Our experience with a total of 7,231 needle aspirates of the breast was reviewed. Ninety-nine cases from the total of 7,231 aspirates studied were from male patients. While an aspiration cytodiagnosis of gynecomastia was made in most of these cases, carcinoma was diagnosed in four cases. Although a clinical distinction between male breast cancer and gynecomastia is often difficult, we found needle aspiration cytology a very useful initial investigation for making this distinction.

A case of angiosarcoma of breast diagnosed by needle aspiration cytology (NAC) is documented. The significant features which enabled the NAC diagnosis included presence of spindly to polygonal malignant endothelial lining cells appearing as papillary tufts merging with solid areas, branching effects, and presence of microacinar structures lined with abnormal spindly to polygonal cells indicative of vasoformative structures. Immunostaining for factor VIII and vimentin was strongly positive in the malignant spindly polygonal endothelial cells and further supported the NAC diagnosis. Similar findings were also seen in sections of cell blocks from aspirate and excised biopsy tissue from the breast tumor in hematoxylin-eosin stained sections and on immunostaining. Despite the rarity of occurrence of angiosarcoma in the breast it was felt that its cytologic diagnosis is possible especially in cases in which the lesion is extensive because of a good chance of getting a cellular sample on aspiration. This can be of considerable value for deciding an appropriate management and as a possible guide to prognosis.

In this study a review of 1948 nipple discharge (ND) samples from 1530 patients in the age range of 18-83 years was undertaken to determine whether cytological findings from ND smears could provide useful diagnostic information regarding various breast lesions. The study included 1494 females and 36 males and was carried out during a period of 20 years 8 months. The clinical information in all patients was obtained from clinicians (coauthors), medical records and a review of biopsies in 205 patients who had undergone surgery following the cytodiagnosis. Of the ND samples examined, 1480 were unilateral while 468 were from 234 bilateral ND. The cytodiagnoses were: benign 624, inadequate (despite two to three repeat samples) 492, inflammatory 96, papillary lesion not otherwise specified (NOS) 229, suspicious 22 (21 females, one male) and malignant 67 (63 females, four males). A breast biopsy in the 22 suspicious cases revealed breast carcinoma in 18 cases (females n = 17, male n = 1), atypical ductal hyperplasia (female n = 1), fibroadenoma (female n = 1) and a papilloma in two females. In the 67 cases with a diagnosis of malignancy 65 revealed a breast carcinoma in the biopsy (female n = 62, male n = 3) while one female was diagnosed as fibroadenoma and one male as florid gynaecomastia. In 63 cases (females n = 61; males n = 2) with clinical lumpy areas consistent with the diagnosis of fibrocystic condition in ND, the biopsy confirmed a fibrocystic process. In 53 of 229 cases with ND findings suggestive of a papillary lesion (NOS) the biopsy revealed a papilloma in 41 cases while in 12 cases no lesion was found. In the remaining cases of all the groups only a clinical follow-up and appropriate investigations were performed with no untoward outcome. Based on our study it is felt that cytological examination of ND smears seems to be a reasonably specific method in the diagnosis of malignant and suspicious cases but may be somewhat less specific for other diagnoses.

No abstract

We reviewed our experience with 9,726 cases of fine-needle aspiration cytology of the breast that were done from January 1983 to February 1992. During our review, we found that 214 aspirates had been submitted from pregnant and lactating women for the investigation of breast mass(es). Despite a variable clinical presentation and spectrum of cytologic findings, we considered the application of aspiration cytology in these women as useful as in the nonpregnant-nonlactating women for management decision. A team approach between the clinician and cytopathologist was always maintained; with this approach, the false-positive or -negative diagnoses were reduced to almost nil. In all cases in which the cytodiagnosis of carcinoma of breast was made, the findings corresponded with subsequent cell blocks from the aspirate and tissue examination. Benign lesions were diagnosed cytologically with minimal difficulty, and all aspirates that were less than optimal for cytodiagnosis were repeated to minimize the chance of missing an abnormality. All the benign lesions were followed throughout pregnancy, postpartum, and thereafter; if the mass persisted, the aspiration was repeated. With this protocol of follow-up, the need for a customary liberal surgical biopsy was reduced to a minimum.