BREAST CYTOPATHOLOGY

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90 4. Primary Malignant TumorsFigure 4.8. Ductal carcinoma. A large tissue fragment composed ofductal epithelium with well-formed papillary architecture. Thepapillae grow as slender projections with round bulbous endings.Because of the low-grade morphology, a distinction from a benignpapillary lesion would be extremely difficult. Follow-up tissue biopsyrevealed ductal carcinoma in situ, micropapillary type. (Smear,Papanicolaou.)Figure 4.9. Ductal carcinoma. Higher magnification shows a wellformedpapillary structure projecting from a broad base. Malignantcells have uniform but hyperchromatic nuclei (left). A histologicsection of the resected ductal carcinoma in situ, micropapillary type,shows concordant histologic features (right). (Smear, Papanicolaou;histologic section, hematoxylin and eosin.)
Ductal Carcinoma 91Pitfalls and Differential Diagnosis• Atypical ductal hyperplasia• Fibroadenoma• Papilloma/ papillomatosisInvasive Ductal Carcinoma NotOtherwise SpecifiedClinical FeaturesInfiltrating duct cell carcinoma not otherwise specified (NOS)is the most common primary carcinoma of the breast, rangingfrom 70% to 80% of all breast carcinomas. It is a heterogeneousgroup of tumors that lack characteristics that wouldallow their classification as a specific histologic subtype, suchas lobular carcinoma. It occurs most frequently in middleagedto elderly women and rarely in males. These tumors arerare in women younger than 40 years of age. Infiltrating ductcell carcinoma may present as a palpable or nonpalpablebreast mass that may or may not demonstrate clinical signsof skin and/or nipple involvement. Possible clinical presentationsinclude hard, fixed mass, “peau d’ orange” skin change,ulceration, bloody nipple discharge, and inverted or retractednipple. Breast carcinoma may also be a solely image-detectedlesion. These lesions can be stellate in appearance or wellcircumscribed.Mammographically, the vast majority of these malig nanciespresent with a poorly defined spiculated mass with or withoutmicrocalcifications. Sonographically, the most common featuresof malignancy are those of a hypoechoic mass withirregular borders and an uneven echo texture.Some of the risk factors for breast carcinoma include anearly menarche, late menopause, diet high in saturated fat,family history of breast cancer, nulliparity, late first live birth,and first-degree relative with breast cancer. Mutations of theBRCA1 and BRCA2 genes are associated with familial breastcancer at an early age.
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Breast Cytopathology
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Syed Z. Ali, MDDepartment of Pathol
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To my parentsGul Bano (late) and Ma
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viiiForewordthis volume to rejuvena
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xSeries Prefaceand form the framewo
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xiiPrefacecarefully selected high-r
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ContentsForeword by Dorothy L. Rose
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2 1. Introduction and Technical Asp
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10 1. Introduction and Technical As
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2Non-neoplastic andProliferative Le
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18 2. Non-neoplastic and Proliferat
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Page 152 and 153: 5Metastatic and SecondaryTumorsMeta
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140 5. Metastatic and Secondary Tum
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Figure 5.6. Metastatic small cell c
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BFigure 5.9. (B) Metastatic papilla
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154 6. Breast Ductal LavageTable 6.
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156 6. Breast Ductal LavageFigure 6
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162 6. Breast Ductal Lavagecarcinom
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164 6. Breast Ductal LavageKrishnam
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166 IndexApocrine carcinomain axill
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168 IndexDuctal carcinoma (cont.)fi
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170 IndexFine-needle aspiration, of
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172 IndexLung cancer, 138metastatic
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174 IndexPapilloma (cont.)invasive
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BREAST CYTOPATHOLOGY

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