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Continuing Medical Education (CME): The American Society of Cytopathology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Cytopathology designates this enduring educational activity for a maximum of 1 AMA PRA Category 1 credit(s).TM Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Clinical History

A 27 year old woman presented with a palpable left breast mass. Medical history includes one pregnancy and normal term delivery approximately one year prior to presentation. On examination of the left breast, there was an approximately 4 cm mobile mass with indistinct borders. The mass had been present for several months and was initially considered as likely related to recent lactation. No axillary adenopathy was appreciated. Fine needle aspiration biopsy without image guidance was performed to sample the mass, with material placed directly into alcohol fixative for liquid based cytology preparation.

Cytopathology Features

Microscopic examination of the ThinPrep cytology specimen reveals moderate cellularity with a background of red blood cells and scant amorphous debris. There are no definitive normal breast epithelial elements identified within the background. The cells of interest are present both in three dimensional groups as well as single cell pattern. In the groups there are areas with cell ‘feathering’ with spindled/elongated cells extending from the edges of the main groups. The cytoplasm is scant, amphophilic, filmy, and without inclusions. The nuclear to cytoplasmic ratio is increased with some cells composed of 90% nucleus. The nuclear shape ranges from ovoid to elongated/spindled. The nuclear membranes are irregular with occasional cells showing fishhook type curves. The nuclei are hyperchromatic with coarse chromatin, and with nucleoli visible in cells near the edges of groups. No definitive intranuclear inclusions are seen.

Claire Anne Therese M. Hemedez, MD
Cherie Paquette, MD, MS

Women & Infants Hospital
Providence, Rhode Island

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