25
Breast
Fig. 25.65 (A) Aspirate of an ill-defined breast lesion in a woman who
received irradiation for prior breast carcinoma. Note the mildly atypical
features including anisonucleosis and the loosely cohesive nature of the
group (Diff-Quik x MP). (B) Resected specimen demonstrating mild atypia of
the ducts as well as prominent stromal fibrosis (H&E x HP).
cytologic features suggestive o f phyllodes tu m o r and unusual
fo r breast carcinom a includ e increased num bers o f naked nuclei
and hyp ercellular strom al fragm ents.9
Sarcomas of the Breast
Sarcomas o f the breast are u n c o m m o n , c o n stitu ting < 1% o f
p rim a ry m a lig n a n t breast tu m o rs.375 T he cytologic features o f
pure breast sarcom a are s im ila r to sarcomas encountered in soft
tissue 283,306,376,377
Breast Angiosarcom a
P rim a ry breast angiosarcom a is the m ost c om m o n p rim a ry
breast sarcom a.378 T he m a jo rity o f these cases fo llo w ra d ia tio n
therapy and a breast-conserving surgery, w ith a latency period
o f 4 -7 years after therapy.378-380 The lesion u su ally develops as a
ra p id ly g row ing mass causing diffuse enlargem ent o f the breast
associated w ith blue-red d isc olo ra tion o f the skin. FN A m ay
be very h e lp fu l in d isting uishing a recurrent carcinom a fro m
angiosarcom a.
Breast angiosarcom a m ay vary fro m a w e ll-d iffere ntia te d
m alig nancy (grade I) resem bling hem angiom as to anaplastic
a n d /o r e p ith e lio id , p o o rly d ifferentiated neoplasm (grade III).
Fig. 25.66 Aspirate from phyllodes tumor showing a hypercellular stromal
fragment and a nearby cluster of benign ductal cells (Papanicolaou x LP).
Fig. 25.67 Aspirate from malignant phyllodes tumor revealing
a dissociative pattern of malignant cells. Other areas in the aspirate
demonstrated more conventional features of phyllodes tumor including
hypercellular stromal fragments and benign ductal groups (Diff-Quik x HP).
Fig. 25.68 Aspirate of benign phyllodes tumor showing atypical epithelial
hyperplasia that could potentially lead to a misdiagnosis of carcinoma
(Diff-Quik x HP).
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