BREAST CYTOPATHOLOGY

150 5. Metastatic and Secondary Tumors
• Spindle cell tumors often represent various types of
sarcomas.
• The aspirates of sarcomas are cellular usually with a spindle
cell pattern.
• Electron microscopy and immunostaining for mesenchymal
markers are helpful to establish the diagnosis of a sarcomatous
lesion.
Pitfalls and Differential Diagnosis
• It is critical to distinguish between a primary breast
carcinoma versus metastatic disease because of the varied
differences in therapeutic approaches and the differences
in the patients’ outcome.
• Even though the clinical presentation of the two may be
very similar, in general, nipple discharge and retraction are
not usually seen in metastatic tumors.
• Metastatic tumors have variable mammographic features
ranging from features similar to peripheral breast disease,
cyst or fibroadenoma to those of a malignant lesion such
as medullary carcinoma.
• Microcalcifications are not frequent except in rare cases
of psammoma bodies in metastatic tumors of ovary or
thyroid.
• Usually the patients with metastatic breast lesions experience
a poor outcome, and about 80% of them die within
1 year.
• It is important to appreciate that the distinction between a
primary breast tumor versus a metastasis may not always
be possible on the basis of a fine-needle aspirate or even a
core biopsy specimen.
• The initial and a very crucial step in diagnosis of a metastatic
breast lesion is the recognition of a cytologic pattern
that is not the usual presentation of a primary breast
carcinoma.
• This should alert the cytopathologist to explore the possibility
of a metastasis.