BREAST CYTOPATHOLOGY

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66 3. Benign and Borderline TumorsFigure 3.13. Benign phyllodes tumor. Higher magnification of thesestromal components shows pleomorphic fusiform nuclei and numerousmyoepithelial cell nuclei. (Smear, Papanicolaou.)• Large, often folded, bland-appearing cohesive epithelialfragments• Dissociated spindle and stromal/mesenchymal cells (seenmore often in the malignant tumors) with plump fusiformnuclei often associated with myxoid or mucinous stromaltissue (metachromatic on Diff-Quik stain)• Rarely, chondroid metaplasia• Occasional mitotic figures in the stromal cells• Stromal fragments most often with monomorphic cells, butoccasional significant atypia (pleomorphic spindle cells)• Occasional multinucleated giant cells, apocrine ductal cells,or foam cells• Malignant phyllodes tumor is significantly more hypercellular,depicting more stromal predominance and moreatypia of the dissociated stromal cells (The stromal cellsmay appear fibrosarcomalike or stromal sarcomalike inthese cases. Positive immunostaining with p53 in thisscenario remains a contentious issue.)
Intraductal Papilloma/Papillomatosis 67Pitfalls and Differential Diagnosis• The distinction between fibroadenoma and phyllodestumor in an aspirate is based on the cellularity of thestromal elements seen in phyllodes tumors and is not alwayspossible to visually appreciate. The size of the lesion is nota valid distinguishing feature.• Diagnosis of low-grade or malignant phyllodes tumor isextremely difficult. These cases should be carefully evaluatedfor the presence of abnormal mitoses and pleomorphism.Other entities that may be considered in thedifferential diagnosis include fibromatoses and certainsarcomas.• Occasionally phyllodes tumors can be deceptively hypocellular,lacking the characteristic stromal fragments. Thismay happen if the needle samples the focally hyalinized ormyxoid areas of the tumor. Therefore, adequate samplingof the lesion should always be attempted by multipleaspirations.Intraductal Papilloma/PapillomatosisPapilloma is a benign tumor of ductal origin, most often seenin larger subareolar lactiferous ducts. It is most often solitary,although multiple tumors can be seen in the peripheral breast.Bilateral tumors are rare. Intraductal hyperplasia with papillaryarchitecture or “papillomatosis” is a nonspecific entitydenoting a phenotypic appearance, which should be distinguishedfrom a true intraductal papilloma. Less often, papillomacomes to attention as a mass lesion (may measure up to3 cm) in the fifth to sixth decades of life (somewhat youngerthan for patients with papillary carcinoma).Clinical Features• Usually presents with nipple discharge, often serous orblood-tinged
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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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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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126 4. Primary Malignant TumorsFigu
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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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