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Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 204-205
Cytomorphology of solitary cylindroma of the breast


Department of Pathology, Mamata Medical College, Khammam, A. P., India

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Vujhini SK, Kolte SS, Sushma Y, Satarkar RN. Cytomorphology of solitary cylindroma of the breast. Indian J Pathol Microbiol 2011;54:204-5

How to cite this URL:
Vujhini SK, Kolte SS, Sushma Y, Satarkar RN. Cytomorphology of solitary cylindroma of the breast. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Nov 22];54:204-5. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/204/77407


Dermal cylindromas are relatively benign skin adnexal tumors of eccrine or apocrine origin. They occur most commonly on head and neck with a male preponderance. Cylindroma of the breast is a very rare entity. To the best of our knowledge only ten cases have been published so far. [1],[2],[3],[4] Although the appearance of breast cylindromas is identical to that of its dermal counterpart arising in the head and neck region, these lesions arise within the breast parenchyma. We herein discuss the typical cytomorphological features of cylindroma of the breast.

A 41-year-old woman presented with freely mobile, firm, non-tender right breast mass of 1.5 cm diameter lateral to areola at 9 o'clock position since 1.5 years. There were no skin or nipple changes and no axillary lymphadenopathy. The patient had no significant family history or skin nodules. Ultrasonography showed well-defined hypoechoeic lesion noted in right breast parenchyma and was diagnosed as fibroadenoma [Figure 1].
Figure 1: A well-defined hypoechoic mass

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Fine needle aspiration (FNA) was performed and smears were stained with hematoxylin and eosin. Smears were highly cellular showing dual population of cells consisting of small and large cells. The small cells showed scanty eosinophilic cytoplasm and round to oval bland darkly stained nuclei. The large cells were oval to plump and showed relatively more cytoplasm and lightly stained plump nuclei. There was no significant nuclear pleomorphism and mitosis. There was abundant eosinophilic hyaline material adjacent to the tumor cells [Figure 2]. Cytological diagnosis given was benign neoplasm---cylindroma.
Figure 2: Highly cellular cytological smears showing small and large cells with abundant basement membrane material [H and E ×100]. Inset shows dark staining small and pale staining large nuclei [H and E ×400]

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Subsequent excision of mass showed an irregular, nodular soft tissue mass measuring 1.5 cm × 1.4 cm × 1.2 cm. Cut section was grey white and homogenous. Microscopically, the tumor was composed of tightly arranged nests of cells with a characteristic "jig-saw" or "mosaic" appearance at low power [Figure 3]. The nests were surrounded and penetrated by an eosinophilic hyaline basement membrane material. The nests of cells were composed of peripheral, small basaloid cells with small dark staining nuclei with palisading and the central cells showing more eosinophilic cytoplasm and large, pale staining vesicular nuclei. At areas, cells were forming tubular lumens. Hyaline basement membrane material was Periodic Acid Schiff (PAS) positive and diastase resistant [Figure 4]. The final diagnosis given on histological examination was cylindroma. Immunohistochemistry was not done.
Figure 3: Tumor cell nests arranged in "jig-saw" pattern separated by basement membrane material [H and E ×100]. Inset [H and E ×400]

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Figure 4: PAS positive diastase resistant hyaline globules in tumor cells [PAS ×400]

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Dermal cylindromas are relatively benign skin adnexal tumors occurring most commonly on head and neck with a male preponderance.

Cylindroma of the breast is a rare entity first described in 2001 by Gokaslan et al. [1] Extensive literature search showed only ten reported cases of breast cylindromas. [1],[2],[3],[4]

Cytological smears are usually richly cellular comprising of two types of cells arranged in diffuse fashion or poorly formed acinar pattern. Small cells show scant cytoplasm and darkly stained round to oval nuclei and the other large cells with relatively abundant cytoplasm and round to oval vesicular pale staining nuclei. The cells are intimately associated with hyaline globules (basement membrane material).

Histologically, the lesions are identical morphologically to dermal cylindromas. Cylindromas consist of nests and trabeculae of cells that mould in a "jigsaw" or "mosaic" appearance. The nests are composed of peripheral basaloid cells with bland darkly stained nuclei and central larger cells with oval vesicular nuclei. The nests also show few duct-like lumina with or without secretions. The nests are separated by thick basement membrane material which shows PAS positivity with diastase resistance and immunoreactivity to collagen IV. Hyaline globules are present focally within the cell nests.

Immunohistochemically, basaloid cells show diffuse positivity for p63 where as larger central cells show CK7-positivity. [4]

Cylindroma of the breast has to be differentiated from solid type of adenoid cystic carcinoma (ACC) both on cytological and histological examinations. Morphologically both tumors have a nodular and trabecular appearance, they also share basaloid and central paler cells. Both tumors also show hyaline globules, basement membrane material, and duct like lumina. However, ACC shows moderate to marked nuclear atypia and brisk mitotic activity which are absent in cylindroma. [5] ACC may be associated with mucin production, a finding absent in cylindroma.

Well-circumscribed mass of long duration and benign impression on imaging made the surgeon to excise the mass rather than mastectomy in our case.

The case is presented here because of its extreme rarity at this site. Correct diagnosis of this benign entity of breast on FNAC, considering the clinical and radiological findings may obviate the need for unnecessary mastectomy as its features may mimic malignancy.

 
   References Top

1.Gokaslan ST, Carlile B, Dudak M, Albores-Saavedra J. Solitary cylindroma (dermal analog tumor) of the breast: A previously undescribed neoplasm at this site. Am J Surg Pathol 2001;25:823-6.   Back to cited text no. 1
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2.Albores-Saavedra J, Heard SC, McLaren B, Kamino H, Witkiewicz AK. Cylindroma (dermal analog tumor) of the breast: A comparison with cylindroma of the skin and adenoid cystic carcinoma of the breast. Am J Clin Pathol 2005;123:866-73.  Back to cited text no. 2
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3.Nonaka D, Rosai J, Spagnolo D, Fiaccavento S, Bisceglia M. Cylindroma of the breast of skin adnexal type: A study of 4 cases. Am J Surg Pathol 2004;28:1070-5.  Back to cited text no. 3
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4.Mahmoud A, Hill DH, O'Sullivan MJ, Bennett MW. Cylindroma of the breast: A case report and review of the literature. Diagn Pathol 2009;4:30.  Back to cited text no. 4
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5.Shin SJ, Rosen PP. Solid variant of mammary adenoid cystic carcinoma with basaloid features: A study of nine cases. Am J Surg Pathol 2002;26:413-20.  Back to cited text no. 5
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Correspondence Address:
Sudhir Kumar Vujhini
Department of Pathology, Mamata Medical College, Khammam, A.P.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.77407

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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