BREAST CYTOPATHOLOGY

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122 4. Primary Malignant Tumors• By World Health Organization definition, apocrine carcinomashould show cytologic and immunohistochemicalcharacteristics of apocrine cells in greater than 90% oftumor cells.• Apocrine carcinoma occurs in the older age group, morecommonly in the sixth and seventh decades.• The carcinoma probably arises from preexisting apocrinemetaplasia rather than de novo.• The prognostic significance of apocrine carcinoma is controversial.It is not any different from invasive mammarycarcinomas NOS, although some reports suggest a somewhatbetter prognosis for this variant.• Bilateral apocrine carcinomas are rare.Cytomorphologic Characteristics (Figures 4.42 and 4.43)• Hypercellularity is present.• Sheets, cords and tubules, and single cells are loosely cohesive,often with prominent apocrine morphology.Figure 4.42. Apocrine carcinoma. A dispersed population of large,pleomorphic cells with polygonal shapes, large nuclei, and abundantgranular cytoplasm. (Smear, Diff-Quik.)
Special Types of Breast Carcinomas 123Figure 4.43. Apocrine carcinoma. A loosely cohesive cluster oflarge, pleomorphic malignant cells. Note the occasional binucleationand abundant granular cytoplasm in the tumor on the left. The correspondinghistologic section is shown on the right. (Smear, Papanicolaou;histologic section, hematoxylin and eosin.)• Cytologic evidence of malignancy is often easy to appreciate(nuclear overlap, pleomorphism, high nucleus to cytoplasmratios, occasional mitoses).• Pleomorphic large nuclei are often eccentrically locatedwithin the dense granular or clear eosinophilic cytoplasm.Cells are often binucleated with discrete and well-delineatedcytoplasmic borders.• The nucleoli are prominent, and multinucleation iscommon.• Background consists of fragmented cytoplasm with nakedmalignant nuclei and granular debris.• Eccentric nuclear placement gives the cells a “cometlike”morphology.• Occasionally necrosis and/or histiocytes are seen.• It represents one of the gray zone cytopathologic diagnoseson FNA.• In difficult cases, immunostaining with Ki-67 (higherexpression) and p53 can be helpful.
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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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58 3. Benign and Borderline TumorsC
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60 3. Benign and Borderline TumorsF
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68 3. Benign and Borderline Tumors
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Page 100 and 101: 86 4. Primary Malignant Tumors• M
Page 102 and 103: 88 4. Primary Malignant TumorsFigur
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Page 152 and 153: 5Metastatic and SecondaryTumorsMeta
Page 154 and 155: 140 5. Metastatic and Secondary Tum
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Page 160 and 161: BFigure 5.9. (B) Metastatic papilla
Page 168 and 169: 154 6. Breast Ductal LavageTable 6.
Page 170 and 171: 156 6. Breast Ductal LavageFigure 6
Page 176 and 177: 162 6. Breast Ductal Lavagecarcinom
Page 178 and 179: 164 6. Breast Ductal LavageKrishnam
Page 180 and 181: 166 IndexApocrine carcinomain axill
Page 182 and 183: 168 IndexDuctal carcinoma (cont.)fi
Page 184 and 185: 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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