TUBULAR CARCINOMA OF THE BREAST - CYTOLOGIC FEATURES IN FINE-NEEDLE ASPIRATIONS AND APPLICATION OF MONOCLONAL ANTI-ALPHA-SMOOTH MUSCLE ACTIN IN DIAGNOSIS
Df. Fischler et al., TUBULAR CARCINOMA OF THE BREAST - CYTOLOGIC FEATURES IN FINE-NEEDLE ASPIRATIONS AND APPLICATION OF MONOCLONAL ANTI-ALPHA-SMOOTH MUSCLE ACTIN IN DIAGNOSIS, Diagnostic cytopathology, 10(2), 1994, pp. 120-125
Twenty fine-needle aspirations (FNAs) of histologically proven tubular
carcinoma of the breast (TCB) were reviewed, and the staining distrib
ution of alpha-smooth muscle actin (SMA) was evaluated to see if this
improved FNA sensitivity. In 18 cases, the aspirates were cellular, co
nsisting predominantly of epithelial cells arranged in cohesive tubula
r structures that appeared angular or twisted. Single epithelial cells
were present in varying numbers in 14 cases (70%). Cribriform fragmen
ts corresponding to in situ ductal carcinoma were noted in 9 cases (45
%). Individual, bare nuclei were present in seven cases (35%). The ini
tial cytologic diagnoses were 10 carcinomas eight suspicious for carci
noma, and two cases were misinterpreted as fibroadenoma. In 8 of 14 ca
ses, the epithelial fragments stained negatively for SMA, whereas in s
ix cases some fragments (< 10%) stained positively. These findings wer
e in contrast to a reticulated staining pattern noted in almost all of
the epithelial fragments in nine fibroadenomas and three fibrocystic
changes. Eighteen well-differentiated invasive ductal carcinomas stain
ed negatively, whereas four had occasional positively staining fragmen
ts. We conclude that TCB displays distinct cytomorphologic features th
at can be recognized or at least suggested by FNA. Awareness of the cy
tologic characteristics-angulated tubular structures with or without s
ingle epithelial cells-coupled with mammographic/ultrasound findings,
is necessary to avoid a misdiagnosis. Alpha-smooth muscle actin staini
ng may help in selected cases. (C) 1994 Wiley-Liss, Inc.