BREAST CYTOPATHOLOGY

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58 3. Benign and Borderline TumorsCytomorphologic Characteristics(Figures 3.1 to 3.8)• Grossly, the aspirate may appear sticky and tenacious,often clogging the needle lumen.• Smears are often hypercellular with a characteristicbiphasic appearance (epithelium and mesenchymal/stromaltissue).• Epithelium appears as cohesive, usually monolayeredsheets of well-organized ductal-type epithelium, often withfoldings, branchings with a “papillarylike” architecture(“staghorn”) or even tubular.• Naked bipolar myoepithelial nuclei are noted scattered inthe smear background in a significant number of cases.These have the so-called rice grain morphology and arebest visualized in Papanicolaou-stained smears.• Variably cellular fibrous stromal fragments are present.• Chondromyxoid stroma is present, often with a brightmetachromatic or magenta-colored appearance on Diff-Quik–stained smears and less obvious on Papanicolaoustainedsmears (pale green).• Juvenile fibroadenomas tend to have a more monomorphicappearance with predominantly larger epithelial fragmentsof a blander uniform columnar type. A papillary architecturecan be a prominent feature.• Uncommon features include significant epithelial atypia(nuclear enlargement, crowding, pleomorphism, and prominentnucleoli), apocrine and foam cells, prominent mucinouschange, multinucleated giant cells, and lack of astromal component (see Figures 3.5 to 3.8).Pitfalls and Differential Diagnosis• Fibrocystic changes• Atypical ductal hyperplasia• Intraductal papilloma, papillary carcinoma• Pyllodes tumor
Fibroadenoma 59Figure 3.1. Fibroadenoma. The case illustrates the degree of hypercellularitythat can be encountered in these tumors. There arenumerous branching fragments of ductal epithelium admixed withbackground myoepithelium. (Smear, Papanicolaou.)Figure 3.2. Fibroadenoma. A branching ductal epithelial fragmentwith the characteristic staghorn appearance is shown on the left. Acombination of stromal matrix with mesenchymal cell proliferationand abundant myoepithelial cells is observed on the right. (Smear,Papanicolaou.)
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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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108 4. Primary Malignant Tumors•
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110 4. Primary Malignant TumorsFigu
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116 4. Primary Malignant TumorsPitf
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120 4. Primary Malignant TumorsInfl
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122 4. Primary Malignant Tumors•
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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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