BREAST CYTOPATHOLOGY

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18 2. Non-neoplastic and Proliferative Lesions• Anucleated squamous cells, parakeratotic cells, and keratinousmaterial• Ductal epithelium with varying degrees of reactive atypia• Granulation tissue• Foamy histiocytes, cholesterol crystalsPitfalls and Differential Diagnosis• Duct ectasia• Ductal carcinoma with squamous differentiation, metastaticsquamous cell carcinoma, and metaplastic carcinomaGranulomatous MastitisClinical Features• Characterized by the presence of granulomatous reactionand giant cell formation• An inflammatory lesion of either unknown etiology or theresult of tuberculosis, fungal infection, epidermal inclusioncyst, or foreign body reaction such as suture and leakagefrom silicone implantsCytomorphologic Characteristics• Variable cellularity (usually high)• Epithelioid histiocytes, singly and in loose clusters• Mixed inflammatory cells, cellular debris• Few to abundant foreign body–type giant cells• Ductal epithelial fragments often with significant reactiveatypiaPitfalls and Differential Diagnosis• Duct ectasia• Low-grade ductal carcinoma
Fibrocystic Changes 19Fibrocystic ChangesFibrocystic changes are the most common cause of breastlumps in women between 30 and 50 years old. These are avariety of changes in the glandular and stromal tissues of thebreast. Clinically, these patients may have cysts, fibrosis, tenderness,or pain. Fibrocystic breasts may make detection ofbreast cancer by mammography more difficult; therefore,ultrasound may be necessary in some cases if a breast abnormalityis detected in a woman with fibrocystic breasts.Clinical Features• Extremely common (50%–90% of all adult women), themost common cause of a clinically palpable breast lump• Usually presents as a symptomatic lump with cyclicalhormonal variation in size and symptomatology• Young to middle aged women, peak incidence just beforemenopause• Usually bilateral and multifocal• May mimic breast cancer clinically, radiologically, andcytopathologically• Causation not exactly known, perhaps hormonal (excess ofestrogen, low progesterone, or their imbalance)• Primarily affects the terminal duct lobular unit• Characterized by presence of gross and microscopic cysts,apocrine metaplasia, and blunt duct adenosis• May be accompanied by epithelial proliferation of varyingdegrees, which should be reported separatelyCytomorphologic Characteristics(Figures 2.1 to 2.3)• Smears usually hypercellular with a varying admixture ofdifferent cell types, including apocrine cells• Usually cohesive fragments of ductal epithelium—“honeycombfragments,” often with focal to confluent apocrine
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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Page 58 and 59: Figure 2.26. Lactational change. Hy
Page 72 and 73: 58 3. Benign and Borderline TumorsC
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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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104 4. Primary Malignant Tumors•
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116 4. Primary Malignant TumorsPitf
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120 4. Primary Malignant TumorsInfl
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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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