[P-09] Metastasis of primary breast undifferentiated pleomorphic sarcoma to the lung mimicking adenocarcinoma on cytology: a case report

Auliya Suluk Brilliant Sumpono1,2, Vivin Febriani1,2 and Irianiwati Widodo1,2

  1. Department of Anatomical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  2. Dr Sardjito Hospital Special Region of Yogyakarta, Indonesia


Background: Undifferentiated pleomorphic sarcoma (UPS) constitutes less than of all sarcomas in adults. UPS dissemination usually occurs haematogenously, lungs are the primary organs for metastasis. We herein present a patient with UPS of the breast with lung metastases after 12 years. Cytological diagnosis mass in the lung is extremely challenging because it is mimicking primary adenocarcinoma of the lung.

Case Presentation: A 58-year-old woman was referred to our hospital because she had dyspnoea for more than one month. She had a history of primary breast undifferentiated pleomorphic sarcoma 12 years ago. CT scan results show a mass in the lung that extends to the mediastinum. Fine needle aspiration with CT scan guidance was performed, cytology and cell block showed clustered and sheet-shaped cells, some of which were arranged in a tubular impression. Polymorphic cells with oval and round nuclei and a slightly vacuolated cytoplasm. We initially diagnosed it as an adenocarcinoma of the lung. Furthermore, immunohistochemical staining was carried out with results TTF1 (-), Napsin A (-) and Vimentin (+). We conclude that fine needle aspiration of the lung mass is metastasis of primary breast undifferentiated pleomorphic sarcoma.

Discussion and Conclusion: Cytology of UPS shows single cells to large storiform fragments. Cells are spindled, plasmacytoid and pleomorphic (often multinucleated) with nuclear morphology. In this case we encounter different patterns and cells. Cytological diagnosis in this case deserves caution. The history of previous examinations and immunohistochemical examination on fine needle aspiration cytology will be very helpful in establishing the diagnosis.