BREAST CYTOPATHOLOGY

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12 1. Introduction and Technical AspectsFine-needle aspiration of normal breast.• Usually scant cellularity• Always cohesive ductal fragments (few to nolobules)• Uniform round nuclei, no crowding, andminimal overlap• Dense chromatin, small inconspicuous nucleoli• Accompanying fibroadipose tissue fragmentsFine-needle aspiration cytologic criteria forbreast carcinoma.• Architectural characteristics (best evaluated at×25–×40 magnification)• Cellular morphology (best evaluated at ×100–×400 magnification)• General characteristics High cellularity Cellular enlargement High nucleus to cytoplasm ratios Nuclear hyperchromasia Macronucleoli (less often observed) Cellular/nuclear monomorphism (not alwayspresent) Eccentric nuclear placement Cellular dishesion with single isolatedepithelial cells Mitoses/karyorrhexis Cellular crowding/overlap Lack of myoepithelial cells Necrosis• Specific characteristics Small cell size with cytoplasmic lumina/vacuoles (lobular carcinoma) Pleomorphic naked nuclei with macronucleoli(medullary carcinoma) Abundant mucin and capillary tangles(colloid carcinoma) Rigid, open-ended tubules (tubularcarcinoma)Note: See Figure 1.7.
Technical Aspects 13Figure 1.7. Cytomorphologic features comparing ductal hyperplasia(left) and infiltrating ductal carcinoma (right). Note in ductalcarcinoma the significant cellular pleomorphism, cellular dissociation,nuclear enlargement, and eccentric nuclei (“plasmacytoid”appearance). Also note the lack of myoepithelial cells. (Smear,Papanicolaou.)Indications for fine-needle aspiration/corebiopsies of palpable breast lesions.• Palpable masses of clinical/patient concern(regardless of radiographic findings)• Masses that can be clinically explained bynormal anatomy/physiology, particularly inyoung patients, can be observed for twomenstrual cycles• Any persistent/suspicious masses in patientswith family history should be biopsiedregardless of imaging findingsSource: Based on data presented at the 1996National Cancer Institute–sponsored conference.
Page 2 and 3: Breast Cytopathology
Page 4 and 5: Syed Z. Ali, MDDepartment of Pathol
Page 6 and 7: To my parentsGul Bano (late) and Ma
Page 8 and 9: viiiForewordthis volume to rejuvena
Page 10 and 11: xSeries Prefaceand form the framewo
Page 12 and 13: xiiPrefacecarefully selected high-r
Page 14 and 15: ContentsForeword by Dorothy L. Rose
Page 16 and 17: 2 1. Introduction and Technical Asp
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Page 30 and 31: 2Non-neoplastic andProliferative Le
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62 3. Benign and Borderline TumorsF
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68 3. Benign and Borderline Tumors
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84 3. Benign and Borderline TumorsG
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86 4. Primary Malignant Tumors• M
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88 4. Primary Malignant TumorsFigur
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92 4. Primary Malignant TumorsHisto
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100 4. Primary Malignant TumorsFigu
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116 4. Primary Malignant TumorsPitf
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134 4. Primary Malignant TumorsClin
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136 4. Primary Malignant Tumorsdiag
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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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