Background: Metastases to axillary lymph nodes are commonly and readily confirmed by fine needle aspiration cytology (FNAC). Most likely, these arise from breast primaries. However, the diagnosis can become complicated when unusual cytomorphology is encountered. Case: We report a 60-year-old woman presenting with bilateral axillary lymphadenopathies but without breast lesions. History showed increasing CA-125 levels. FNAC yielded carcinoma cells showing prominent papillary pattern, being composed of mild to moderately differentiated malignant cells, with focal abortive glandular formation and squamous metaplasia. IHC stains were done and the tumor cells were PAX-8 positive, but GATA-3 and GCDFP-15 negative. Coupled with the clinical history, a diagnosis of metastatic endometrioid adenocarcinoma was made. Conclusion: Nodal metastases with papillary cytomorphology can rarely arise from nonbreast primaries. The presence of papillary pattern, particularly in the absence of a clinically detectable breast lesion, should raise the possibility of a metastasis. Correlation with patient history, imaging findings and judicious use of IHC studies are crucial for a correct diagnosis.
Acta Cytologica

中文翻译：

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具乳头状形态的腋窝淋巴结转移：罕见的起源。

背景：细针穿刺细胞学检查（FNAC）通常容易地证实腋窝淋巴结转移。这些很可能是由乳腺原发引起的。但是，当遇到异常的细胞形态时，诊断可能会变得复杂。案件：我们报告一位60岁的妇女出现双侧腋窝淋巴腺病，但没有乳腺病变。历史表明CA-125水平升高。FNAC产生的癌细胞表现出突出的乳头状模式，由轻度至中度分化的恶性细胞组成，伴有局灶性流产性腺体形成和鳞状化生。进行了IHC染色，肿瘤细胞为PAX-8阳性，但GATA-3和GCDFP-15阴性。结合临床病史，对转移性子宫内膜样腺癌进行了诊断。结论：非乳腺原发很少发生具有乳头状细胞形态学的淋巴结转移。乳头状模式的存在，特别是在没有临床可检测的乳腺病变的情况下，应增加转移的可能性。与患者病史，影像学发现和正确使用IHC研究的相关性对于正确诊断至关重要。
细胞学学报