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Nodular sclerosing adenosis of breast: A diagnostic pitfall in fine needle aspiration cytology.

Sreedharanunni S, Das A, Veenu S, Srinivasan R, Singh G - J Cytol (2013)

Bottom Line: The smears were cellular with cohesive clusters and scattered epithelial cells showing moderate nuclear pleomorphism and focal acinar formation.Subsequent histopathological examination revealed it to be nodular sclerosing adenosis.The cytohistological correlation of this uncommon lesion, a potential pitfall in breast fine needle aspiration diagnosis which may lead to a false-positive diagnosis is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT
Fine needle aspiration cytology was performed in a 46-year-old female presenting with a breast lump and mammography suggesting a malignancy. The smears were cellular with cohesive clusters and scattered epithelial cells showing moderate nuclear pleomorphism and focal acinar formation. Stromal fragments, benign epithelial cell clusters and a few naked nuclei were noted in the background. Considering the clinical features, mammography findings as well as cytological features, a diagnosis of ductal carcinoma was suggested. Subsequent histopathological examination revealed it to be nodular sclerosing adenosis. The cytohistological correlation of this uncommon lesion, a potential pitfall in breast fine needle aspiration diagnosis which may lead to a false-positive diagnosis is discussed.

No MeSH data available.


Related in: MedlinePlus

Nodular sclerosing adenosis: Cytomorphological and corresponding histological features. (a) Irregular cohesive clusters of cells along with naked nuclei and bipolar cells in the background; (b) Hyalinized eosinophilic stromal fragments; (c) Acinar formation; (d) Moderate nuclear pleomorphism and nucleoli; (e) Histological section showing tubular arrangement showing atypia, compressed by stroma; (f) Immunohistochemistry showing SMA positivity (a, c, d, e, H and E ; b, MGG ; f, immunoperoxidase; original magnification: a, b, ×200; c-f, ×400)
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Figure 1: Nodular sclerosing adenosis: Cytomorphological and corresponding histological features. (a) Irregular cohesive clusters of cells along with naked nuclei and bipolar cells in the background; (b) Hyalinized eosinophilic stromal fragments; (c) Acinar formation; (d) Moderate nuclear pleomorphism and nucleoli; (e) Histological section showing tubular arrangement showing atypia, compressed by stroma; (f) Immunohistochemistry showing SMA positivity (a, c, d, e, H and E ; b, MGG ; f, immunoperoxidase; original magnification: a, b, ×200; c-f, ×400)

Mentions: FNAC was performed using a 23-gauge needle and smears were air-dried and stained using May Grünwald-Giemsa method as well as fixed in 95% ethanol and stained with hematoxylin and eosin. Lump was gritty on FNA and yielded particulate material. The smears were highly cellular and showed predominantly three-dimensional cohesive clusters and few scattered cells [Figure 1a and b]. At places, the clusters showed acinar formation [Figure 1c]. Occasional clusters of apocrine cells and singly scattered large cells with moderate nuclear pleomorphism and conspicuous nucleolus were also found [Figure 1d]. Admixed benign cell clusters, few bipolar cells and hyalinized eosinophilic stroma were found in the background [Figure 1b]. Considering the overall picture, a cytological diagnosis of ductal carcinoma was made, and she was advised surgical excision and histopathological examination to rule out invasion. Lumpectomy was performed, and the histopathological examination of the specimen showed a nodular lesion with expanded lobular units which showed extensive adenosis with marked sclerosis of intervening stroma. The proliferating glands were distorted in many areas and showed apocrine metaplasia at places. The lining cells showed moderate nuclear pleomorphism and atypia [Figure 1e]. The individual glands were surrounded by myoepithelial cells which were confirmed by immunohistochemistry for smooth muscle actin (SMA) [Figure 1f]. There was no evidence of any associated lobular or ductal intraepithelial neoplasia. The surrounding area showed features of fibrocystic disease. There was no evidence of an in situ or invasive malignancy. Based on these features, a diagnosis of nodular sclerosing adenosis was made.


Nodular sclerosing adenosis of breast: A diagnostic pitfall in fine needle aspiration cytology.

Sreedharanunni S, Das A, Veenu S, Srinivasan R, Singh G - J Cytol (2013)

Nodular sclerosing adenosis: Cytomorphological and corresponding histological features. (a) Irregular cohesive clusters of cells along with naked nuclei and bipolar cells in the background; (b) Hyalinized eosinophilic stromal fragments; (c) Acinar formation; (d) Moderate nuclear pleomorphism and nucleoli; (e) Histological section showing tubular arrangement showing atypia, compressed by stroma; (f) Immunohistochemistry showing SMA positivity (a, c, d, e, H and E ; b, MGG ; f, immunoperoxidase; original magnification: a, b, ×200; c-f, ×400)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643363&req=5

Figure 1: Nodular sclerosing adenosis: Cytomorphological and corresponding histological features. (a) Irregular cohesive clusters of cells along with naked nuclei and bipolar cells in the background; (b) Hyalinized eosinophilic stromal fragments; (c) Acinar formation; (d) Moderate nuclear pleomorphism and nucleoli; (e) Histological section showing tubular arrangement showing atypia, compressed by stroma; (f) Immunohistochemistry showing SMA positivity (a, c, d, e, H and E ; b, MGG ; f, immunoperoxidase; original magnification: a, b, ×200; c-f, ×400)
Mentions: FNAC was performed using a 23-gauge needle and smears were air-dried and stained using May Grünwald-Giemsa method as well as fixed in 95% ethanol and stained with hematoxylin and eosin. Lump was gritty on FNA and yielded particulate material. The smears were highly cellular and showed predominantly three-dimensional cohesive clusters and few scattered cells [Figure 1a and b]. At places, the clusters showed acinar formation [Figure 1c]. Occasional clusters of apocrine cells and singly scattered large cells with moderate nuclear pleomorphism and conspicuous nucleolus were also found [Figure 1d]. Admixed benign cell clusters, few bipolar cells and hyalinized eosinophilic stroma were found in the background [Figure 1b]. Considering the overall picture, a cytological diagnosis of ductal carcinoma was made, and she was advised surgical excision and histopathological examination to rule out invasion. Lumpectomy was performed, and the histopathological examination of the specimen showed a nodular lesion with expanded lobular units which showed extensive adenosis with marked sclerosis of intervening stroma. The proliferating glands were distorted in many areas and showed apocrine metaplasia at places. The lining cells showed moderate nuclear pleomorphism and atypia [Figure 1e]. The individual glands were surrounded by myoepithelial cells which were confirmed by immunohistochemistry for smooth muscle actin (SMA) [Figure 1f]. There was no evidence of any associated lobular or ductal intraepithelial neoplasia. The surrounding area showed features of fibrocystic disease. There was no evidence of an in situ or invasive malignancy. Based on these features, a diagnosis of nodular sclerosing adenosis was made.

Bottom Line: The smears were cellular with cohesive clusters and scattered epithelial cells showing moderate nuclear pleomorphism and focal acinar formation.Subsequent histopathological examination revealed it to be nodular sclerosing adenosis.The cytohistological correlation of this uncommon lesion, a potential pitfall in breast fine needle aspiration diagnosis which may lead to a false-positive diagnosis is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT
Fine needle aspiration cytology was performed in a 46-year-old female presenting with a breast lump and mammography suggesting a malignancy. The smears were cellular with cohesive clusters and scattered epithelial cells showing moderate nuclear pleomorphism and focal acinar formation. Stromal fragments, benign epithelial cell clusters and a few naked nuclei were noted in the background. Considering the clinical features, mammography findings as well as cytological features, a diagnosis of ductal carcinoma was suggested. Subsequent histopathological examination revealed it to be nodular sclerosing adenosis. The cytohistological correlation of this uncommon lesion, a potential pitfall in breast fine needle aspiration diagnosis which may lead to a false-positive diagnosis is discussed.

No MeSH data available.


Related in: MedlinePlus