Chell S E, Nayar R, De Frias D V, Bedrossian C W
Division of Cytopathology, Northwestern Memorial Hospital, Chicago, IL, USA.
Ann Diagn Pathol. 1998 Jun;2(3):173-80. doi: 10.1016/s1092-9134(98)80005-1.
This case study illustrates the unusual morphologic findings of a metastatic breast carcinoma to the lung. The tumor showed chondromatous differentiation and mimicked a primary chondroid lesion of the lung on fine-needle aspiration and needle core biopsy. The patient was a 59-year-old woman with a previous history of stage II carcinoma of the breast, which had been reported as "poorly differentiated, infiltrating ductal carcinoma," with two of 13 axillary lymph nodes showing metastatic ductal carcinoma. The pathology report received from the outside institution contained no mention of metaplastic components, and because the new pulmonary lesion was a peripherally located, well-circumscribed mass found incidentally on abdominal computed tomography scan in the lower lung field cuts, pulmonary chondroid hamartoma was initially postulated as a preliminary diagnosis. However, on review of the outside glass slide material from a prior lumpectomy, chondromatous differentiation was identified and a final diagnosis of metaplastic carcinoma of the breast with pulmonary metastasis was made. To the best of our knowledge, this is the only reported case of a metastasis of metaplastic breast carcinoma initially identified from fine-needle aspiration biopsy. The importance of recognizing and reporting metaplastic elements in primary breast tumors is discussed, and the value of direct morphologic comparison of cytologic material to prior histology is emphasized.
本病例研究阐述了转移性乳腺癌肺转移的罕见形态学表现。该肿瘤显示软骨样分化，在细针穿刺抽吸活检和针芯活检时酷似原发性肺软骨样病变。患者为一名59岁女性，既往有II期乳腺癌病史，之前被报告为“低分化浸润性导管癌”，13个腋窝淋巴结中有2个显示转移性导管癌。从外部机构收到的病理报告未提及化生成分，由于新的肺部病变是在腹部计算机断层扫描的下肺野切片中偶然发现的一个位于周边、边界清晰的肿块，最初推测初步诊断为肺软骨样错构瘤。然而，回顾之前肿块切除术的外部玻片材料时，发现了软骨样分化，最终诊断为乳腺化生癌伴肺转移。据我们所知，这是唯一一例最初通过细针穿刺活检确诊的乳腺化生癌转移病例。本文讨论了识别和报告原发性乳腺肿瘤中化生成分的重要性，并强调了将细胞学材料与先前组织学进行直接形态学比较的价值。
