Fine-Needle Aspiartion Cytology of Breast with Prominent Lymphocytic Infiltrate: A Cyto-Histologyc Correlation Study.
Katherine Watts, Bettina Papouchado. Cleveland Clinic, OH
Background: The presence of prominent lymphocytic infiltrate in breast fine needle aspiration cytology (FNAC) brings up a differential diagnosis that includes benign and malignant lesions. Distinction among these processes is crucial because it dictates therapy and defines prognosis. The aim or our study is to review our experience with prominent lymphocytic infiltrate in breast FNAC in the diagnosis of benign and malignant lesions.
Design: Breast FNA cases performed at our institution between 1994 and 2010 were retrieved from the pathology electronic archives. Cytologic smears, cell block preparation, and histologic follow-up of lesions with prominent benign or atypical lymphocytic infiltrate were reviewed.
Results: Sixty one breast FNAC cases were selected, based on the presence of prominent lymphocytic infiltrate. Histologic correlation was available in 41 cases (67%). The patients age ranged from 22 to 99 years old (mean age: 56) and all were female. The aspirates were categorized as benign lymphoid cells in 24 cases (58%), reactive lymphoid cells in 2 cases (5%), atypical lymphoid cells suspicious for lymphoma in 8 cases (20%), and adenocarcinoma with prominent lymphocytic infiltrate suggestive of medullary carcinoma in 7 cases (17%). Overall, of the 41 cases with lymphoid cells, 14 cases (34%) had benign intramammary lymph nodes or fibrocystic disease, 8 (20%) had lymphoma, 16 (39%) had ductal or lobular breast carcinoma, and 3 (7%) had medullary carcinoma. Of the 24 cases with benign lymphoid cells, 12 (50%) had benign lymph nodes or fibrocytic disease, 1 (4%) had lymphoma, 9 (38%) had ductal or lobular carcinoma, and 2 (8%) had medullary carcinoma. Of the 2 cases with reactive lymphoid cells, 1 had lymphoma and 1 had invasive ductal carcinoma. Of the 8 cases suspicious lymphoma, 1 (13%) had fibrocytic change, 6 (75%) had lymphoma, and 1 (13%) had breast carcinoma. Of the 7 cases with lymphoid cells and atypical ductal cells suspicious for medullary carcinoma, 1 (14%) had fibrocystic change, 5 (72%) had invasive ductal or lobular breast carcinoma with prominent lymphocytic infiltrate, and 1 (14%) had medullary carcinoma.
Conclusions: The presence of prominent benign lymphocytic infiltrate in breast FNAC may be seen in different types of breast carcinomas, or may originate from an intramammary lymph node. Although rare, lymphoma is the most common diagnosis when atypical lymphoid cells are seen. A wide differential diagnosis including benign and malignant entities should always be considered when a prominent lymphocytic infiltrate is present in breast FNAC.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 89, Wednesday Afternoon