Cytopathology 1992,3,49-53
Fine needle aspiration of breast carcinoma in a fibroadenoma R. K. G U P T A A N D C . D O W L E * Departments of Cytology and *Surgery, Wellington Hospital, Wellington, New Zealand Acceptedfor publication 23 May 1991
GUPTA R. K. AND DOWLE C.
(1992) Cytopathology 3,49-53
Fine needle aspiration of breast carcinoma in a fibroadenoma A case of concurrent carcinoma of the breast with a fibroadenoma in a 59-year-old woman is described. The diagnosis was made on fine needle aspiration cytology. Despite the rarity of such a lesion, it is felt that a cytological diagnosis of this lesion from a fine needle aspirate specimen is possible. Keywords: breast, carcinoma, fibroadenoma, fine needle aspirate, cytology
INTRODUCTION In a recent communication', we described the cytological findings in a fine needle aspirate (FNA) of the breast in a case in which carcinoma was concurrently found with a fibroadenoma. We describe another case in which the components of both breast carcinoma and fibroadenoma were found in a FNA of the breast.
CASE R E P O R T A 59-year-old woman presented with a 2 cm firm, rubbery discrete mass above the left areola of 2 weeks duration. Mammography revealed focal microcalcification. There was no family history of cancer or any other breast disease. All biochemical and haematological investigations were normal. A chest X-ray and bone scan were negative. FNA was performed using a size 22 needle, and a diagnosis of breast malignancy with a fibroadenoma was made. Following the cytodiagnosis, a wide local excision of the mass was undertaken. The patient was treated post-operatively with radiotherapy to the breast with adjuvant tamoxifen therapy and has since remained well with no evidence of recurrence or metastasic spread 9 months later. Correspondence: Dr R. K. Gupta, The Cytology Unit, Wellington Hospital, Wellington, New Zealand.
50 R.K. Gupta & C. Dowle
Figure 1. Low power view of cytological filter preparation showing a group of benign ductal cells from the fibroadenoma(thin arrowhead)and malignant cells from the breast carcinoma (thick arrowheads). Papanicolaou. x 295.
MATERIALS AND METHODS Washings were prepared from the aspirated material and processed in the following ways: by filtration (Schleicher and Schuell), by centrifugation and by the preparation of cell blocks. The filters and cytospin preparations were stained by the Papanicoloau method, and the tissue sections by the haematoxylin and eosin method. The excised specimen of breast tissue was first fixed in 10% neutral buffered formalin. Following a macroscopic description, representative samples of breast tissue were taken and processed, embedded, cut at 5 pm and stained by haematoxylin and eosin. RESULTS
Cytologicalfindings Papanicolaou stained filter preparations and cytospin preparations from the aspirated material showed two populations of cells. One was aggregations of hyperplastic ductal cells admixed with rare clusters of ductal cells with fronding, separated by bare (stromal) nuclei. The hyperplastic ductal cell nuclei were uniform with a regular nuclear membrane and fine chromatin. The other was groups of cells with malignant features characterized by nuclear pleomorphism, irregular nuclear membrane, coarse chromatin, an increase in nuclear : cytoplasmic ratio and macronucleoli (Figure 1).
Breast carcinoma in afibroadenoma 5 1
52 R.K. Gupta & C. Dowle
Figure 4. High power view of breast carcinoma. Haematoxylin & eosin. x 550.
Histopathological$ndings
On gross examination the excised specimen consisted of a nodular 6 x 3 x 2.5 cm piece of breast tissue. The cut surface was somewhat firm and incorporated a well demarcated 2.5 x 1.5 cm firm, gritty, circumscribed nodule. Microscopic examination of the tissue and cell blocks revealed a moderately cellular lesion with epithelial cell lined slit-like spaces with intervening hyalinized stroma in which variable numbers of fibroblasts and spindle shaped benign nuclei were seen. The pattern was consistent with a fibroadenoma which in some fields appeared burnt out (Figures 2 and 3). In continuity with this were seen epithelialcells with the classical pattern of an intraduct adenocarcinoma of the breast (Figure 4).
DISCUSSION The concurrent development of an epithelial malignancy of the breast with a fibroadenoma is quite rare and in the few reported cases, the diagnosis has been made by the histological examination of excised t i ~ s u e ~The . ~ wider . use of FNA makes it likely that cytopathologists will soon be confronted with this entity. As we recently stressed', we believe that if a dual population of cells is seen in a FNA sample, with some cells showing the pattern of a fibroadenoma and others the pattern of a breast carcinoma, it is possible to make a diagnosis of breast cancer developing in a fibroadenoma. The present case provides further illustration of this. ACKNOWLEDGEMENT The authors wish to express their gratitude to Mrs Christine Christoforou for secretarial and typing assistance. The technical assistance of Mr Robert Fauck and Mr Andrew McHutchison is also acknowledged.
Breast carcinoma in aJihroadenoma 53
REFERENCES Gupta RK, Simpson J. Carcinoma of the breast in a fibroadenoma. Diagnosis by fine needle aspiration cytology. Diag Cytopath 1991; 7: 60-2. Diagnostic Cytology by Membrane Filter. Application bulletin 100 R. Ann Arbor, Michigan: Gelman Sciences, 1984: 11-16.
3 Ozzelo L, Gump FE. The management of patients with carcinoma in fibroadenomatous tumours of the breast. Surg Gynecol Obstet 1985; 160 99-104. 4 Pick PW, Issoifides IA. Occurence of breast carcinoma within a fibroadenoma: a review. Arch Pathol Lab Med 1984; 108,590-4.
Fine needle aspiration of breast carcinoma in a fibroadenoma R. K. G U P T A A N D C . D O W L E * Departments of Cytology and *Surgery, Wellington Hospital, Wellington, New Zealand Acceptedfor publication 23 May 1991
GUPTA R. K. AND DOWLE C.
(1992) Cytopathology 3,49-53
Fine needle aspiration of breast carcinoma in a fibroadenoma A case of concurrent carcinoma of the breast with a fibroadenoma in a 59-year-old woman is described. The diagnosis was made on fine needle aspiration cytology. Despite the rarity of such a lesion, it is felt that a cytological diagnosis of this lesion from a fine needle aspirate specimen is possible. Keywords: breast, carcinoma, fibroadenoma, fine needle aspirate, cytology
INTRODUCTION In a recent communication', we described the cytological findings in a fine needle aspirate (FNA) of the breast in a case in which carcinoma was concurrently found with a fibroadenoma. We describe another case in which the components of both breast carcinoma and fibroadenoma were found in a FNA of the breast.
CASE R E P O R T A 59-year-old woman presented with a 2 cm firm, rubbery discrete mass above the left areola of 2 weeks duration. Mammography revealed focal microcalcification. There was no family history of cancer or any other breast disease. All biochemical and haematological investigations were normal. A chest X-ray and bone scan were negative. FNA was performed using a size 22 needle, and a diagnosis of breast malignancy with a fibroadenoma was made. Following the cytodiagnosis, a wide local excision of the mass was undertaken. The patient was treated post-operatively with radiotherapy to the breast with adjuvant tamoxifen therapy and has since remained well with no evidence of recurrence or metastasic spread 9 months later. Correspondence: Dr R. K. Gupta, The Cytology Unit, Wellington Hospital, Wellington, New Zealand.
50 R.K. Gupta & C. Dowle
Figure 1. Low power view of cytological filter preparation showing a group of benign ductal cells from the fibroadenoma(thin arrowhead)and malignant cells from the breast carcinoma (thick arrowheads). Papanicolaou. x 295.
MATERIALS AND METHODS Washings were prepared from the aspirated material and processed in the following ways: by filtration (Schleicher and Schuell), by centrifugation and by the preparation of cell blocks. The filters and cytospin preparations were stained by the Papanicoloau method, and the tissue sections by the haematoxylin and eosin method. The excised specimen of breast tissue was first fixed in 10% neutral buffered formalin. Following a macroscopic description, representative samples of breast tissue were taken and processed, embedded, cut at 5 pm and stained by haematoxylin and eosin. RESULTS
Cytologicalfindings Papanicolaou stained filter preparations and cytospin preparations from the aspirated material showed two populations of cells. One was aggregations of hyperplastic ductal cells admixed with rare clusters of ductal cells with fronding, separated by bare (stromal) nuclei. The hyperplastic ductal cell nuclei were uniform with a regular nuclear membrane and fine chromatin. The other was groups of cells with malignant features characterized by nuclear pleomorphism, irregular nuclear membrane, coarse chromatin, an increase in nuclear : cytoplasmic ratio and macronucleoli (Figure 1).
Breast carcinoma in afibroadenoma 5 1
52 R.K. Gupta & C. Dowle
Figure 4. High power view of breast carcinoma. Haematoxylin & eosin. x 550.
Histopathological$ndings
On gross examination the excised specimen consisted of a nodular 6 x 3 x 2.5 cm piece of breast tissue. The cut surface was somewhat firm and incorporated a well demarcated 2.5 x 1.5 cm firm, gritty, circumscribed nodule. Microscopic examination of the tissue and cell blocks revealed a moderately cellular lesion with epithelial cell lined slit-like spaces with intervening hyalinized stroma in which variable numbers of fibroblasts and spindle shaped benign nuclei were seen. The pattern was consistent with a fibroadenoma which in some fields appeared burnt out (Figures 2 and 3). In continuity with this were seen epithelialcells with the classical pattern of an intraduct adenocarcinoma of the breast (Figure 4).
DISCUSSION The concurrent development of an epithelial malignancy of the breast with a fibroadenoma is quite rare and in the few reported cases, the diagnosis has been made by the histological examination of excised t i ~ s u e ~The . ~ wider . use of FNA makes it likely that cytopathologists will soon be confronted with this entity. As we recently stressed', we believe that if a dual population of cells is seen in a FNA sample, with some cells showing the pattern of a fibroadenoma and others the pattern of a breast carcinoma, it is possible to make a diagnosis of breast cancer developing in a fibroadenoma. The present case provides further illustration of this. ACKNOWLEDGEMENT The authors wish to express their gratitude to Mrs Christine Christoforou for secretarial and typing assistance. The technical assistance of Mr Robert Fauck and Mr Andrew McHutchison is also acknowledged.
Breast carcinoma in aJihroadenoma 53
REFERENCES Gupta RK, Simpson J. Carcinoma of the breast in a fibroadenoma. Diagnosis by fine needle aspiration cytology. Diag Cytopath 1991; 7: 60-2. Diagnostic Cytology by Membrane Filter. Application bulletin 100 R. Ann Arbor, Michigan: Gelman Sciences, 1984: 11-16.
3 Ozzelo L, Gump FE. The management of patients with carcinoma in fibroadenomatous tumours of the breast. Surg Gynecol Obstet 1985; 160 99-104. 4 Pick PW, Issoifides IA. Occurence of breast carcinoma within a fibroadenoma: a review. Arch Pathol Lab Med 1984; 108,590-4.
