MYCOSES OF THE BREAST - DIAGNOSIS BY FINE-NEEDLE ASPIRATION

Fungal infections of the breast are unusual and may clinically mimic c arcinoma. When studied by fine-needle aspiration (FNA), such masses ma y yield necrosis, granulomatous inflammation, reactive histiocytes, an d atypical epithelial cells. Cohesive groups of atypical epithelial ce lls featured nuclear enlargement and overlapping, as well as prominent nucleoli. The organisms may be widely scattered, so that careful eval uation was required for their identification. In concert with provocat ive clinical findings, these features may lead to an erroneous diagnos is of malignancy. We describe three women with mycotic masses of the b reast initially studied by FNA. The first patient presented at age 31 with a large, firm breast mass, chest wall extension, and radiographic evidence of vertebral bone involvement. FNA was requested to confirm the clinical diagnosis of advanced breast carcinoma. In addition to th e atypia described above, the smears showed yeast forms indicative of blastomycosis surrounded by neutrophils. She remains well, following a ntifungal treatment. The second case of Blastomycosis was diagnosed by FNA of a breast mass in a 64-yr-old woman, who also responded to trea tment. The third patient's preoperative needle aspiration showed granu lomas, but no organisms were identified, even with special stains; sil ver stains of surgically excised tissue showed histoplasmosis. (C) 199 5 Wiley-Liss, Inc.