BREAST CYTOPATHOLOGY

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28 2. Non-neoplastic and Proliferative LesionsMalignant• Intracystic papillary carcinoma• Infiltrating lobular carcinoma• Apocrine carcinoma• Tubular carcinomaPublished Accounts and Authors’ Experiences of PracticalProblems in Gray Zone Diagnoses• Cellular fibroadenoma versus ductal carcinoma• Solitary ductal papilloma versus intracystic papillarycarcinoma• Apocrine metaplasia versus well-differentiated apocrinecarcinoma• Lobular carcinoma versus benign breast lesions (lactationalchanges)• Tubular carcinoma versus benign breast (or fibroadenoma)• Atypical ductal hyperplasia versus cribriform ductalcarcinoma in situColumnar Cell Lesions of the BreastColumnar cell lesions are increasingly encountered in breastFNA in women between the ages of 35 and 50 years. It canbe a common finding in breasts with microcalcifications orcan be an incidental finding in fibroadenomas or fibrocysticchanges. These peculiar lesions involve the terminal ductlobular unit and display well-formed columnar cells withapical secretory snouts, also called CAPSS or “columnaralteration with prominent apical snouts and secretions.”Columnar cell lesions represent a spectrum of proliferativeepithelial change with and without significant cytologic atypia.These are often nonpalpable lesions that could be multifocalor bilateral in the breasts. Most common histologic follow-upfinding is benign fibrocystic change. The clinical significanceof columnar cell lesions is not well-defined; however, theycan be seen in association with lobular lesions (atypia, in situcarcinoma) and tubular carcinoma.
Silicone Mastitis 29When FNAs are performed on these lesions, the mostcommon scenario is a palpable breast mass or a radiographicdensity or nodule. Cytomorphologically, moderate to abundantthree-dimensional cellular fragments are seen composedof polygonal round to oval cells. There is usually a loss ofpolarity especially toward the center of the fragments wherecellular crowding and disorganization are quite pronounced.Characteristically, the cells at the periphery display columnarmorphology with prominent palisading in the long axis.Rarely flat sheets with branchings and infoldings are alsoseen. Secretory snouts are seen in up to half of the cases onFNA. Myoepithelial cells are almost always present intermingledwith the ductal epithelium. Some cases have a significantnumber of single epithelial cells requiring a carefulevaluation to avoid overdiagnosis, as significant atypia israrely seen in such cells. Foamy histiocytes and apocrinemetaplastic cells are rare.Differential diagnosis of columnar cell lesions includespapilloma, fibroadenoma, low-grade ductal carcinomas, andpostradiation changes.Silicone MastitisClinical Features• Often associated with ruptured silicone tissue expanders• Exuberant proliferative tissue reaction may result in singleor multiple nodules simulating malignancyCytomorphologic Characteristics(Figures 2.8 to 2.11)• Characterized by pools or globs of liquid silicone,often surrounded by epithelioid histiocytes, foamy macrophages,or foreign body–type giant cells forming “siliconegranulomata”• Cytohistologic picture may also resemble fat necrosis• Smears are moderately cellular
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
Page 24 and 25: 10 1. Introduction and Technical As
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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78 3. Benign and Borderline Tumors
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80 3. Benign and Borderline Tumors
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82 3. Benign and Borderline TumorsF
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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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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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