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INTRODUCTION: Carcinoma arising from the axillary tail of Spence (CATS) is a rare entity that requires a high level of clinical suspicion. The clinicopathologic, prognostic, and imaging features of CATS are poorly understood. CASE SUMMARY: A 46-year-old woman presented to our hospital with right axillary swelling associated with bleeding and foul-smelling discharge. She had initially presented to a different hospital with a similar presentation where she was diagnosed with metastatic carcinoma, favouring adenocarcinoma on the FNAC report, following which she received 3 cycles of chemotherapy. MRI and PET-CT scan workups at our hospital showed a soft tissue mass likely arising from the axillary tail of the right breast with a few enlarged axillary lymph nodes and an unremarkable right breast. She underwent excision of the mass with axillary lymph node dissection and reconstruction with a pedicled Latissimus dorsi flap. The final diagnosis was based on immunohistochemistry, with tumor cells positive for GATA3 and CK-7, negative for estrogen and progesterone receptors (ER, PR), positive for human epidermal growth factor receptor 2 (Her2 neu), and having a Ki-67 labelling index of 45 %. DISCUSSION: Carcinoma of the axillary tail of Spence (CATS) has a reported incidence of 0.3 %. There have been only few papers till date that have reported the clinicopathologic, prognostic, and imaging features of CATS. MRI is an important imaging modality to localize CATS. Histologic examination aids in the diagnosis by identifying the presence of a histologic pattern of primary breast carcinoma and immunohistochemical characteristics such as ER, PR, Her2neu, and gross cystic disease fluid protein (GCDFP). Due to the rarity of CATS, no specific guidelines concerning management currently exist. Surgical management involves wide local excision of the axillary mass with axillary lymph node dissection. CONCLUSION: CATS, even though rare, should be considered in the differential diagnosis of a patient presenting with an axillary mass. MRI is a valuable tool to distinguish CATS from other lesions. Immunohistochemistry is essential to confirm the diagnosis.
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CONTEXT AND BACKGROUND: Cytological grading of salivary gland lesion, which is a simple, cost-effective, and reproducible method, can be used as a tool for the selection of treatment modality. The proposed Milan classification establishes one guideline for reporting of salivary gland cytology and thus helps in individualized treatment and follow-up. AIMS AND OBJECTIVES: (1) The aims and objectives of this study were to establish the validity and reliability of the Milan classification of cytological grading in salivary gland swelling and (2) to calculate the malignancy risk. MATERIALS AND METHODS: This prospective study was designed in clinically diagnosed salivary gland swelling at the Department of Pathology of a tertiary care referral hospital. Fine-needle aspiration (FNA) was done, and stained smears were examined under light microscope and cytological findings were noted according to the Milan classification. Tissue for the histopathological study was obtained in 119 cases. The previous cytological findings were compared to subsequent histopathology report. RESULTS: : Among 119 FNAs, 2.5% were nondiagnostic and 55.4% were nonneoplastic. While no samples were placed in the atypia of undetermined significance category, benign tumors accounted for 25.2%. About 1.7% was grouped in the salivary gland neoplasm of uncertain malignant potential, 2.5% of cases were categorized as suspicious of malignancy, and 12.6% of cases comprised as malignant tumors. Overall, malignancy risk was observed to be the highest (93.3%) in Category 6 and lowest (3.0%) in nonneoplastic category. CONCLUSIONS: The six-tier diagnostic categories of the Milan classification scheme help in segregating patients with salivary gland lesions into the management categories of follow-up, conservative surgery, and radical surgery with/without chemotherapy.