Introduction: Multinucleated giant cells (MGC) are a rare finding when evaluating axillary sentinel lymph nodes. Some are described as foreign body-type MGC accompanied by foamy macrophages. They have been rarely reported in nodes from patients in which a previous breast biopsy was performed. The tissue damage induced by biopsy results in secondary changes including fat necrosis and hemorrhage that can migrate to axillary nodes. In this report, we illustrate a lipogranulomatous reaction in cytologic samples obtained during a sentinel lymph node examination of a woman previously biopsied because of breast carcinoma. We have found no previous cytologic descriptions and consider it an interesting finding that should be known to avoid diagnostic misinterpretations. Case: A 51-year-old woman underwent mastectomy of the right breast with a sentinel lymph node biopsy at our medical center. One month before, a control mammography revealed suspicious microcalcifications and a vacuum-assisted breast biopsy resulted in a diagnosis of high-grade intraductal carcinoma with comedonecrosis. Surgery with a sentinel lymph node biopsy was performed. The sentinel node was processed as an intraoperative consultation. Frozen sections and air-dried Diff-Quik stained samples were obtained. They showed abundant lymphocytes with MGC and tumoral cells. MGC showed ample cytoplasm with evident vacuoles of variable size. Occasional hemosiderin-laden macrophages were also present. The complete histologic analysis and immunohistochemical studies revealed no malignant cells. Histologic analysis showed, in subcapsular location, occasional MGC phagocyting lipid droplets. Hemosiderin-laden macrophages were a common finding. Conclusion: Lipogranulomas may appear at axillary sentinel lymph nodes because of fat necrosis induced by previous breast biopsy. The most important consideration is not confounding MGC with epithelial cell clusters. This can occur with not well-processed samples, especially if unmounted.
Acta Cytologica

中文翻译：

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腋前哨淋巴结中脂粒肉芽肿反应的细胞学特征

简介：在评估腋下前哨淋巴结时，多核巨细胞（MGC）是一个罕见的发现。一些被描述为伴有泡沫巨噬细胞的异物型MGC。在先前进行过乳腺活检的患者淋巴结中，很少有报道。活检引起的组织损伤导致继发性变化，包括脂肪坏死和出血，可迁移至腋窝淋巴结。在这份报告中，我们举例说明了先前因乳腺癌而活检的女性的前哨淋巴结检查中获得的细胞学样本中的脂肪肉芽肿反应。我们以前没有发现任何细胞学描述，并认为这是一个有趣的发现，应该避免诊断误解。案子：一名51岁妇女在我们的医疗中心接受了前哨淋巴结活检，对右乳房进行了乳房切除术。一个月前，对照乳腺X线照片显示可疑的微钙化，并且真空辅助的乳房活检结果诊断为伴有粉刺坏死的高级别导管内癌。进行了前哨淋巴结活检手术。前哨淋巴结作为术中会诊进行处理。获得冷冻切片和风干的Diff-Quik染色的样品。他们显示了丰富的淋巴细胞与MGC和肿瘤细胞。MGC显示出充足的细胞质，且具有明显的大小可变的液泡。偶尔也有载满铁血黄素的巨噬细胞。完整的组织学分析和免疫组织化学研究显示，没有恶性细胞。组织学分析显示，在囊下位置，偶有MGC吞噬脂滴。载有铁血黄素的巨噬细胞是常见的发现。结论：由于先前的乳腺穿刺活检引起的脂肪坏死，脂肪肉芽肿可能出现在腋前哨淋巴结处。最重要的考虑因素是不要将MGC与上皮细胞簇混淆。如果样品处理不当，尤其是在未安装样品时，可能会发生这种情况。
细胞学学报