Primary stromal sarcoma of breast with malignant fibrous histiocytoma-like features causing diagnostic dilemma on fine-needle aspiration cytology in a patient with squamous cell carcinoma of cervix: a case report.

摘要

A variety of malignant spindle-cell tumors are known to occur in the breast, which are collectively referred to as "breast spindle-cell tumors." Their interpretation on fine-needle aspiration cytology (FNAC) can be highly tricky. Here, we report a case. A 47-year-old female presented with a hard, mobile lump in the right breast for 4 months. Five years previous to this, she was treated with radiotherapy for squamous-cell carcinoma (SCC) of cervix. FNA of the breast lump showed high-cell yield with clusters, fascicles, and dissociated cells displaying spindle-cell morphology, with marked pleomorphism, many bizarre uninucleate/multinucleate giant cells, and a striking mitotic activity. At places, the cells in a necrotic background simulated keratinized squamous cells. Considering the past history of SCC of cervix, the first possibility of metastatic SCC with a differential diagnosis of metaplastic carcinoma, malignant phylloides, and a primary sarcoma of the breast was considered. Subsequent trucut/excision biopsy with appropriate immunomarkers revealed it to be a case of primary stromal sarcoma of the breast with malignant fibrous histiocytoma (MFH)-like features. Malignant spindle-cell tumor of breast in a patient with SCC of cervix (which also has a tendency to manifest with spindle cell morphology) can cause genuine diagnostic difficulty. In such patients, use of appropriate panel of markers is mandatory for distinguishing between the metastatic SCC from cervix and other more commonly occurring spindle-cell malignancies of the breast.