A case report of malignant phyllodes tumor of the breast with cytologic presentation of tumor cells in pleural effusion.
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The cytological findings of a malignant phyllodes tumor of the breast with pleural effusion are reported. A 50-yearold woman was admitted to the hospital with complaint of right breast mass. A large tumor in the right breast was resected by simple mastectomy and diagnosed histologically as being a malignant phyllodes tumor. After the operation, recurrent lymph node metastases involving axillary, infraclavicular, pulmonary hilar and mediastinal nodes were found. patient was readmitted with right pleural effusion and died of respiratory failure 18 months after the operation.<BR>The cytologic specimen from the tumor in the right breast contained a mixture of malignant neoplastic cells and benign epithelial cells. Malignant neoplastic cells were observed singly as well as in loosely cohensive clusters. The most commonly observed cells were spindle-shaped fibroblastlike cells with elongated nuclei and enlarged nucleoli. The nuclear chromatin of these cells was coarsely granular and marked increased in amount. Multi-nucleated giant cells were frequently found. A small number of epithelial cells were present in clusters and showed a sheet-like appearance. The cytologic diagnosis of the primary tumor was malignant pyllodes tumor.<BR>A smear from pleural effusion was suggested a diagnosis of malignant phyllodes tumor. The most frequently observed neoplastic cells in pleural effusion were polygonal cells with predominantly round to oval nuclei. Few multinucleated giant cells were observed and no epithelial cells were detected. There were some different cytologic findings between neoplastic cells of the primary tumor and the pleural effusion.<BR>It is well-known that most malignant phyllodes tumors metastasize via the blood. Most commonly the lung and skeleton are involved, though in our case, no blood-bone metastasis was clinically demonstrated. It is considered that tumor cells spread by the lymphatic channels involving pulmonary hilar and mediastinal nodes, and infiltrated the pleural cavity.<BR>Electron microscopical and immunohistochemical findings of the tumor suggested that stromal tumor cells of the malignant phyllodes tumor consisted of primitive mesenchymal cells with differentiation to smooth muscle cells.
- 特定非営利活動法人 日本臨床細胞学会の論文
特定非営利活動法人 日本臨床細胞学会 | 論文
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