽肿反应。我们没有发现以前的细胞学描述，认为这是一个有趣的发现，应该了解以避免诊断误解。
一名 51 岁女性因右乳腺癌在我们的医疗中心接受了乳房切除术和前哨淋巴结活检。一个月前，控制乳房 X 线照相术显示可疑微钙化，真空辅助乳房活检导致高级别导管内癌伴坏疽。进行了带有前哨淋巴结活检的手术。前哨淋巴结作为术中咨询进行处理。获得了冷冻切片和风干 Diff-Quik 染色样本。它们显示大量淋巴细胞和肿瘤细胞，伴有 MGC。MGC 具有丰富的细胞质，具有不同大小的明显空泡。偶尔也存在含铁血黄素的巨噬细胞。完整的组织学分析和免疫组织化学研究显示没有恶性细胞。组织学分析显示，在包膜下位置，偶尔有 MGC 吞噬脂质滴。含铁血黄素的巨噬细胞是常见的发现。
由于先前乳腺活检引起的脂肪坏死，前哨腋窝淋巴结可能会出现脂肪肉芽肿。最重要的是不要将 MGC 与上皮细胞簇混淆。这可能发生在处理不当的样本中，尤其是未安装的样本中。
