BREAST CYTOPATHOLOGY

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124 4. Primary Malignant TumorsPitfalls and Differential Diagnosis• Atypical squamous metaplasia. This is an uncommon buta known cause of “atypical/suspicious” diagnosis on FNA.It shows moderate cellularity with syncytial sheets of atypicalductal cells with oval nuclei, coarse chromatin, angulatedmacronucleoli, and abundant amphophilic cytoplasm.There is often anisonucleosis and occasional bizarre cellswith giant nucleoli. Apocrine differentiation is not readilyapparent. Signet-ring forms have also been reported. Histologically,atypical squamous metaplasia is characterizedby the replacement of ductal epithelium by a single layerof apocrine cells that display at least a threefold variationin nuclear size. “Atypical apocrine hyperplasia” is a similarlesion with hyperplastic features regarded by some as aform of atypical ductal hyperplasia. Additionally, atypicalapocrine cells have also been reported on FNA in thesetting of sclerosing adenosis (atypical apocrine adenosis).Although diagnostic confusion with ductal carcinoma NOSor apocrine carcinoma may arise on FNA, it is helpful toremember that, unlike carcinoma, in atypical squamousmetaplasia the atypical nuclei are only focally present andare never a diffuse feature. Also many myoepithelial cellsare present and no mitoses or karyorrhexis is noted. Thetrue malignant potential of atypical squamous metaplasiais not known.• Ductal carcinoma with neuroendocrine differentiation.• Acinic cell carcinoma.• Squamous cell carcinoma.• Granular cell tumor.• Metastatic tumors (malignant melanoma).• Apocrine carcinoma arising in axillary apocrine glandsshould be distinguished from breast primaries.Metaplastic CarcinomaClinical Features• Metaplastic carcinomas account for less than 1% of allinvasive breast carcinomas.
Special Types of Breast Carcinomas 125• This extremely rare type of breast tumor includes varioussubtypes, that is, adenosquamous carcinoma, carcinosarcoma(homologous or heterologous), and spindle cellcarcinomas.• Tumors may be a monophasic (spindle cells only) or biphasicsarcomatoid type (carcinomatous and sarcomatouscomponents).• Clinical presentation is not different from the usual infiltratingbreast carcinomas.• These tumors may be cystic in nature.• These tumors usually are very aggressive tumors with apoor prognosis.Cytomorphologic Characteristics (Figures 4.44 to 4.46)• Depends on the specific subtype• May show an admixture of malignant glandular and squamousepithelium• Spindle cells, with fusiform nuclei and delicate wispy cytoplasmicprocesses• Occasional metachromatic stromal fragments• Occasional multinucleated giant cells and malignant heterologoustumor elements• Occasional necrotic and inflammatory debris in the smearbackgroundPitfalls and Differential Diagnosis• Benign mixed tumor of the skin• Sarcomas• Squamous metaplasia in cystic lesions• Metastatic cancers• Phyllodes tumor• Fibromatosis• Nodular fasciitis
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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
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Page 186 and 187: 172 IndexLung cancer, 138metastatic
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174 IndexPapilloma (cont.)invasive
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BREAST CYTOPATHOLOGY

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