Cytologic findings in malignant myoepithelioma: a case report and review of the literature

BACKGROUND: Myoepithelioma of the breast is a rare tumor and the cytologic features have only been described in one previous report. CASE PRESENTATION: The present case comprises a 70 year old woman with a mammographic equivocal and ultrasonographic suspicious lesion. The aspirates were cellular and consisted mainly of single spindle or polymorphic, polygonal cells. The nuclei were generally large, ranging from 2 - > 5 × RBC. Most nuclei had a distinct medium-sized nucleolus. The nuclear outlines were irregular with buds and folds. The chromatin was granular. In the background there was abundant granular metachromatic ground substance and some metachromatic stromal fragments. A few mitotic figures were found. The cytologic diagnosis was suspicious for malignancy and a metaplastic carcinoma where only the non-epithelial component had been aspirated, or a non-epithelial lesion, was suggested. Macroscopically the tumor was round, seemingly well circumscribed, firm and with a white cut surface. The lesion consisted of spindled and polygonal cells with distinct pleomorphism. There were 6–9 mitoses per high power field (HPF). The tumor infiltrated in the surrounding fatty tissue. On immunohistochemistry, tumor cells were positive for smooth muscle actin, keratin MNF 116 and vimentin. Desmin and S-100 were negative. Ultrastructurally, there were abundant tonofilaments, including globular filamentous bodies and granulated endocytoplasmic reticulum with many dilated cisterns. The histologic diagnosis was malignant myoepithelioma. CONCLUSION: The case mirrors completely the WHO definition and the previous cytological and histological descriptions of malignant myoepitheliomas in the literature which describe a spindle cell population with unequivocal nuclear atypia, metachromatic background substance and mitoses.