Fig. 25.38 (A) Syncytial cluster of malignant ductal cells beneath a
group of smaller benign ductal cells maintaining a honeycomb pattern
(Papanicolaou x MP). (B) Individually scattered malignant ductal cells
having nuclei two to three times the size of the benign ductal cells, which are
arranged in a cohesive honeycomb cluster (Diff-Quik x MP).
and m a lig n a n t lym p h o m a .264 In ductal carcinom a, the aspirates
consist p re d o m in a n tly o f p leo m o rp hic cells arranged in three-
d im e nsion al clusters rathe r th an syncytial groups. M etastatic
carcinom a in in tra m a m m a ry lym p h node is the m ost d iffic u lt
d iffe re n tia l diagnosis because neoplastic cells are adm ixed w ith
lym phocytes. Therefore clinical find ing s m ay be h elp ful. Finally,
high-grade lym p h o m a presents as a dyscohesive p o p u la tio n o f
m a lig n a n t ly m p h o id cells, devoid o f neoplastic e p ith elial cells,
w h ic h can be easily assessed im m u n o p h e n o ty p ic a lly b y flo w
cytom etry.263
Key features of medullary carcinoma
• Cellular smears;
• Loose syncytial aggregates and single cells;
• Bizarre tumor cells with pleomorphic high-grade nuclei,
having prominent nucleoli and occasional stripped tumor
nuclei; and
• Benign lymphoid cells with occasional plasma cells.
intraductal Carcinoma
Fig. 25.39 (A) Aspirate from infiltrating ductal carcinoma showing
clusters of malignant cells infiltrating the fat (Diff-Quik x MP). (B) High-power
view of a ductal carcinoma demonstrating malignant cytologic features
including anisonucleosis with hyperchromasia and prominent nucleoli
(Papanicolaou x HP).
The cyto m o rph o lo gy o f D C IS varies according to w h ethe r
Fig. 25.40 Fine-needle aspirate of poorly differentiated ductal carcinoma
com edo o r non-com edo-type D C IS has been aspirated, as previ-
revealing numerous individually scattered malignant cells. These malignant
ously discussed.265 Aspirates fro m non-com edo-type (lo w grade)
cells demonstrate high nuclear grade (nuclear grade III) (Diff-Quik x HP).
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