Osteoclast-like Multinucleated Giant Cells
A Clue to Invasive Mammary Carcinoma
Keywords:
mammary carcinoma, osteoclast-like, giant cells, low grade
Abstract
Mammary carcinoma with osteoclast-like giant cells is a rare variant of infiltrating breast carcinoma, first described by Rosen in 1979. Clinically and on sonomammography, the well-circumscribed margin of these tumors may suggest a benign lesion such as fibroadenoma and lead to a false negative diagnosis, as in this case of a 46 year old female with right breast lump. Fine needle aspiration cytology showed cohesive clusters with minimal cellular atypia mimicking fibroadenoma. But, presence of osteoclast-like multinucleated giant cells in the background was puzzling. So, lumpectomy was performed. Histopathology showed well differentiated invasive duct carcinoma, confirmed as luminal A type on immunohistochemistry. Till date, over 200 cases have been reported worldwide but we describe probably the only case from India, with complete work-up. The purpose of sharing this experience is to avoid missing malignancy on cytology in lesions which radiographically mimic fibroadenoma, osteoclast-like giant cells being a clue. Immunohistochemistry plays a diagnostic and predictive role. This low grade, rare but unique breast carcinomas must be documented for optimal patient management.References
1. Rosen PP. Multinucleated mammary stromal giant cells: a benign lesion that simulates inva¬sive carcinoma. Cancer 1979; 44: 1305-1308.
2. Ellis IO, Collins L, Ichihara S, MacGrogen G. Invasive carcinoma of no special type. In: World Health Organization Classification of Tumors of the Breast, Lakhani SR, Ellis IO, Schnitt SJ, Tan PH et al. 4th edition, IARC Press, Lyon, France, 2012:36–37.
3. Bauditz J., Rudolph B., Wermke W. Osteoclast-like giant cell tumors of the pancreas and liver. World Journal of Gastroenterology. 2006; 12:7878–7883.
4. Baschinsky DY, Frankel WL, Niemann TH. Gastric carcinoma with osteoclast-like giant cells. American Journal of Gastroenterology 1999; 94:1678-1681.
5. Kobayashi S, Yamadori I, Ohmori M, Kurokawa T, Umeda M. Anaplastic carcinoma of the thyroid with osteoclast-like giant cells. An ultrastructural and immunohistochemical study. Acta Pathol Jpn. 1987 May; 37(5):807-15.
6. Holland R, van Haelst UJ. Mammary carci¬noma with osteoclast-like giant cells. Additional observations on six cases. Cancer 1984; 53: 1963-1973.
7. Cai N, Koizumi J, Vazquez M. Mammary carcinoma with osteoclast-like giant cells: a study of four cases and a review of literature. Diagn Cytopathol 2005; 33: 246-251.
8. Chapter 23 - Mammary Carcinoma with Osteoclast-Like Giant Cells. In: Rosen's Breast Pathology. Rosen PP. 3rd Edition, Lippincott Williams & Wilkins 2009: 571-580.
9. Krishnan C, Longacre TA. Ductal carcinoma in situ of the breast with osteoclast-like giant cells. Human pathology 2006; 37: 39-372.
10. Zhou, S., Yu, L., Zhou, R. et al. Virchows Arch 2014; 464: 681. doi: 10.1007/s00428-014-1573-y
11. Agnantis NT, Rosen PP. Mammary carcinoma with osteoclast-like giant cells: A study of eight cases with follow up data. Am J Clin Pathol 1979; 72:383-389.
2. Ellis IO, Collins L, Ichihara S, MacGrogen G. Invasive carcinoma of no special type. In: World Health Organization Classification of Tumors of the Breast, Lakhani SR, Ellis IO, Schnitt SJ, Tan PH et al. 4th edition, IARC Press, Lyon, France, 2012:36–37.
3. Bauditz J., Rudolph B., Wermke W. Osteoclast-like giant cell tumors of the pancreas and liver. World Journal of Gastroenterology. 2006; 12:7878–7883.
4. Baschinsky DY, Frankel WL, Niemann TH. Gastric carcinoma with osteoclast-like giant cells. American Journal of Gastroenterology 1999; 94:1678-1681.
5. Kobayashi S, Yamadori I, Ohmori M, Kurokawa T, Umeda M. Anaplastic carcinoma of the thyroid with osteoclast-like giant cells. An ultrastructural and immunohistochemical study. Acta Pathol Jpn. 1987 May; 37(5):807-15.
6. Holland R, van Haelst UJ. Mammary carci¬noma with osteoclast-like giant cells. Additional observations on six cases. Cancer 1984; 53: 1963-1973.
7. Cai N, Koizumi J, Vazquez M. Mammary carcinoma with osteoclast-like giant cells: a study of four cases and a review of literature. Diagn Cytopathol 2005; 33: 246-251.
8. Chapter 23 - Mammary Carcinoma with Osteoclast-Like Giant Cells. In: Rosen's Breast Pathology. Rosen PP. 3rd Edition, Lippincott Williams & Wilkins 2009: 571-580.
9. Krishnan C, Longacre TA. Ductal carcinoma in situ of the breast with osteoclast-like giant cells. Human pathology 2006; 37: 39-372.
10. Zhou, S., Yu, L., Zhou, R. et al. Virchows Arch 2014; 464: 681. doi: 10.1007/s00428-014-1573-y
11. Agnantis NT, Rosen PP. Mammary carcinoma with osteoclast-like giant cells: A study of eight cases with follow up data. Am J Clin Pathol 1979; 72:383-389.
Published
2018-07-18
Issue
Section
Case Report
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