cell p o p u la tio n possessing u n ifo rm , s lig h tly hyp erchrom atic
n uc le i.48 162 A variab le n u m b e r o f in d iv id u a lly scattered a typ i-
cal e p ith e lia l cells m ay be present.
The cytologic diagnosis o f atypia in breast FN A is challeng-
ing and lacks w ell-d efined criteria. T he N a tio n a l Cancer In stitu te
(N C I) has recognized th is p rob lem and has created a category o f
a typ ical/ind eterm inate.164 Furth er investigators subdivided this
category in to atypical, p rob ab ly benign, suspicious, and p rob -
ably m alig n an t.165,166 They fo u n d th a t m a jo rity o f cases having
suspicious find ing s proved to be m alig nant, w h ile ab out 50% o f
cases w ith atypical find ing s turned o u t to be carcinom a. O th er
investigators fo u n d no specific m orp h olog ic criteria to relia b ly
d ifferentiate benign fro m m a lig n a n t lesions in cases diagnosed
w ith atypia.148,167
Fig. 25.19 Aspirate of florid ductal hyperplasia showing a crowded sheet
of epithelial cells with some nuclear overlapping. Note that myoepithelial
cells are present within the group of cells (Diff-Quik x LP).
Fig. 25.20 (A) Aspirate of atypical ductal hyperplasia showing a cohesive
group of atypical ductal cells demonstrating nuclear overlapping, nuclear
enlargement, and variation in nuclear size and shape. Note, however, that
myoepithelial cells are still present within the group of ductal cells (Diff-
Quik x HP). (B) Aspirate of atypical hyperplasia revealing loosely cohesive
groups of atypical cells. Although quite worrisome, myoepithelial cells are still
present. Tissue confirmation would be needed to definitively separate this
lesion from ductal carcinoma in situ (Papanicolaou x LP).
Key features of atypical ductal hyperplasia
• Increased crowding and overlapping of cells within the
• Bipolar nuclei (myoepithelial cells) present;
• Variation in nuclear size with nucleoli;
• No or very few single atypical cells; and
• Less evidence of apocrine cells.
C ytologic features used to d ifferentiate fibrocystic change
fro m atypical hyperplasia are subjective. Therefore, w h en there
is any d o ub t as to the presence o f atypia, the trip le test assess-
m e n t sho uld be considered and excisional b iop sy o r fo llo w -u p
undertaken, as appropriate.
Juvenile Papillomatosis
Juvenile p ap illo m a to sis is a p rolifera tive breast lesion th a t
occurs a lm ost exclusively in young fem ales in the age range o f
1 0-40 years (m ean, 21 years). These patients present w ith a dis-
crete breast mass m im ic k in g fib road enom a, b u t asp iration often
produces cyst flu id .168 C ytolog ic find ing s include increased cellu-
la rity w ith occasional apocrine groupings and num erous naked
b ip o la r nuclei in the background. It is im p o rta n t to suspect this
diagnosis in you ng w om en, because ju ve n ile p ap illom atosis
m ay be a m arker fo r breast cancer fo r the patient's fa m ily and
m ay indicate a need fo r continued long -term fo llo w -u p . Patients
w ith ju ve n ile p ap illom atosis m ay also have an increased risk o f
m alignancy.168
Fibroadenom as are the m ost freq uent benign breast tu m o r th a t
m ay appear in all age groups, b u t th ey are especially c om m o n
in you ng w o m e n (20 -35 yea rs o ld ).120 P alp ation reveals a d o m i-
nant, m ovable, discrete mass generally u su a lly m easuring less
th a n 4 cm in diam eter. A single lesion is m ost often id entified ,
a lthoug h as m an y as 20% o f patients have m u ltip le lesions.
Fibroadenom as often increase in size w ith pregnancy. Aspira-
tio n generally produces a hyp ercellular specim en consisting o f
large sheets o f e p ith elial cells arranged in tig h tly cohesive h o n -
eycomb groupings (Fig. 25.21). Bottles and colleagues and o th -
ers believe th a t the branching a n tle r-h o rn cluster pattern o f the
e p ith elial cells is fa irly characteristic b u t n o t ab solutely specific
fo r the diagnosis o f fib road enom a (Fig. 25.2 2 ).169 The ep ithelial
cells have ro u n d nuclei w ith occasional sm all nucleoli. N u m e r-
ous b ip o la r naked nuclei are seen, inc lu d in g som e associated
w ith in sheets o f e p ith elial cells and m an y lyin g free in the sm ear
background (Fig. 25.2 3 ).9,112,169
previous page 718 ComprehensiveCytopathology 1104p 2008 read online next page 720 ComprehensiveCytopathology 1104p 2008 read online Home Toggle text on/off