Cytological Evaluation of Pathological Male Breast Lesions

Abstract

Objective: This study aimed to determine the cytodiagnostic spectrum of various male breast lesions, which were corroborated on histopathology as appropriate, to describe the process of the cytomorphology of some uncommon pathological lesions, and to discuss the reasons of their misdiagnoses.

Materials and methods: In this 8-year study, a total of 114 patients underwent fine needle aspiration cytology (FNAC). In a representative case, nipple discharge from an 8-month-old child was examined. Confirmatory histopathology was obtained in 38 cases only.

Results: Gynecomastia was the most common (63.5%) male breast pathology. Invasive breast carcinoma of no special type was the most common variant of male breast malignancy. Half of the "gray zone" of cytological lesions was confirmed as cancer, but the rest were diagnosed as fibrocystic disease and intraductal papilloma. All cases with malignant cytology matched their corresponding histopathology. However, a tumor from an intraductal papillary carcinoma was miscued as ductal carcinoma on previous FNAC.

Conclusion: Cytological evaluation of male breast lesions provides highly sensitive and specific results with excellent histologic reproducibility. Thus, it should be the ideal pretherapeutic diagnostic procedure for male breasts. However, some benign pathological conditions, which are particularly associated with epithelial hyperplasia, perplex the cytomorphologic scenario into the "gray zone."

Keywords: Breast carcinoma; fine needle aspiration cytology; gray zone; gynecomastia; male breast.

Figure 1

Cytologically, compact folded sheets of benign epithelial cells and stripped bipolar nuclei in gynecomastia (Papanicolaou staining, ×40)

Figure 2

Representative histomorphology of gynecomastia characterized by florid epithelial hyperplasia surrounded by paucicellular fibrotic stroma (hematoxylin-eosin staining, ×40)

Figure 3

Subareolar abscess on cytology: scattered neutrophils, anucleated squames, and multinucleate giant cells (Leishman-Giemsa staining, ×40)

Figure 4

Cytologically, degenerating adipocytic fragments, foamy histiocytes, giant cells, and background fat vacuoles characteristics of fat necrosis (Papanicolaou staining, ×40)

Figure 5

Histology of lymphocytic mastopathy: atrophic ductules surrounded by lymphocytic infiltrates and collagenous fibrosis (hematoxylin-eosin stain, ×40)

Figure 6

Cytomorphologically, apocrine epithelial changes, cyst macrophages and lymphocytes define fibrocystic changes (Papanicolaou staining, ×100)

Figure 7

Compact overlapping and arborizing micropapillary fragments of epithelial cells aspirated from benign papilloma (Papanicolaou staining, ×400)

Figure 8

On histology, benign intracystic papilloma presenting as a pedunculated, broad club-like papilla stuffed with numerous glandular components (hematoxylin-eosin staining, ×40)

Figure 9

Mammary duct ectasia in an 8-month-old infant expresses siderophages, blood components, and occasional epithelial sheets (Leishman-Giemsa staining, ×100)

Figure 10

Cytomorphology of mucinous carcinoma: isolated polyhedral malignant cells and “chicken-wire” vascular fragments floating amidst pool of extracellular mucin (Papanicolaou staining, ×100)

Figure 11

Cytomorphologically, clustered undifferentiated tumor cells within ample necro-inflammatory debris along with welldifferentiated malignant squamous cells featuring nuclear pyknosis and cytoplasmic orangeophilia suggestive of metaplastic breast carcinoma (Papanicolaou staining, ×400)

Figure 12

Basaloid variant of squamous cell carcinomarepresentative of the cytodiagnosis of metaplastic carcinoma shown in Figure 11 (hematoxylin–eosin staining, ×100)

Figure 13

Proliferative breast disease with atypia on cytology: Epithelial cells forming cribriform and crowded overlapping clusters with slight nuclear irregularities, prominent nucleoli (Papanicolaou staining, ×400)

Figure 14

Corresponding histomorphology of an intraductal papilloma: Bilayer epithelial-myoepithelial cells covering the fibrovascular cores (hematoxylin-eosin staining, ×40)

Figure 15

Histology of fibrocystic changes expressing cyst formation and pericystic chronic inflammation (hematoxylin-eosin staining, ×40)