Breast
Cytopathology Competency Assessment
Diseases and Conditions of the Breast

Author: Gordon H. Yu, M.D. (see Authors page)

Revised: 1 June 2016, last major update September 2012

Copyright: (c) 2012-2016, PathologyOutlines.com, Inc.

Cite this page: Cytology/Competency Assessment - Diseases and Conditions of the Breast. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastcytcompdiseases.html. Accessed May 29th, 2017.
Medical Knowledge
  1. Inflammation
    1. Acute Mastitis and Breast Abscess
      1. Recognize clinical scenarios in which mastitis may develop
      2. Become familiar with the clinical presentation of mastitis and the most common causative organisms
      3. Become familiar with the cytomorphologic features of FNA of mastitis, including the possibility of cytologic atypia in the presence of marked inflammation
    2. Subareolar Abscess
      1. Understand the pathogenesis of subareolar abscess
      2. Become familiar with the cytomorphologic features of FNA of subareolar abscess, including the hallmark squamous material
    3. Chronic mastitis: Duct Ectasia, Comedomastitis, and Plasma Cell Mastitis
      1. Understand the pathogenesis of duct ectasia
      2. Become familiar with the cytomorphologic features of duct ectasia, including its differential diagnosis
    4. Lymphocytic Mastitis
      1. Become familiar with the clinical conditions associated with lymphocytic mastitis as well as its typical cytomorphologic findings when aspirated
    5. Granulomatous Mastitis
      1. Become familiar with the most common causes of granulomatous mastitis
      2. Become familiar with the typical cytomorphologic features of granulomatous mastitis, including the possibility of significant cytologic atypia
      3. Silicone Mastitisphologic findings when aspirated
        • Become familiar with the cytomorphologic appearance of silicone when aspirated, as well as the associated cellular findings
      4. Idiopathic Granulomatous Mastitis
        • Become familiar with the cytomorphologic features encountered in this condition and its possible causes
  2. Fat Necrosis
    1. Recognize the clinical presentation of fat necrosis and possible factors which may predispose to its development
    2. Become familiar with the clinical appearance of fat necrosis and the typical cytomorphologic features encountered when aspirated
  3. Mucocele-Like Lesions
    1. Become familiar with the typical clinical features of mucocele-like lesions
    2. Become familiar with the typical cytomorphologic features seen in FNA of these lesions, including useful diagnostic features for distinction of benign lesions from mucinous carcinoma
    3. Appreciate the difficulty in definitively excluding malignancy in FNAs of mucinous lesions, resulting in frequent excision
  4. Breast Masses and Pregnancy
    1. Recognize the advantages of FNA over mammography and surgical biopsy in this patient population
    2. Galactocele
      1. Learn the pathogenesis of galactocele and its cytologic features when aspirated
    3. Breast Infarct
      1. Learn the clinical and cytologic appearance of this rare lesion
    4. Lactational Changes
      1. Understand the clinical and cytologic appearance of lactating breast
    5. Lactational Nodule
      1. Recognize lactational nodules as the most common breast masses in young pregnant patients
      2. Become familiar with the clinical presentation of lactational nodules
      3. Become familiar with the typical cytomorphologic features of FNA of these nodules, including the background features, hypercellularity and prominent nucleoli
    6. Breast Cancer in Pregnancy
      1. Recognize breast carcinoma as the most common malignancy diagnosed during pregnancy
      2. Become familiar with the pathologic features of most pregnancy-associated breast carcinomas
      3. Become familiar with the cytomorphologic features of breast carcinoma (similar to those seen in non-pregnant patients)
  5. Fibrocystic Disease of the Breast (FCD)
    1. Recognize FCD as the most common breast lesion undergoing FNA biopsy
    2. Recognize the high incidence of FCD in women
    3. Become familiar with the clinical presentation and typical physical examination findings of FCD
    4. Recognize the elements which compose FCD and may appear in FNA specimens
      1. Cysts
        • Understand the rationale for microscopic examination of aspirated cyst fluid
        • Recognize the importance of examining all bloody cyst fluids and the need to reaspirate any residual mass following cyst drainage
        • Become familiar with the cytomorphologic appearance of typical cyst fluid
      2. Fibrosis
        • Become familiar with the typical cytomorphologic features seen when areas of fibrosis are aspirated, including characteristic features noted by the aspirator
      3. Epithelial Proliferation
        • Epithelial Hyperplasia
          • Recognize the typical cytomorphologic appearance seen when hyperplastic epithelium is aspirated, including the presence of a second population of naked, bipolar nuclei
        • Adenosis
Systems Based Practice
  1. Recognize the utility of clinical history, including lactation and pregnancy status, when interpreting FNA specimens from the breast in pre-menopausal patients
  2. Appreciate the importance of integrating clinical and radiologic features of aspirated lesions when making the diagnosis of various lesions, particularly those commonly encountered (i.e. fibrocystic disease)