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Metastatic malignancy to the breast is a rare form of breast malignancy (<1% of all breast tumors) with difficult diagnosis and often dismal prognosis. 1,2 Melanoma, hematological malignancies and rhabdomyosarcoma commonly affect the breast secondarily although carcinomas of pulmonary, ovarian and renal origin are also reported to metastatize to the breast. 2,3 Metastatic deposits can be the presenting complaint to the patient and this becomes a diagnostic challenge for both the clinician and the pathologist. Such cases highlight the importance of the multidisciplinary diagnostic approach involving the physicians, radiologist and pathologist. | C A S E HIS TORYA 38-year-old married lady presented with nodular subcentimetric, firm to hard cutaneous lesions in the right inframammary region and right hand. The overlying skin could not be pinched off from the nodule. The lady was severely breathless at the time of examination. The lady presented with a right breast lump 12 months back for which she was biopsied elsewhere. The breast mass was reported from outside as infiltrating duct carcinoma, not otherwise specified in core needle biopsy. Fine needle aspiration cytology of the breast mass was not performed. She was referred to our institute as she developed progressive shortness of breath at that time approximately 3 weeks after the breast biopsy and was found to have an endobronchial mass in addition to the breast mass. An endobronchial biopsy from the lung mass was reported as adenocarcinoma with neuroendocrine differentiation. The patient was diagnosed with dual malignancy at that time and was managed accordingly. However, she was lost to follow-up. On examination at re-presentation, there was a hard lump involving the upper outer quadrant of her right breast approximately measuring 3 cm in diameter. This lump was separate from the cutaneous nodule in the right inframammary region.A fine-needle-aspiration cytology was performed from the right inframammary swelling and the swelling of the right hand with 22G needle and stained for May-Grünwald-Giemsa (MGG) and Hematoxylin and Eosin after air drying and alcohol fixation respectively. The slide and block of the breast biopsy was reviewed.Unfortunately, the patient succumbed to the illness and could not be contacted further. We could not obtain the images of the skin nodules either for the same reason.The cytology smears were highly cellular and showed a tumor in diffuse sheets and occasional small clusters. Scattered acinar/ rosette-like structures/punched-out spaces were also identified ( Figures 1A and B). The cell population was discreet and only focally showed cohesion. Individual cells were relatively monomorphic and showed sudden anisocytosis ( Figure 1C). These cells had eccentrically placed oval to round nuclei, vesicular to finely granular chromatin, inconspicuous to a few prominent nucleoli and moderate to abundant amount of cytoplasm ( Figure 1C). A few binucleate cells were noted. Occasional tumor cells showed intranuclear inclusions ( Figure 1C). The c...