Papillary neoplasms of the breast: clues in fine needle aspiration cytology

Abstract

Papillary neoplasms of the breast include a wide spectrum of mammary lesions. The differential diagnosis of benign and malignant lesions can be problematic not only cytologically, but also histopathologically. Aspiration smears can demonstrate that cytological differentiation is feasible. A retrospective study of 30 cases of papillary tumour of the breast, 15 papillary carcinomas and 15 papillomas, was performed to find the cytological differences between the pathologies. Cytological samples of papillary carcinomas were characterized by an abundance of cellular material, three-dimensional papillary clusters without fibrovascular connective tissue cores, small papillae arranged in cell balls, tall columnar cells and isolated naked nuclei. Numerous haemosiderin-laden macrophages were seen. There were no eosinophilic bipolar cytoplasmic granules, bipolar naked nuclei or apocrine metaplasia. In the papillomas there was less material; the papillae had cohesive stalks surrounded by columnar cells in a honeycomb pattern. We also found fewer small papillae and isolated columnar cells. In addition, the presence of apocrine metaplasia and bipolar naked nuclei was noted. We suggest that papillary carcinoma of the breast can be diagnosed by cytology and differentiated from papilloma.

Papillary Breast Lesions Diagnosed on Cytology

“…Additional features that help with the distinction are subareolar or nipple location of the lump, softness, nonmobility, nipple discharge and cyst formation or bleeding; they favor DP rather than FA. 12 FA, the most common benign tumor and the one needled most frequently, is also the most common cause of false positive, suspicious and atypical diagnoses. 9 PC usually shows bland cytology and can be confused with benign lesions.…”

Role of Mammography, Ultrasound and Large Core Biopsy in the Diagnostic Evaluation of Papillary Breast Lesions

“…Recent works have emphasized that diagnostic accuracy can be improved by evaluating the cytological or core biopsy features of the lesions [3, 4, 5, 6, 17, 18]. However, the management of papillary lesions is still controversial.…”

Columnar cell lesions: Fine‐needle aspiration biopsy features

“…Most importantly, FNAs from papillomas usually contain fibrovascular cores lined by monolayer sheets. 15,16 Although monolayer sheets were noted in some of our CCL cases, fibrovascular cores were absent. In addition, benign papillomas do not display the nuclear enlargement characteristic of CCLs.…”