PMC3981477_01
(A) A delicate papillary fragment showing mainly epithelial cells with mild loss of cohesion and occasional myoepithelial cells (Giemsa x 160); (B) papillary fragments with cohesive cells showing squamous metaplasia (center) (Giemsa x 80); (C) a group of epithelial cells showing poorly formed acini with loss of cohesion and mild nuclear pleomorphism (Giemsa x 320); (D) a group of cells showing apocrine metaplasia (Giemsa x 160); (E) whole mount of the section showing a papillomatous lesion in large duct with necrosis and degeneration on the surface (H&E x 20); (F) higher magnification of surface showing squamous metaplasia with necrosis and degeneration (H&E x 40).
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Microscopically, the smears were highly cellular showing finger like projections with scant fibrovascular core, ductal epithelial cells in branching sheets, and cohesive clusters (Fig. 1A). The ductal epithelial cells showed mild overcrowding and atypia with mild pleomorphism and prominent nucleoli (Fig. 1B). At places, cells were showing foamy changes and squamous metaplasia (Figs. 1C and 1D). At places, squamous metaplasia, multilayering, overcrowding, and mild pleomorphism were seen (Figs. 1E, 1F, and 2A-D).
(A) Middle area showing densely packed papillary structures lying back to back and lined by epithelial cells (H&E x 40); (B) basal area showing intact ductal lining with papillary structures (H&E x 40); (C) and (D) higher magnification showing mildly pleomorphic epithelial cells with prominent nucleoli, mild loss of polarity, and multilayering. Myoepithelial cells are not clearly visible (H&E x 320); (E) Myoepithelial cells showing positive cytoplasmic staining for HMWCK (IHC x 160); (F) myoepithelial cells showing positive nuclear staining for p63 (IHC x 160).
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Immunohistochemistry showed cytoplasmic positivity for HMWCK and nuclear positivity for p63 confirming the presence of myoepithelial layer (Figs. 2E and 2F).