Pure primary signet ring cell carcinoma breast: A rare cytological diagnosis
A 70-year-old female noticed a palpable mass in her left breast in the lower outer quadrant for 2 months with bloody discharge from the left nipple for a week. Physical examination revealed a mass measuring approximately 3 cm × 2 cm. It was firm, hard and non-mobile. Another mass was palpable in the left axillary region measuring about 4 cm × 3 cm. There was no evidence of supraclavicular lymphadenopathy. The examination of the contralateral breast and axilla was normal.\nOn mammography, the lesion appeared as a radiodense mass measuring 2.5 cm × 2 cm in the inferolateral quadrant with axillary lymphadenopathy (4.8 cm × 2.9 cm) and was categorized as breast imaging reporting and data system (BIRADS) IV-C-highly suspicious. Patient was advised to undergo fine needle aspiration cytology (FNAC).\nOn aspiration of mass in the left breast the smears prepared were stained with May-Grünwald-Giemsa (MGG) stain. Smears were cellular showing epithelial cells in small clusters and few that were individually scattered. These cells showed eccentrically placed nuclei and abundant cytoplasm. Nuclei were large, irregular and showed indentations by cytoplasmic vacuoles at places. Nuclei showed coarse chromatin with indistinct nucleoli []. Background comprised of dirty necrotic material with occasional cystic macrophages.\nFNAC of nodule in the left axilla yielded just adequate cellularity with cells showing similar cytological features and more cystic macrophages. No indigenous lymph node population was present.\nNipple discharge showed many cystic and hemosiderin laden macrophages and few dysplastic cells and degenerated cells in a hemorrhagic background. These dysplastic cells also had eccentric placed nuclei with abundant vacuolated cytoplasm [].\nPeriodic acid Schiff (PAS) staining and diastase-PAS (d-PAS) staining was carried out and the cytoplasm showed both PAS and d-PAS positivity suggestive of mucin []. The diagnosis of SRCC was made and was confirmed by histopathological examination of a trucut biopsy from the lesion. Patient was advised to undergo excision and chemotherapy, but she refused any further treatment.