Aspiration biopsy of mammary lesions with abundant extracellular mucinous material: Review of 43 cases with surgical follow-up

We reviewed 43 fine-needle aspiration biopsy (FNAB) smears with abundant extracellular mucinous material to determine whether accurate classification of mucinous lesions is achievable on FNAB: 26 had carcinoma (pure colloid carcinoma [CCA], 23; mixed CCA/invasive ductal carcinoma [IDC], 3); 17 had b...

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Bibliographic Details
Published in:American journal of clinical pathology 2003-08, Vol.120 (2), p.194-202
Main Authors: VENTURA, Karyna, CANGIARELLA, Joan, LEE, Irene, MOREIRA, Andre, WAISMAN, Jerry, SIMSIR, Aylin
Format: Article
Language:English
Subjects:
Adenocarcinoma, Mucinous - classification
Adenocarcinoma, Mucinous - pathology
Adenocarcinoma, Mucinous - surgery
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Biopsy, Needle
Breast Neoplasms - classification
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Carcinoma, Ductal, Breast - classification
Carcinoma, Ductal, Breast - pathology
Carcinoma, Ductal, Breast - surgery
Diagnosis, Differential
Extracellular Space
Female
Fibroadenoma - classification
Fibroadenoma - pathology
Fibroadenoma - surgery
Fibrocystic Breast Disease - classification
Fibrocystic Breast Disease - pathology
Fibrocystic Breast Disease - surgery
Follow-Up Studies
Gynecology. Andrology. Obstetrics
Humans
Mammary gland diseases
Medical sciences
Middle Aged
Mucocele - classification
Mucocele - pathology
Mucocele - surgery
Sensitivity and Specificity
Treatment Outcome
Tumors
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Summary:We reviewed 43 fine-needle aspiration biopsy (FNAB) smears with abundant extracellular mucinous material to determine whether accurate classification of mucinous lesions is achievable on FNAB: 26 had carcinoma (pure colloid carcinoma [CCA], 23; mixed CCA/invasive ductal carcinoma [IDC], 3); 17 had benign lesions on follow-up (benign MLL, 6; fibrocystic change [FCC], 6; myxoid fibroadenoma [MFA], 5). All carcinomas were identified correctly as malignant on FNAB. The initial cytologic diagnoses in benign cases were benign in 8, atypical in 8, and "suspicious" for carcinoma in 1. CCAs were moderate to markedly cellular with mild to moderate atypia and lacked oval bare nuclei. Marked nuclear atypia was confined predominantly to cases with mixed CCA/IDC. A distinct feature of CCA was thin-walled capillaries. FCCs and benign MLLs had overlapping cytologic features and showed variable cellularity and no or mild atypia. MFAs were markedly cellular with dyscohesion and variable atypia; stromal fragments and oval bare nuclei were present in every case. Mucinous lesions can be divided into 2 categories by FNAB: those that are adenocarcinomas and those that are not. CCAs have distinctive features that allow a definitive diagnosis on FNAB. Unnecessary surgery can be avoided in MFA by careful evaluation of smear characteristics. Cytologic features of FCC and MLL overlap. Owing to the documented association of MLL with carcinoma, we recommend that lesions that cannot be classified definitively as adenocarcinoma or MFA be considered for conservative excision, even in the absence of atypia.
ISSN:0002-9173
1943-7722
DOI:10.1309/2MKQRJ3DLPMT4LJA