|Year : 2012 | Volume
| Issue : 2 | Page : 96-97
Cytomorphology of nipple discharge and fine needle aspiration of duct papilloma
HB Bannur, VV Suranagi, R Davanagere, B Hungund, PV Patil
Department of Pathology, J.N. Medical College, Belgaum, Karnataka, India
|Date of Web Publication||1-Oct-2012|
H B Bannur
Department of Pathology, J.N. Medical College, Belgaum-590 010, Karnataka
Source of Support: None, Conflict of Interest: None
The primary role of fine needle aspiration (FNA) of the breast is the distinction between benign and malignant lesions; but in many cases, additional information may be obtained. The major breast lesions that yield papillary fragments on FNA are papillary carcinoma, papilloma, fibroadenoma, and invasive ductal carcinoma that have a papillary component. We present cytomorphological features of nipple discharge and FNA of breast lump in a 32-year female.
Keywords: Duct papilloma, FNA, nipple discharge, papillary lesions
|How to cite this article:|
Bannur H B, Suranagi V V, Davanagere R, Hungund B, Patil P V. Cytomorphology of nipple discharge and fine needle aspiration of duct papilloma. J Sci Soc 2012;39:96-7
|How to cite this URL:|
Bannur H B, Suranagi V V, Davanagere R, Hungund B, Patil P V. Cytomorphology of nipple discharge and fine needle aspiration of duct papilloma. J Sci Soc [serial online] 2012 [cited 2017 Jul 27];39:96-7. Available from: http://www.jscisociety.com/text.asp?2012/39/2/96/101858
| Introduction|| |
Papillary lesions of the breast encompass a wide spectrum of benign and malignant entities constituting less than 2% of all breast tumors. FNA is being employed with increasing frequency for the preoperative diagnostic workup of breast lesions.  The clinical presentation of duct papilloma is variable, nipple discharge sometimes being the main symptom, and a palpable mass in other cases.
Here we report a case of duct papilloma of the breast diagnosed by nipple discharge and FNA, later confirmed by histopathology.
| Case Report|| |
A 32-year female presented with history of lump in the right breast with nipple discharge of 2 months duration. On examination, the lump was in the upper outer quadrant close to the areola, firm in consistency, mobile, and measured 1x1 cm. The nipple discharge was bloody. No axillary lymphnodes were palpable. Other physical and systemic examinations were normal. Her routine hematological and biochemical investigations were within normal limits.
Nipple discharge was obtained by squeezing the nipple, and the discharge was placed on glass slides, fixed and stained by Papanicolaou (Pap) and MayGrümwald-Giemsa (MGG) stains. FNA of the breast lump was done using a 23-gauge needle attached to a 10-ml disposable syringe. Smears were made, fixed and stained by Pap and MGG stains. Nipple discharge showed clumps of ductal epithelial cells arranged in papillary fronds. These cells had pale and scanty cytoplasm, round nuclei, dark with finely granular cytoplasm. The cells showed no cytological atypia. Several naked bipolar nuclei were seen at the margin of the cell clusters [Figure 1]a. Background showed RBCs and foamy macrophages. Aspirate from the lump was moderately cellular comprised of numerous papillary fragments of regular appearing ductal epithelial cells with connective tissue cores [Figure 1]b. Few apocrine cells and bare nuclei were also seen. Background showed foam cells and RBCs. A diagnosis of duct papilloma was given.
|Figure 1: (a) Nipple discharge smear shows papillary clusters of epithelial cells bordered by bipolar nuclei (Pap stain; ×100). (b ) FNA shows staghorn clusters of epithelial cells with few foamy macrophages in the background (Pap stain; ×100)|
Click here to view
The breast lesion was excised. Histology showed orderly proliferation of ductal epithelium on well-defined fibrovascular stalk attached to the ductal wall. Few of the papillary fronds had extended into adjacent duct spaces. Cellular pleomorphism was not seen. Myopeithelial cell layer was present between the core and the epithelial cells [Figure 2]. The histology confirmed the cytological diagnosis of duct papilloma.
|Figure 2: Section shows dilated duct filled with ductal epithelial cells in papillary fronds (H and E stain; ×100)|
Click here to view
| Discussion|| |
Duct papillomas are thought to be hyperplastic lesions of the ducts. According to the World Health Organization, duct papilloma is a "regular papillary overgrowth without mitoses or hyperchromatism." They occur predominantly in women between the ages of 35 and 55 years. Most patients present with single duct nipple discharge, which is often blood stained. Duct papilloma are divided into two main subgroups: Central (solitary) papilloma, which arise from the main ducts and are usually single, and peripheral (multiple) papilloma, which are associated with terminal duct lobular units and are multiple.  Both conditions need to be distinguished from each other and from intracystic papillary carcinoma (IPC). This is because solitary papillomas carry only a slight increase in relative risk for carcinoma while multiple papillomas are frequently associated with low-grade cribriform ductal carcinoma in situ. 
Presence of clumps of epithelial cells in a nipple discharge should be regarded as very suggestive of either papilloma or carcinoma.  Papillary clusters composed of >30 ductal cells were detected only in discharges from cancer cases and papillomas by Takeda T et al.  Jackson et al. were able to detect the presence of an occult papilloma in 46% of cases by the cytologic examination of a nipple secretion before any visible bleeding had occurred. 
The major cytological differential diagnosis in a breast that yields papillary fragments are IPC, papilloma, fibroadenoma, and invasive ductal carcinoma. IPC yields a highly cellular aspirate with complex cytologic atypia, hemorrhagic diathesis, and hemosiderin-laden macrophages. Both papilloma and fibroadenoma have similar staghorn configuration of epithelial cells. Papillae in papilloma have a connective tissue core, apocrine cells, and foamy macrophages which are not commonly seen in fibroadenoma. Fibroadenomas often have stromal fragments as well as large number of myoepithelial cells. Ductal carcinoma may have a component of micropapillary carcinoma or papillary carcinoma. These tumors demonstrate severe cytologic atypia. 
| References|| |
|1.||Ishihara A, Kobayashi TK. Infarcted intraductal papilloma of the breast: Cytologic features with stage of infarction. Diagn Cytopathol 2006;34:373-6. |
|2.||Ellis IO, Pinder SE, Lee AH. Tumors of the breast. In: Fletcher CD, editor. Diagnostic Histopathology of Tumors. 3 rd ed. Vol 1. China: Churchill Livingstone; 2007. p. 914-6. |
|3.||Zakhour H, Wells C. Diagnostic Cytopathology of the Breast. London: Churchill Livingstone; 1999. p.137-40. |
|4.||Saphir O. Cytologic examination of breast secretion. Am J Clin Pathol 1950;20:1001-10. |
|5.||Takeda T, Matsui A, Sato Y, Irumagawa H, Kato A, Ito K, et al. Nipple Discharge Cytology in Mass Screening for Breast Cancer. Acta Cytol 1990;34:161-4. |
|6.||Jackson D, Todd DA, Gorsuch PL. Study of breast secretion for detection of intramammary pathologic change and of silent papilloma. J Int Coll Surg 1951;15:552-68. |
|7.||Jeffrey PB, Ljung BM. Benign and Malignant Papillary Lesions of the Breast. A Cytomorphologic study. AM J Clin Pathol 1994;101:500-7. |
[Figure 1], [Figure 2]