Breast metastatic alveolar rhabdomyosarcoma: FNA findings
Subgroup: Volume 10, Issue 1
Date: January 2008
Type: Case Report
Start Page: 38
End Page: 40
- SM Owji Associate Professor of Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Po Box: 71344-1864, Shiraz, Fars, Iran
- PV Kumar Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
- H Noorani Department of Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
City, Province: Shiraz, Fars
A 25-year-old woman, a known case of vulvar rhabdomyosarcoma presented with bilateral breast nodules. Fine needle aspiration was performed. The smears revealed numerous round malignant cells, positive for malignancy. Histopathologic and immunocytochemical examination confirmed the diagnosis of metastatic alveolar rhabdomyosarcoma. The cytological findings of alveolar rhabdomyosarcoma of the breast are rarely reported. The clinical history and immunocytochemical study contributed to the diagnosis of metastatic alveolar rhabdomyosarcoma.
Keywords: Breast; Rhabdomyosarcoma; Alveolar type; FNA cytology
Alveolar rhabdomyosarcoma involving the female genital tract is rare. This neoplasm occurs predominantly in the adolescent age group, characteristically presenting as either a painless or mildly painful mass. Moreover, metastasis to the breast is uncommon. The histopathologic and immunohistochemical findings of this tumor have been described fully in many papers.1-9 However, the cytological findings are rarely reported.2 Here we would like to describe the cytological findings in a case of metastatic alveolar rhabdomyosarcoma of the breast and discuss the differential diagnosis.
A 25 year old woman presented in 2002 with a 2-week history of a swelling of the right labia majora. Clinical examination revealed a painless, soft tumor measuring about 5 cm. The tumor was excised and the histological examination revealed alveolar rhabdomyosarcoma (Fig. 1). The patient underwent 1 year of intensive chemotherapy and radiotherapy. One and half year after the initial presentation, the patient developed bilateral breast enlargement with a lump in the right breast. A mammography revealed a clear lesion in the right breast but the left one showed only dense parenchyma (Fig. 2). However, a few small nodules were noticed in the left breast on palpation. Clinically, the lesions in the breasts were diagnosed as metastatic tumors. So FNA study was advised to confirm the diagnosis of metastasis or to rule out the possibility of benign lesions. The aspiration material was obtained from both breasts. The smears were hypercellular and composed of mainly isolated and noncohesive groups of round malignant cells with scant cytoplasm. However, the cells also revealed a good amount of basophilic cytoplasm. Rosette-like structures were frequently noticed. We also noticed a few more interesting findings, such as binucleation, intranuclear inclusions, nuclear grooves and cytoplastmic vacuoles (Figs. 3). So we diagnosed the smears as positive for malignancy. The immunohistochemical findings were in favor of rhabdomyosarcoma.
Fig 1: Histologic section of labia majora mass shows alveolar rhabdomyosarcoma. Hematoxlin Eosin: 220; 360.
Fig 2: Mammography shows RT breast nodule and dense thickening of LT breast.
Fig 3: ABCD Smears revealed cytoplasmic vacuole, nuclear groove, binucleatio and nuclear inclusion. Wright-Giemsa: 900.
Alveolar rhabdomyosrcoma can involve the breast rarely as either primary or secondary. The breast metastases from rhabdomyosarocma are also uncom mon; only a few cases have been reported. Metastatic lesions are usually single. Multiple lesions and bilateral diffuse involvement are uncommon. Because of the density of the breast parenchyma in the young women, mammographic and ultrasonographic studies may be inconclusive. So contrast enhanced MRI study is considered the best for the detection of metastatic lesions in the breast of the young female. The histological, immunohistochemical and radiological findings have been fully described in many papers.1,3-9 However, the fine-needle aspiration cytological findings have been reported only rarely.2
Outpatient cases presented with bilateral breast enlargement with well defined nodule in the right breast and a few small discrete nodules in the left breast. Clinically, a benign lesion was considered. CT and mammographical studies were in favor of benign lesions, fibroadenomas. However, the FNA smears revealed numerous round malignant cells mixed with rosette-like structures and binucleated cells. So we ruled out the clinical diagnosis of benign lesions. Because of round cells, we considered many differential disgnoses such as lobular carcinoma, lymphomaleukemia, ewings sarcoma, emybryonal rhabdomyosarcoma and melanoma. But the clinical history, immunocytochemical studies and the large size of the cells helped us to rule out the above-mentioned tumors. The presence of rosette-like structures also raised the possibility of neuroblastoma and Askin’s tumor. Again, the clinical history and immunocytochemical studies helped to rule out those tumors.
In conclusion, the cytological findings of metastatic alveolar rhabdomyosarcoma of the breast are rarely reported. Clinical history and immunocytochemical studies are necessary for the diagnosis of metastatic alveolar rhabdomyosarcoma of the breast.
The authors would like to thank Dr. D. Mehrabani, Miss Gholami and Mrs. Ghorbani at Center for Development of Clinical Research of Nemazee Hospital for editorial and typing assistance.
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