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Presented by Dr. Pedram Argani and prepared by Dr. J. David Peske.
This is a 61 year old female with a breast mass.
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1. Question
Diagnosis:
Correct
Answer: D
Histologic Description: The small ducts in this biopsy contain fibrovascular cores, which supports the classification as micropapilloma. The epithelial proliferation filling the ducts is solid and is associated with central necrosis, which raises concern for carcinoma in situ. However, the cells filling the ducts have the classic features of usual duct hyperplasia; namely, ill-defined cell borders, syncytial growth pattern, nuclear size variation, hypochromasia, and occasional intranuclear inclusions. A known pitfall associated with papillomas is that they may show epithelial necrosis, likely due to an ischemia. This case also had biopsy site changes which also could have contributed to the necrosis.
Differential Diagnosis: Ductal carcinoma in situ cells would demonstrate more rigid cell borders, hyperchromatic nuclei, and typically polarized spaces. Atypical ductal hyperplasia would have some features of carcinoma in situ that are of insufficient in extent to diagnose ductal carcinoma in situ. Atypical lobular hyperplasia would feature discohesive cells with intracytoplasmic vacuoles that lack E-cadherin immunoreactivity.Incorrect
Answer: D
Histologic Description: The small ducts in this biopsy contain fibrovascular cores, which supports the classification as micropapilloma. The epithelial proliferation filling the ducts is solid and is associated with central necrosis, which raises concern for carcinoma in situ. However, the cells filling the ducts have the classic features of usual duct hyperplasia; namely, ill-defined cell borders, syncytial growth pattern, nuclear size variation, hypochromasia, and occasional intranuclear inclusions. A known pitfall associated with papillomas is that they may show epithelial necrosis, likely due to an ischemia. This case also had biopsy site changes which also could have contributed to the necrosis.
Differential Diagnosis: Ductal carcinoma in situ cells would demonstrate more rigid cell borders, hyperchromatic nuclei, and typically polarized spaces. Atypical ductal hyperplasia would have some features of carcinoma in situ that are of insufficient in extent to diagnose ductal carcinoma in situ. Atypical lobular hyperplasia would feature discohesive cells with intracytoplasmic vacuoles that lack E-cadherin immunoreactivity.
