Fig. 29.7 (A) Giant fibroadenoma. Large tumor of the left breast in a 15-year-old girl with fast-growing erythematous skin and prominent veins. (B) Macroscopic
view of the tumor. (C) Mixed breast tumor with ducts partially obliterated (left) and moderately cellular stroma with spindle cells without atypias (H&E x HP).
(D) Large angulated sheets of benign mammary epithelium and abundant bipolar myoepithelial cells without atypias. Fine-needle aspiration (Papanicolaou x HP).
is also e xtra c ellu la r secretion, g iving th is neop lasm a m ic ro -
cystic appearance. C ells sho w cytop lasm ic vacuoles and slig h t
to m od erate a typ ia.29 Fine-needle aspirates sho w m oderate
a m o un ts o f atypical e p ith e lia l cells w ith variab le p le o m o r-
p h ism and h yp e rch rom atic nuclei w ith p ro m in e n t n u c le o li,
arranged in an isolated fa s h io n and w ith th re e -d im e n sio n a l
aggregates. S om etim es there is secretory m a te ria l in th e back-
g rou n d .30
Key features of secretory carcinoma
• A typ ic a l e p ith e lia l cells;
• C ells in th re e -d im e n s io n a l aggregates; and
• S ecretory m a te ria l in th e b ackg round .
M am m a ry gland sarcomas are very infre q ue nt in children. A ng i-
osarcomas, m alig n an t phyllodes tum ors, neuroblastom as, lip o -
sarcomas, and P N E T-E W S , am ong others, have been observed.
Metastases o f sarcomas in the breast are rare, especially those
o f em b ryonary rhabdom yosarcom a. Im m u n oc ytoc he m istry is
essential fo r establishing the d efinitive diagnosis.29
Malignant Hematopoietic Neoplasms
M alig n an t hem atop oietic neoplasm s are very in fre q ue nt in m a m -
m ary glands o f children. There are p rim a ry and secondary vari-
ants. W ith in the first group, the m ost freq uent are non-H od g kin's
lym p hom as, especially sm all noncleaved cell lym p h o m a (som e-
tim es b ilateral) and diffuse large-cell lym p hom a. The second-
ary group includes leukem ic breast involvem en t (granulocytic
sarcoma). Im m u n oc ytoc he m istry is critical fo r typ ifyin g the
hem atop oietic neoplasm s.29
Genital Tract Tumors
In children, these include an im p o rta n t group o f benign and
m a lig n a n t lesions.31