Journal of Cytology
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Year : 2015  |  Volume : 32  |  Issue : 1  |  Page : 75-76
Plasmacytoid appearance of tumor cells in breast aspirates on fine needle aspiration cytology: Diagnostic predicament for the cytopathologist


1 Department of Pathology, Command Hospital (Air Force), Bangalore, Karnataka, India
2 Department of Pathology and Microbiology, Command Hospital (Air Force), Bangalore, Karnataka, India

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Date of Web Publication16-Apr-2015
 

How to cite this article:
Mutreja D, Kinra P, Patil SD, Tewari V. Plasmacytoid appearance of tumor cells in breast aspirates on fine needle aspiration cytology: Diagnostic predicament for the cytopathologist. J Cytol 2015;32:75-6

How to cite this URL:
Mutreja D, Kinra P, Patil SD, Tewari V. Plasmacytoid appearance of tumor cells in breast aspirates on fine needle aspiration cytology: Diagnostic predicament for the cytopathologist. J Cytol [serial online] 2015 [cited 2019 Jul 23];32:75-6. Available from: http://www.jcytol.org/text.asp?2015/32/1/75/155250


Sir,

Plasmacytoid appearance of cells in breast aspirates on fine needle aspiration cytology (FNAC) can cause diagnostic difficulties. We describe a case of a 66-year-old woman with plasmacytoid morphology of breast tumor cells on FNAC, confirmed to have lobular carcinoma breast on histology. The aspirates showed high cellularity and consisted of dyscohesive population of cells with predominantly plasmacytoid morphology, causing confusion with a primary plasmacytoma of the breast.

A 66-year-old woman noticed a painless lump in the right breast of 2 months duration. Clinical examination revealed an ill-defined firm mass in the lower outer quadrant of the right breast measuring 2 cm. The overlying skin, nipple and areola were normal. Mammography revealed a right-sided, ill-defined hypoechoic lesion measuring 1.5 cm × 0.98 cm at 6 to 7 o'clock position with few prominent subareolar ducts (BIRADS 4).

A FNAC of the lump revealed cellular smears with moderate to abundant cytoplasm and eccentrically placed nuclei with moderate anisonucleosis. The low-power appearance was reminiscent of a plasmacytoma as the cytoplasm was amphophilic and occasional binucleate cells were also seen. On higher magnification, intracytoplasmic vacuoles were seen [Figure 1]a. No single cell distribution or "Indian-file" pattern was seen. Nucleoli were inconspicuous and there was no increase in mitotic activity. A diagnosis of "suspicious for breast carcinoma, ductal versus lobular" was offered and trucut biopsy for histopathology confirmation was advised. Histology revealed dyscohesive proliferation of cells with dense eosinophilic cytoplasm and eccentrically placed nuclei, distending ductal lumina. Tumor cells showed expression of estrogen and progesterone receptors on immunohistochemistry and absence of HER2neu and membranous E-cadherin expression. A diagnosis of solid invasive lobular carcinoma (ILC) was established. The patient underwent modified radical mastectomy. On the resection specimen, multiple foci of lobular intraepithelial neoplasia were seen [Figure 1]b.
Figure 1: (a) Cellular smears showing dyscohesive sheets of cells with moderate to abundant cytoplasm, eccentrically placed nuclei showing moderate anisonucleosis (MGG, x400). Inset shows intracytoplasmic vacuoles (red arrow). (b) Stained section showing solid sheets of cells with dense eosinophilic cytoplasm and eccentrically placed nuclei (H and E, x400)

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ILC of the breast, commonly observed in post-menopausal women, may be tricky to diagnose on FNAC frequently due to paucicellularity of smears, small cell size and bland appearance of tumor cells in the aspirate samples. [1],[2] This is the most common variant of breast carcinoma associated with an increased false-negative diagnosis on FNAC. Besides this, the distinction between invasive ductal and ILC may not always be possible on FNAC.

In this case, smears were cellular, unlike the classical ILC, where scanty cellularity is usually encountered. Majority of the cells had plasmacytoid appearance. Many cells showed perinuclear clearing, causing a diagnostic dilemma with hof of plasma cells. The points in favor of breast carcinoma were the absence of the cartwheel chromatin of the nucleus of plasma cell, lack of mitosis, inconspicuous nucleoli and presence of intracytoplasmic vacuoles in perinuclear distribution [Figure 1]a.

Plasmacytoid appearance of tumor cells in breast FNAC have been reported in ILC, particularly in the pleomorphic variant, [3] invasive ductal carcinoma including secretory carcinoma breast, [4] the apocrine type, carcinoma with endocrine differentiation, [5] primary plasmacytoma of breast and the rare granular cell tumor. [3]

This case emphasizes the importance of recognizing cytomorphological features of ILC on FNAC when plasmacytoid cells are encountered.

 
   References Top

1.
De las Morenas A, Crespo P, Moroz K, Donnelly MM. Cytologic diagnosis of ductal versus lobular carcinoma of the breast. Acta Cytol 1995;39:865-9.  Back to cited text no. 1
    
2.
Jayaram G, Swain M, Chew MT, Yip CH. Cytologic appearances in invasive lobular carcinoma of the breast. A study of 21 cases. Acta Cytol 2000;44:169-74.  Back to cited text no. 2
    
3.
Augustine AJ, Kini H, Lobo FD, Pai R, Ramesh BS, Rau AR. Pleomorphic lobular carcinoma of the breast - A diagnostic dilemma. J Cytol 2007;24:193-5.   Back to cited text no. 3
  Medknow Journal  
4.
Jena M, Shariff S. Cytodiagnosis of secretory carcinoma of the breast: A report on two cases. Diagn Cytopathol 2010;38:921-4.   Back to cited text no. 4
    
5.
Kawanishi N, Norimatsu Y, Funakoshi M, Kamei T, Sonobe H, Kawano R, et al. Fine needle aspiration cytology of solid neuroendocrine carcinoma of the breast: A case report. Diagn Cytopathol 2011;39: 527-30.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Deepti Mutreja
Department of Pathology, Command Hospital (Air Force), Bangalore - 560 007, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.155250

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