title: Leiomyosarcoma of the breast: a difficult diagnosis on fine-needle aspiration biopsy.
abstract: Leiomyosarcoma of the breast is rarely encountered in fine-needle aspiration (FNA) cytologic material. We report a case of primary leiomyosarcoma of the breast in a 52-yr-old female. Aspiration cytology showed large, dissociated round to spindle cells with abundant vacuolated cytoplasm, pleomorphic nuclei, prominent nucleoli, and occasional intranuclear cytoplasmic invaginations. Mitotic figures, osteoclast-like giant cells, and stromal fragments were identified. A diagnosis of malignant neoplasm representing either a sarcoma, a poorly differentiated carcinoma, or a metaplastic carcinoma was made. The patient underwent a wide excision of the lesion after negative work-up. Histologic examination and immunohistochemical studies established the diagnosis of leiomyosarcoma. This case is presented here because we feel that, although FNA cytology with eventual ancillary studies is a valuable diagnostic tool to evaluate any breast mass, malignant spindle cell neoplasms of the breast still represent a diagnostic challenge for the cytopathologist. Recognition of all cytologic features of leiomyosarcoma may help to formulate a correct diagnosis.
authors.affiliation: New York University School of Medicine, New York, New York 10016, USA.
authors.forename: Xiao
authors.initials: X
authors.lastname: Jun Wei
authors.forename: Karen
authors.initials: K
authors.lastname: Hiotis
authors.forename: Roberto
authors.initials: R
authors.lastname: Garcia
authors.forename: Pascale
authors.initials: P
authors.lastname: Hummel Levine
mesh_terms: D000199:Actins / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D003893:Desmin / Q000032:analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007890:Leiomyosarcoma / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D014746:Vimentin / Q000032:analysis
chemical_list: D000199:Actins; D014408:Biomarkers, Tumor; D003893:Desmin; D014746:Vimentin