25
Breast
Fig. 25.28 (A) Aspirate from a lactating adenoma consisting of a uniform group of epithelial cells having vacuolated frayed cytoplasm and background
secretion (Papanicolaou x LP). (B) Loose cluster of acinar cells showing intranuclear and cytoplasmic vacuolation with fraying of the cytoplasm
(Diff-Quik x HP). (C) Group of acinar cells showing prominent cytoplasmic vacuolation. Note how prominent the nucleoli can be in the epithelial cells
from aspirates of lactating adenomas (Papanicolaou x HP). (D) Lactating adenoma showing intraluminal secretion and cytoplasmic vacuolation of the
acinar cells (H&E x LP).
Localized Amyloid Tumor of the Breast
Localized a m ylo id tu m o r o f the breast is an exceedingly rare les-
ion . W e have encountered tw o examples o f this entity, includ ing
one p atient w ith m etachronous b ilateral lesions.224 T his unusual
lesion occurs p re d o m in a n tly in elderly w o m e n and can be m am -
m og rap hically and c lin ic a lly confused w ith carcinom a.224,225 FNA
b iopsy can be a useful procedure to m ake a p re lim in a ry diagno-
sis w hen a m ylo id is appreciated in the smears. C ytologic finding s
o f a m ylo id include irregular clum ps o f m etachrom atic h om og -
enous m aterial in the m od ified W rig h t stain (D iff-Q u ik ) and
irreg ular cylind ric fragm ents o f refractile to glassy eosin o p hilic
m aterial in the Papanicolaou-stained smears. Som e interspersed
spindle-shaped cells are present at the periphery and w ith in the
substance o f the a m ylo id m ate ria l.224 Associated osseous m eta-
plastic and foreig n b od y reaction have been reported in the FNA
smears o f am yloidosis o f the breast.226 Congo red staining w ith
p rio r potassium perm anganate inc ub a tion id en tifie d the A L
type o f a m ylo id in b o th o f o u r cases, w h ic h was also confirm ed
w ith im m un oflu ore sc e nt studies fo r im m u n o g lo b u lin s and by
electron m icroscopy.224 A m y lo id tu m o rs o f the breast can occur
in three separate settings: secondary am yloidosis, systemic o r
m u ltip le m yelom a-associated am yloidosis, and as a localized
p rim a ry tu m o r having a benign course.224
Papilloma
S o lita ry p ap illom as occur m ost fre q u e n tly in w o m e n fro m 50 to
60 years o f age.81 Patients often present w ith a serous o r b lo o d y
n ip p le secretion. FN A smears reveals e p ith elial cells arranged in
tig h t sheets o r th ree-d im ensional clusters w ith depth o f focus
(Fig. 25.3 3 ). Spindle-shaped strom al cells also are present occa-
sionally. Because d iffe re n tia tin g a benign p a p illo m a fro m a
w e ll-d iffere ntia te d p a p illa ry carcinom a can be d iffic u lt, surgical
excision is advised w h en a p a p illa ry lesio n is encountered. Pap-
illo m a s can also be confused w ith fibroadenom as, because b o th
can have branching e p ith elial groups. T he presence o f c olum -
nar e p ith elial cells, strom al cores, o r fo a m cells favors a p ap il-
lom a, whereas increased num bers o f b ip o la r naked nuclei favor
fibroadenom a.
In fa rc tio n o f p a p illo m a is u n c o m m o n and can be seen
w ith pregnancy, lactation, and external in ju ry .227 It also seen
m ore o fte n in o ld e r patients w ith large p ap illom as.228 Infarcted
intrad uctal p a p illo m a has the p o ten tial fo r a false-positive
733
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