Contributed by : Karen K. Deal, MD, PhD, Anisa Kanbour, MD, and Manju E. Nath, MD
Published on line in April 1998
The patient is a 54-year old female, gravida 3, para 2, who presented with a palpable upper outer quadrant left breast nodule. Her previous surgical history is significant for a total abdominal hysterectomy and bilateral salpingo-oopherectomy in 1995 for a fibroid uterus and an ovarian fibroma. She has no history of cancer, and her family history is negative for breast carcinoma. Medications at the time of presentation included Lodine for arthritis and Estrace.
Mammography revealed a 1.2 cm oval nodule in the upper outer quadrant of the left breast (2 o'clock). Ultrasound revealed a solid mass with a cystic area. The overall radiologic impression was suggestive of a fibroadenoma.
FINE NEEDLE ASPIRATION:
An ultrasound-guided fine needle aspirate was performed. Smears (Papanicolaou and Diff-QuikTM stains) and a cell block were made from the aspirated material. Microscopic examination revealed stromal and ductal epithelial cells arranged in an unusual papillary and acinar pattern with a myoepithelial proliferation on the background of a basophilic myxoid matrix (Images 02, 03, 04 and 05).
FINE NEEDLE ASPIRATION DIAGNOSIS:
ATYPICAL SMEAR: UNUSUAL BIPHASIC TUMOR.
RECOMMENDATION: PLEASE BIOPSY.