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A 49-year-old African American woman presented with a palpable lump in the left breast at the 5-o'clock position. Ultrasound of the palpable area demonstrated a single 3.2-cm complex hypoechoic, partially shadowing lobulated and irregular solid mass, which was partially imaged mammographically because of its far posterior location. A chest radiograph and bone scan did not reveal any metastatic disease. A fine-needle aspiration biopsy of the mass was performed followed by a lumpectomy with lymph node sampling. Grossly, the lumpectomy specimen revealed a 4.3-cm, firm, gray-white mass with small foci of myxoid or gelatinous stroma. The patient received chemotherapy for approximately 6 to 7 months and radiation therapy to her breast. One year later, she developed shortness of breath and was found to have multiple lung metastases, bilateral pleural effusions, and an enlarged right supraclavicular lymph node. A fine-needle aspiration biopsy of the supraclavicular node and cytologic examination of the subsequent pleural effusion were positive for tumor cells.
Fine-needle aspiration biopsy of the breast mass revealed a cellular aspirate with dyscohesive tumor cells with high nucleus-to-cytoplasm ratio and pleomorphic nuclei. Fragments of metachromatic chondromyxoid extracellular material contained cells that were reminiscent of chondrocytes (Figure 1). Histopathology of the excised tumor revealed a poorly differentiated neoplasm composed mostly of solid sheets of small undifferentiated cells with frequent mitoses and foci of necrosis (Figure 2). Interspersed with the tumor cells were sharply delineated areas of chondromyxoid matrix...