BREAST CYTOPATHOLOGY

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98 4. Primary Malignant TumorsFigure 4.19. Lobular carcinoma. Malignant cells seen in an intactlobular architecture as well as singly in the smear background. Afollow-up biopsy procedure revealed in situ and infiltrating lobularcarcinoma. (Smear, Papanicolaou.)the distinction between in situ and invasive lobular neoplasiashould not be attempted with FNAPitfalls and Differential Diagnosis• Atypical lobular hyperplasia• Pregnancy/lactational changesInvasive Lobular CarcinomaClinical FeaturesInfiltrating lobular carcinoma is diagnosed in approximately7%–10% of primary breast carcinomas. It occurs in a widerange of age groups, ranging from 26 to 86 years. Clinicalpresentation is similar to those of other primary breast carcinomas;however, it is not associated with Paget’s disease, andoccasionally it may present as an indurated area without anydiscrete mass. Infiltrating lobular carcinoma has a different
Lobular Carcinoma 99pattern of metastatic presentation and tends to involve skeletal,visceral, serosal, and meningeal areas. Similarly, ovary,bone, and uterus are the common sites of metastasis from thistumor.Mammographically, it can present as an asymmetric densitywith no clearly delineated margin with no or little architecturaldistortion. A mass may be firm to hard or not readilypalpable or visible. The mass may be detected mammographically,although microcalcifications are uncommon. Multifocalinfiltrating lobular carcinoma may present with minimaldistortion with no significant mass or increased density. Thesesubtle mammographic features warrant careful examinationof the breast and sampling of any suspicious area. Infiltratinglobular carcinoma is often bilateral and shows evidence ofmulticentricity.Histologic FeaturesPathologically, infiltrating lobular carcinoma is characterizedby diffuse infiltration of mammary stroma and ductal structuresby neoplastic cells in a pagetoid growth pattern. Thetumor may be difficult to define by gross examination becauseof the diffuse nature of the malignancy. Areas of carcinomain situ are commonly seen. Histologic growth patterns oflobular carcinoma include solid, alveolar, and the pleomorphicvariant.This variety of patterns exhibits similar prognostic behaviorexcept the pleomorphic variant, which is associated witha more unfavorable outcome. By immunohistochemistry, amajority of the lobular carcinomas (up to 95%) are estrogenreceptor positive, while 60%–70% are progesterone receptorpositive. Immunohistochemical analysis has shown a completeloss of E-cadherin expression in a majority of infiltratinglobular carcinomas (80%–100%).Cytomorphologic Characteristics (Figures 4.19 to 4.25)• Lesions have variable cellularity, and smears are usuallyhypercellular.• Cells have small uniform nuclei and small nucleoli.
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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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Figure 2.26. Lactational change. Hy
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Page 100 and 101: 86 4. Primary Malignant Tumors• M
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Page 152 and 153: 5Metastatic and SecondaryTumorsMeta
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148 5. Metastatic and Secondary Tum
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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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