The Value of Fine Needle Aspiration Cytology in Breast Fibromatosis: Study of Two New Cases and Review of the Literature

Abstract

We report two new cases of breast fibromatosis studied by needle aspiration cytology observed in a 32-year-old man and a 49-year-old woman. The lesions manifested as palpable, painless, and firm masses of the para-areolar breast soft tissues. Preoperative fine needle cytology revealed scant cellularity, featuring oval and spindle cells with bland nuclei and occasional larger polygonal cells with high nuclear:cytoplasmic ratio. Histologically, interwoven fascicles of spindle cells with bland nuclei, infiltrating the adjacent breast fat, were recognized. Based on available reports in the literature, we concluded that needle aspiration cytology, although not entirely specific, may be a source of important information in patients with breast fibromatosis. In particular, it confidently allows the exclusion of breast cancer and other more common diseases and is useful in planning a surgical approach to the lesion.

Fibromatosis of the Male Breast: A Case Report With Immunohistochemistry Study and Review of the Literature.

“…The occurrence of extramammary fibromatosis in younger women, often during pregnancy, the rapid tumor growth in women of childbearing age compared to juvenile and postmenopausal women and men, and spontaneous regression at menopause have suggested the influence of sex steroid hormones in the growth of this tumor. 1,[4][5][6][7][8] Since fibromatosis is an infiltrative proliferation of fibroblastic and myofibroblastic cells, the positivity for vimentin and smooth muscle actin was not surprising. Curiously, fibromatosis in the breast differs from fibromatosis arising in other parts of the body due to its hormone receptor profile.…”

“…In cases where suspicious breast findings do not correlate with the usual diagnostic measures, such as those from fine-needle aspiration or core needle biopsy, the diagnosis of a fibromatosis mimicking breast cancer should be considered in the differential diagnosis. [8][9] We report the case of a 47-year-old man with mammary fibromatosis. To the best of our knowledge, this is the sixth case of fibromatosis reported in the male breast.…”

Inflammatory Myo.broblastic Tumor of the Breast

“…16 In fibromatosis the cellularity is often sparse, and isolated atypical spindle cells showing large nuclei with fine chromatin and lacy cytoplasm are seen. 17,18 Metaplastic carcinoma is markedly cellular, with pleomorphic nuclei and 2 or more distinct neoplastic elements. 19 Coffin et al, in a study of 84 extrapulmonary cases of IMT, described 3 basic histologic patterns: a nodular fasciitis-type reaction with myxoid, vascular and inflammatory granulation tissue-like areas; fibrous histiocytoma-like morphology with compact spindle cells with intermingled lymphocytes, plasma cells and eosinophils; and desmoid or scarlike histology with dense, platelike collagen.…”

Fibromatosislike Metaplastic Carcinoma of the Breast as a Diagnostic Pitfall for Fine Needle Aspiration Cytology

“…The cytologic appearance of a small number of fibromatoses occurring within the breast has been reported. [16][17][18][19] Reports of most of these cases antedated the description of fibromatosis-like metaplastic carcinoma by Gobbi et al 5 Immunohistochemistry for epithelial membrane antigen and cytokeratin was performed on the 2 cases reported by Pettinato et al 16 and demonstrated the absence of positivity for epithelial markers in the neoplastic proliferation, effectively ruling out a metaplastic carcinoma.…”

“…[13][14][15]17 In these reports, the fine needle aspiration smears from the breast nodules were cellular and contained cohesive clusters of benign ductal epithelium admixed with a dominant population of isolated, elongated cells in a background of granular amorphous material. [16][17][18][19] Occasionally, small aggregates of spindle cells were seen, as were fragments of collagen tissue. 16,17 The dominance of spindle cells in the reported cases of mammary and nonmammary fibromatoses appear distinct from the cytologic findings in our case of fibromatosislike metaplastic carcinoma of the breast.…”