Role of cytology in fibroadenoma with clinging carcinoma
A 48 years old lady, a known diabetic and hypertensive, presented with bilateral breast lumps of one week duration. There was no family history of breast or ovarian tumors. Patient had regular menstrual cycles in the past. On examination, there was a 4 × 4 cm hard lump in lower inner quadrant of left breast which was fixed to the chest wall and there was a lump in right breast, firm mobile measuring 1 × 1 cm in the lower outer quadrant. Impression of left breast lump on magnetic resonance imaging (MRI) was suspicious of malignancy []. Right breast lump was a 2.3 × 1.5 cm well defined mass lesion with type 1 contrast enhancement pattern (less than 6% malignant probability) with bilateral axillary lymphadenopathy. Ultrasound and bone scan were negative for detectable metastasis.\nFNAC was done from both the breast lumps and left axillary lymph node. Right axillary lymph node was clinically not palpable. Smears from the left breast showed poorly cohesive clusters of ductal cells with pleomorphism, hyperchromasia and prominent nucleoli. Myoepithelial cells and bare nuclei were not seen. FNAC from left axillary lymph node also showed similar cells.\nThe smears from the right breast mass showed three dimensional clusters of cells with hyperchromatic nuclei, prominent nucleoli. There were singly scattered pleomorphic cells with mitotic figures. Admixed with these clusters were benign ductal cells with no nuclear pleomorphism along with myoepithelial cells. A few bare nuclei were also seen. Cytologic diagnosis of duct cell carcinoma of bilateral breast lumps with left axillary lymph node metastasis was made [].\nTrucut biopsy of left breast lump showed features of infiltrative duct cell carcinoma. Immunohistochemistry was positive for estrogen and progesterone receptors. On the basis of the physical examination results, right breast lump was suspected as a fibroadenoma. Hence, lumpectomy was performed. The specimen grossly was a 1 × 1 cm, circumscribed tumor. Histopathology of multiple and serial sections revealed ductal structures surrounded by hyalinized stroma with focal myxoid areas. The lining of the ductal structures was bilayered. A significant number of ducts showed stratification of the lining epithelium, nuclear hyperchromasia and irregular nuclear contours, but myoepithelial lining was intact. There were no solid or cribriform areas, no stromal infiltration. The latter was confirmed by immunohistochemical staining with smooth muscle actin (SMA) and pancytokeratin (Pan CK). A diagnosis of fibroadenoma with DCIS, clinging type, was made (DCIS) [].