PART TWO
Diagnostic Cytology
Fig. 25.18 (A and B) Aspirate of collagenous spherulosis showing metachromatically staining amorphous spherules surrounded by myoepithelial cells
(Diff-Quikx LP and HP). (C) Resected lesion demonstrating papillomatosis with associated collagenous spherulosis. Note the fibrillary quality of the
spherules. (H&E x LP).
It is generally agreed th a t FN A cytolog y cannot re lia b ly
d istin g uish A D H fro m a n o n -c o m e d o -typ e o f D C IS .27,161,162
Therefore surgical b iop sy c o n firm a tio n is req uired w henever
A D H o r D C IS, n on -c o m e d o-typ e , is suggested b y th e cytologic
find ing s, because o f th e overlap p ing cytologic features. H o w -
ever, atypical hyperplasia can u su a lly be d isting uished fro m the
com edo-type o f D C IS .26,27 T he com edo type o f D C IS consists o f
m arked ly p le o m o rp h ic cells associated w ith a necrotic back-
ground.
Aspirates fro m n o n p ro life ra tiv e breast lesions are scantly
to m ild ly cellular, consisting o f fla t groups and sheets o f u n i-
fo rm cells arranged in a honeycom b fa sh io n associated w ith
m yo e p ith e lia l cells (b ip o la r stripp ed o r naked n u c le i).27,163
T he b ip o la r nuclei are situated w ith in th e groups and sin g ly
in the background. M od erate and flo rid ductal hyperplasia are
generally m od e rate ly cellular, w ith th e presence o f crowded
sheets, regular o r irre g ular cell spacing, and associated b ip o -
la r naked nuclei (Fig. 2 5 .1 9 ).27,163 Som e o f th e groups can be
fo ld e d o r angulated, and secondary irre g ular lu m e n fo rm a tio n
can be present. Som e cytologic v a ria tio n in cell size and shape
is noted w ith in th e groups, b u t single inta ct e p ith e lia l cells are
e ith e r n o t present o r very scarce. Aspirates o f A D H are gener-
a lly h ig h ly cellular, w ith crowded groups consisting o f cells
w ith b o th b enig n and atypical features.27,163 T he la tte r includes
greater v a ria tio n in cell size and shape and loss o f p o la rity
(Fig. 2 5.2 0 ). T he nuclei o f th e e p ith e lia l cells sho w a greater
degree o f hyperchrom asia, and n u c le o li can be re a d ily appreci-
ated. O ccasional single atypical cells can be present. However,
in contrast to D C IS, m yo e p ith e lia l cells (b ip o la r naked n uclei)
are present. Sneige and Staerkel have presented th e ir criteria
fo r the diagnosis o f p ro life ra tive e p ith e lia l lesions o f the breast
based o n b o th architectural and cytologic characteristics in an
a tte m p t to b etter d iffe re n tia te ductal hyperplasia fro m A D H
and A D H fro m D C IS .162 A ccording to Sneige and Staerkel, aspi-
rates fro m ductal hyperplasia shows groups o f e p ith e lia l cells
adm ixed w ith m yo e p ith e lia l cells and strom a l cells arranged
in a com p lex o r c rib rifo rm fa s h io n .162 T he e p ith e lia l cells had
oval to ro u n d nuclei possessing a b la n d c h ro m a tin pattern.
According to th e investigators, cell stream ing w ith overrid ing
nuclei o r tapered in te rc e llu la r bridges is a feature o f ductal
hyperplasia.48 A fe w single e p ith e lia l cells m ay also be present.
In contrast, A D H has a m ore m o n o to n o u s atypical e p ith e lia l
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