Journal of Cytology
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CASE REPORT
Year : 2004  |  Volume : 21  |  Issue : 4  |  Page : 193-196

Medullary carcinoma as a well-circumscribed lesion in the axillary tail of breast: A diagnostic dilemma in fine needle aspiration cytology


1 Associate Professor, Department of Pathology, Faculty of Medicine, Kuwait University and Consultant in Surgery, Mubarak Al-Kabeer Hospital, Kuwait
2 Registrar, Department of Cytology, Mubarak Al-Kabeer Hospital, Kuwait
3 Assistant Professor, Department of Pathology, Faculty of Medicine, Kuwait University and Consultant in Surgery, Mubarak Al-Kabeer Hospital, Kuwait
4 Resistrar, Department of Pathology, Mubarak Al-Kabeer Hospital, Kuwait
5 Senior Registrar, Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait
6 Associate Professor, Department of Surgery, Faculty of Medicine Kuwait University and Consultant in Surgery, Mubarak Al-Kabeer Hospital, Kuwait

Correspondence Address:
D K Das
Associate Professor of Pathology, Faculty of Medicine, Kuwait University. PO Box - 24923. Safat -13110
Kuwait
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Source of Support: None, Conflict of Interest: None


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We report a case of medullary carcinoma of breast in a 48 year old woman, who presented with a 2 x 2 cm mobile lump in the axillary tail of left breast and another mass close to left areola at 7 O'clock position. FNA smear from the axillary tail mass showed pleomorphic malignant cells in clusters and syncytial sheets, amongst rich lympho-plasmacytic cell component. FNA cytology of the mass close to the areola showed features of cystic disease of the breast. Although FNA cytodiagnosis of the mass in the axillary tail was medullary carcinoma (MC), the possibility of a metastatic carcinoma in an intramammary lymph node from an occult primary in the breast could not be ruled out altogether. The patient underwent lumpectomy along with axillary clearance. The lumpectomy specimen confirmed the cytodiagnosis of MC. The neoplastic cells were negative for estrogen and progesterone receptors as well as for cyclin D but positive for c-erb-B 2 and cathepsin D. The patient had an uneventful recovery in the post surgical period. Thus, the diagnosis of medullary carcinoma in axillary tail of breast could be suggested by FNA cytology, which helped the surgeon deciding in favor of lumpectomy but the clinico-cytologic features of this case led to a diagnostic dilemma, necessitating a frozen section confirmation.


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