Giant cells in phyllodes tumour of breast: a diagnostic dilemma
Keywords:
Phyllodes tumor, Multinucleate giant cells, Ki-67 index
Abstract
Phyllodes tumour (PT) accounts for 0.3-1% of all primary tumours of the breast. Classification of PT into benign, borderline and malignant types is important in determining the prognosis of the disease. Occurrence of multi-nucleate giant cells (MNGC) in PT is a rare occurrence. Two types of MNGC have been described in mammary neoplasms, the multinucleate stromal giant cells (MNSGC) and the osteoclast-like giant cells (OLGC). Of thirteen cases of Phyllodes tumour (PT) with MNGC reported till date, eleven possessed pleomorphic, bizarre-appearing MNSGC and two had bland-looking OLGC. We present a case of borderline PT with multiple foci of both MNSGC and OLGC intermixed together in a hypervascular stromal background. To the best of our knowledge, such a case has not been reported earlier. The case also highlights the dilemma in grading of PT in the presence of many pleomorphic MNSGC. In these cases, Ki-67 proliferation index is important as it is not increased in the otherwise pleomorphic and bizarre-appearing MNSGC. It is also similar to the surrounding stromal cells, implying that MNSGC do not represent a more malignant population of cells. The case details along with a brief review of literature are presented.References
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2. Rosen PP. Multinucleate mammary stromal giant cells. A benign lesion that simulates invasive car-cinoma. Cancer 1979;44:1305-8.
3. Powell CM, Cranor ML, Rosen PP. Multinucleate stromal giant cells in mammary fibroepithelial neoplasms. Arch Pathol Lab Med. 1994;118: 912-6.
4. Fernandez-Aquilos, Noel JC. Malignant Phyllodes tumour of the breast with osteoclast-like giant cells: A case report. Ann Pathol.2007;27: 31-4.
5. Hemalatha AL, Sumana Sindhuram V, Asha U. Case reports in Pathology 2012.Artcle ID 835687.
6. Cai N, Koizumi J, Vazquez M. Mammary carci-noma with osteoclast-like giant cells: a study of four cases and a review of literature. Diagn Cy-topathol. 2005; 33:246–51.
7. Holland R, van Haelst UJ. Mammary carcinoma with osteoclast-like giant cells. Additional obser-vations on six cases. Cancer.1984,53:1963-73.
8. Shishido-Hara Y, Kurata A, Fujiwara M, Itoh H , Imoto S, Kamma H. Two cases of breast carci-noma with osteoclastic giant cells: Are the osteo-clastic giant cells pro-tumoural differentiation of macrophages? Diagnostic Pathology 2010;5:55
Published
2014-01-28
Issue
Section
Case Report
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