Fine needle aspiration cytology of mammary carcinoma with osteoclast‐like giant cells

Abstract

Carcinoma with osteoclast-like giant cells (OCGC) is an uncommon neoplasm characterized by giant cells, prominent vascularization, haemorrhage and areas of cribriform epithelial growth with moderate atypia. Multinucleated giant cells (MGC) have been described in several other breast lesions raising an interesting differential diagnosis, mainly with benign disorders. Due to its rarity few cases have been described cytologically. We retrospectively reviewed 13 fine needle aspiration samples from nine patients with this variant of carcinoma. Nine corresponded to breast tumours and four to axillary, liver, subcutaneous and mediastinal metastatic lesions. The expression of CD68 by giant cells was evaluated immunocytochemically in six cases. All patients had a complete pathological study of the breast neoplasm. Smears showed a double component of epithelial and giant cells. Epithelial clusters were predominantly of intermediate size with irregular contours. Most were cohesive but others showed cellular dissociation with scarce to moderate cellular pleomorphism. Giant cells had well defined, deeply stained cytoplasm and round to elongated morphology. Two metastatic cases were devoid of them. Haemosiderin-laden macrophages were common in smears from breast tumours. In the six cases tested CD68 was expressed in MGC. Cytological features of mammary carcinoma with OCGC correlate closely with the histological ones. Most cases are clearly recognizable as malignant but in others cytological atypia may be minimal, mimicking a benign lesion. In difficult cases the presence of haemosiderin-laden macrophages and the histiocytic nature of the MGC are helpful diagnostic features.

Cytologic Features of Malignant Melanoma with Osteoclast-Like Giant Cells

“…In summary, morphology and immunophenotype showed no similarities between malignant melanoma cells (including multinucleated, giant ones) and OGCs. As for other neoplasms rich in OGCs [9,14,16] these findings support a reactive, monocyte/macrophage origin for OGCs in melanoma. In conclusion, OGCs are a rare but well-recognized finding in malignant melanoma.…”

“…In general, smears from carcinomas with OGCs will show a neoplastic population with cellular adhesion and cohesive groups. It is interesting to note that some of the tumors showing numerous OGCs usually have a hemorrhagic stroma with siderophages [8,9]. The presence of this pigment can also create similarities with melanoma.…”

Fine Needle Aspiration Cytology of Mammary Carcinoma with Choriocarcinomatous Features

“…1 When pleomorphic giant cells are present in the FNAC of breast lesions, various diagnostic possibilities should be considered, including benign soft tissue giant cell tumor, fibroadenoma, phylloides tumor, atypical fibrous histiocytoma, sarcoma, metaplastic carcinoma, carcinomas containing malignant MGC and carcinomas with osteoclast giant cells. 1,[10][11][12][13][14][15] Most cases are obviously recognizable as malignant, but in others cytologic atypia may be negligible, imitating a benign lesion. In difficult cases the presence of nuclear atypia, inflammatory cells, hemosiderin-laden macrophages and the nature of the MGCs that may be supported by immunocytochemistry, are helpful diagnostic features.…”

“…Theoretically, they could be derived from 4 different stem cells-epithelial, myoepithelial, (myo)fibroblastic and histiocytic. 1,2,10,11 Stromal MGCs in fibroepithelial lesions of the breast are discriminated by the occurrence of overlapping, hyperchromatic nuclei, characteristically arranged in a floret-like pattern and by the demonstration of myofibroblastic or fibroblastic differentiation on immunohistochemical assessment. 2,12 Foreign body type, possibly the most common type of MGC occurring in the breast, is frequently associated with a prior surgical procedure or duct rupture.…”

Indeterminate and Erroneous Fine-Needle Aspirates of Breast with Focus on the ‘True Gray Zone': A Review

“…The diagnosis of cribriform carcinoma is difficult on FNAC due to the relative cohesive nature of the malignant epithelium and the low nuclear grade [93,94,95,96]. Key to arriving at the correct diagnosis is recognizing cribriform as opposed to honeycombed architecture in the large sheets, absent-to-sparse ME cells and low nuclear grade.…”