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ISSN: 2157-7099
Journal of Cytology & Histology
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A Case of Delayed Metastatic Duct Carcinoma of Breast in Distant Lymph Node 10 Years Later

Chi-Min Shih*

Department of Life Science, Tunghai University, 1727, Sec.4, Taiwan Boulevard, Taichung, Taiwan

*Corresponding Author:
Chi-Min Shih
Department of Life Science Tunghai
University 1727 Sec.4, Taiwan
Boulevard Taichung Taiwan
Tel:
886 4 2359 0121
E-mail: [email protected]

Received Date: June 28, 2015 Accepted Date: June 30, 2015 Published Date: June 30, 2015

Citation: Shih C (2015) A Case of Delayed Metastatic Duct Carcinoma of Breast in Distant Lymph Node 10 Years Later. J Cytol Histol 6:i110. doi:10.4172/2157-7099.1000i110

Copyright: © 2015 Shih C. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Description

53-year-old female, breast carcinoma, left, S/P modified radical mastectomy ten years ago (in 2005)

She also received courses of chemotherapy until 2006. June 11th, 2015: Enlargement of bilateral inguinal lymph nodes, and more obvious over the right side, measuring up to 1.31 × 1.30 × 0.67 in dimensions. No mass or nodule is found over the rest body parts (Figure 1).

cytology-histology-copy-description

Figure 1: Copy of description of positive physical examination.

Cytology Report

Lymph node, groin, right, fine needle aspiration cytology were Positive for malignancy, in favor of metastatic carcinoma (Figures 2-5).

cytology-histology-two-large-atypical

Figure 2: Two large atypical cells are seen (Pap stain, 400X).

cytology-histology-a-cluster-cohesive

Figure 3: A cluster of cohesive atypical cells in the background with small lymphocytes (Pap stain, 400X).

cytology-histology-a-large-cluster

Figure 4: A large cluster of cohesive neoplastic epithelial cells (Pap stain, 400X).

cytology-histology-a-few-clusters

Figure 5: A few clusters of neoplastic epithelial cells with hyperchromatic nuclei (Pap stain, 400X).

Immunocytochemical Study

Direct immunostaining on stained slides S/P Papaniclaou stain (Figures 6).

cytology-histology-direct-immunostaining

Figure 6: Direct immunostaining on stained and uncovered slides S/P Papaniclaou stain.

Revised Cytology Report After ICC Study

Lymph node, groin, right, fine needle aspiration and ICC stain --- Metastatic carcinoma, in favor of breast origin. Cytokeratin (AE1/ AE3):+, ER:+ (Figure 7-8)

cytology-histology-immunocytochemical

Figure 7: Immunocytochemical (ICC) study: Cytokeratin (AE1/AE3): + (400X).

cytology-histology-icc-study-estrogen

Figure 8: ICC study: estrogen receptor (ER): + (arrows) (400X).

cytology-histology-tumor-emboli-found

Figure 9: Tumor emboli can be found in a few blood vessel lumens.

cytology-histology-tumor-emboli-found

Figure 10: Tumor emboli can be found in a few blood vessel lumens.

cytology-histology-uneven-nests-lymph

Figure 11: Uneven distribution of metastatic nests over one half of the lymph node.

cytology-histology-focally-cytoplasm

Figure 12: Focally clear cytoplasm and solid growth pattern.

cytology-histology-moderate-pleomorphism

Figure 13: Moderate nuclear pleomorphism, and no brisk mitotic figures (circle).

cytology-histology-immunohistochemical

Figure 14: Immunohistochemical (IHC) study: ER: +

cytology-histology-ihc-study-Intense

Figure 15: IHC study: Intense positive PR immunostaining cancer cells over left side, and negative PR immunostaining cancer cells over right side of the picture (100X).

cytology-histology-ki-67-pr-positive

Figure 16: Ki-67 proliferation index: up to 10% at PR positive area (200X).

cytology-histology-ki-67-pr-negative

Figure 17: Ki-67 proliferation index: 20% at PR negative area (200X).

Anatomical Diagnosis

It was carried out on June 24th, 2015. Lymph nodes, inguinal, right, biopsy showed Metastatic ductal carcinoma, breast in origin (one positive lymph node and one smaller negative lymph node).

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