Objective: To review our experience and the literature on inconclusive/erroneous fine-needle aspirates (FNAs) of breast with the focus on the ‘true gray zone'. To describe the cytology, differential diagnosis, pitfalls and limitations of common and rare lesions. Study Design: We conducted a literature search focusing on breast FNAs with statistical data of C3 and C4 categories including false-positive and false-negative cases. Similar data from 2003 to 2009 was obtained from our institution. Results: C3 and C4 categories account for 3-17% of breast FNAs. Contributing factors are technical difficulties, inexperienced pathologists interpreting FNAs of breast and overlap of cytologic features of certain benign and malignant conditions; this last, ‘true gray zone' accounts for 2% of cases. Fibroadenoma, proliferative breast lesions, gynecomastia, infiltrating and in situ low-grade adenocarcinomas and tubular, cribriform, lobular and mucinous carcinomas are the most common problematic lesions. Granular cell tumor, adenomyoepithelioma, pregnancy-related lesions, fat necrosis, inflammatory and radiation changes, adenoid cystic carcinoma, spindle-cell lesions and Phyllodes tumor are less common. Conclusion: Inconclusive/erroneous FNAs of breast due to the ‘true gray zone' are rare. Most are due to the overlapping cytologic features of some benign and malignant conditions. Practical features that may help arrive at the correct diagnoses are elucidated.

Keywords:
Breast cancer, Cytologic features, Fine-needle aspirate, Indeterminate, Erroneous
1.
Simsir A, Rapkiewicz A, Cangiarella J: Current utilization of breast FNA in a cytology practice. Diagn Cytopathol 2009;37:140-142.
2.
Simsir A, Cangiarella J, MD: Challenging breast lesions: pitfalls and limitations of fine-needle aspiration and the role of core biopsy in specific lesions. Diagn Cytopathol 2012;40:262-272.
3.
Rosa M, Mohammadi A, Masood S: The value of fine needle aspiration biopsy in the diagnosis and prognostic assessment of palpable breast lesions. Diagn Cytopathol 2012;40:26-34.
4.
National Cancer Institute Fine-Needle Aspiration of Breast Workshop Subcommittees: The uniform approach to breast fine-needle aspiration biopsy. Diagn Cytopathol 1997;16:295-311.
5.
Bibbo M, Wilbur D: Breast; in: Comprehensive Cytopathology, ed 3. Philadelphia, Saunders Elsevier, 2008, p 715.
6.
Sidawy M, Ali S: Fine Needle Aspiration Cytology; in Goldblum JR (ed): A volume in the series: Foundations in Diagnostic Pathology. Philadelphia, Churchill Livingstone, 2007.
7.
Eckert R, Howell LP: Number, size, and composition of cell clusters as related to breast FNA adequacy. Diagn Cytopathol 1999;21:105-111.
8.
Petersen JL, Koolman-Schellekens MA, van de Peppel-van de Ham T, van Heerde P: Atypia in fine-needle aspiration cytology of the breast: a histologic follow-up study of 301 cases. Semin Diagn Pathol 1989;6:126-134.
9.
Al-Kaisi N: The spectrum of the ‘gray zone' in breast cytology. A review of 186 cases of atypical and suspicious cytology. Acta Cytol 1994;38:898-908.
10.
Chaiwun B, Sukhamwang N, Lekawanvijit S, Sukapan K, Rangdaeng S, Muttarak M, Thorner PS: Atypical and suspicious categories in fine needle aspiration cytology of the breast: histological and mammographical correlation and clinical significance. Singapore Med J 2005;46:706.
11.
Deb RA, Matthews P, Elston CW, Ellis IO, Pinder SE: An audit of ‘equivocal' (C3) and ‘suspicious' (C4) categories in fine needle aspiration cytology of the breast. Cytopathology 2001;12:219-226.
12.
Bibbo M, Scheiber M, Cajulis R, Keebler CM, Wied GL, Dowlatshahi K: Stereotaxic fine needle aspiration cytology of clinically occult malignant and premalignant breast lesions. Acta Cytol 1988;32:193-201.
13.
Kanhoush R, Jorda M, Gomez-Fernandez C, Wang H, Mirzabeigi M, Ghorab Z, Ganjei-Azar P: ‘Atypical' and ‘suspicious' diagnoses in breast aspiration cytology. Cancer 2004;102:164-167.
14.
Willis SL, Ramzy I: Analysis of false results in a series of 835 fine needle aspirates of breast lesions. Acta Cytol 1995;39:858-864.
15.
Howell LP: Equivocal diagnoses in breast aspiration biopsy cytology: sources of uncertainty and the role of ‘atypical/indeterminate' terminology. Diagn Cytopathol 1999;21:217-222.
16.
Sneige N: Fine-needle aspiration of the breast: a review of 1,995 cases with emphasis on diagnostic pitfalls. Diagn Cytopathol 1993;9:106-112.
17.
Layfield LJ, Dodd LG: Cytologically low grade malignancies: an important interpretative pitfall responsible for false negative diagnoses in fine-needle aspiration of the breast. Diagn Cytopathol 1996;15:250-259.
18.
Ishikawa T, Hamaguchi Y, Tanabe M, Momiyama N, Chishima T, Nakatani Y, Nozawa A, Sasaki T, Kitamura H, Shimada H: False-positive and false-negative cases of fine-needle aspiration cytology for palpable breast lesions. Breast Cancer 2007;14:388-392.
19.
Nggada HA, Tahir MB, Musa AB, Gali BM, Mayun AA, Pindiga UH, Yawe KD, Khalil MI: Correlation between histopathologic and fine needle aspiration cytology diagnosis of palpable breast lesions: a five-year review. Afr J Med Med Sci 2007;36:295-298.
20.
O'Neil S, Castelli M, Gattuso P, Kluskens L, Madsen K, Aranha G: Fine-needle aspiration of 697 palpable breast lesions with histopathologic correlation. Surgery 1997;122:824-828.
21.
Feichter GE, Haberthür F, Gobat S, Dalquen P: Breast cytology. Statistical analysis and cytohistologic correlations. Acta Cytol 1997;41:327-332.
22.
Choi YD, Choi YH, Lee JH, Nam JH, Juhng SW, Choi C: Analysis of fine needle aspiration cytology of the breast: a review of 1,297 cases and correlation with histologic diagnoses. Acta Cytol 2004;48:801-806.
23.
Jamal AA, Mansoor I: Analysis of false positive and false negative cytological diagnosis of breast lesions. Saudi Med J 2001;22:67-71.
24.
Kline TS: Masquerades of malignancy: a review of 4,241 aspirates from the breast. Acta Cytol 1981;25:263-266.
25.
Mooney EE, Seigler HF, Layfield LJ: Reporting fine-needle aspirates of breast: a survey of preferences among surgeons. Diagn Cytopathol 1998;19:317-320.
26.
Petersen JL, Thunnissen FB, van Heerde P: Fine needle aspiration cytology of radiation-induced changes in nonneoplastic breast lesions. Possible pitfalls in cytodiagnosis. Acta Cytol 1989;33:176-180.
27.
Dornfeld JM, Thompson SK, Shurbaji MS: Radiation-induced changes in the breast: a potential diagnostic pitfall on fine-needle aspiration. Diagn Cytopathol 1992;8:79-80;discussion 80-1.
28.
Filomena CA, Jordan AG, Ehya H: Needle aspiration cytology of the irradiated breast. Diagn Cytopathol 1992;8:327-332.
29.
Mitre BK, Kanbour AI, Mauser N: Fine needle aspiration biopsy of breast carcinoma in pregnancy and lactation. Acta Cytol 1997;41:1121-1130.
30.
Novotny DB, Maygarden SJ, Shermer RW, Frable WJ: Fine needle aspiration of benign and malignant breast masses associated with pregnancy. Acta Cytol 1991;35:676-686.
31.
Grenko RT, Lee KP, Lee KR: Fine needle aspiration cytology of lactating adenoma of the breast. A comparative light microscopic and morphometric study. Acta Cytol 1990;34:21-26.
32.
Gupta RK, McHutchison AG, Dowle CS, Simpson JS: Fine-needle aspiration cytodiagnosis of breast masses in pregnant and lactating women and its impact on management. Diagn Cytopathol 1993;9:156-159.
33.
Choudhury M, Singal MK: Lactating adenoma - cytomorphologic study with review of literature. Indian J Pathol Microbiol 2001;44:445-448.
34.
Mehrotra R: Fine needle aspiration diagnosis of tuberculous mastitis. Indian J Pathol Microbiol 2004;47:377-380.
35.
Gupta D, Rajwanshi A, Gupta SK, Nijhawan R, Saran RK, Singh R: Fine needle aspiration cytology in the diagnosis of tuberculous mastitis. Acta Cytol 1999;43:191-194.
36.
Martínez-Parra D, Nevado-Santos M, Meléndez-Guerrero B, García-Solano J, Hierro-Guilmain CC, Pérez-Guillermo M: Utility of fine-needle aspiration in the diagnosis of granulomatous lesions of the breast. Diagn Cytopathol 1997;17:108-114.
37.
Gupta RK: Fine needle aspiration cytology of granulomatous mastitis: a study of 18 cases. Acta Cytol 2010;54:138-141.
38.
Poniecka AW, Krasuski P, Gal E, Lubin J, Howard L, Poppiti RJ: Granulomatous inflammation of the breast in a pregnant woman: report of a case with fine needle aspiration diagnosis. Acta Cytol 2001;45:797-801.
39.
Farmer C, Stanley MW, Bardales RH, Korourian S, Shah H, Bradsher R, Klimberg VS: Mycoses of the breast: diagnosis by fine-needle aspiration. Diagn Cytopathol 1995;12:51-55.
40.
Adeniran A, Al-Ahmadie H, Mahoney MC, Robinson-Smith TM: Granular cell tumor of the breast: a series of 17 cases and review of the literature. Breast J 2004;10:528-531.
41.
DeMay RM, Kay S: Granular cell tumor of the breast. Pathol Annu 1984;2:121-148.
42.
Ingram DL, Mossler JA, Snowhite J, Leight GS, McCarty KS Jr: Granular cell tumors of the breast. Steroid receptor analysis and localization of carcinoembryonic antigen, myoglobin, and S100 protein. Arch Pathol Lab Med 1984;108:897-901.
43.
Strobel SL, Shah NT, Lucas JG, Tuttle SE: Granular-cell tumor of the breast. A cytologic, immunohistochemical and ultrastructural study of two cases. Acta Cytol 1985;29:598-601.
44.
Simsir A, Cangiarella J: Challenging breast lesions: pitfalls and limitations of fine-needle aspiration and the role of core biopsy in specific lesions. Diagn Cytopathol 2012;40:262-272.
45.
Kollur SM, El Hag IA. FNA of breast fibroadenoma: Observer variability and review of cytomorphology with cytohistologic correlation. Cytopathology 2006;17:239-244.
46.
Stanley MW, Tani EM, Skoog L: Fine needle aspiration of fibroadenomas of the breast with atypia: a spectrum including cases that cytologically mimic carcinoma. Diagn Cytopathol 1990;6:375-382.
47.
Simsir A, Waisman J, Cangiarela J: Fibroadenomas with atypia: causes of under- and overdiagnosis by aspiration biopsy. Diagn Cytopathol 2001;25:278-284.
48.
Benoit JL, Kara R, McGregor SE, Duggan MA: Fibroadenoma of the breast: diagnostic pitfalls of fine needle aspiration. Diagn Cytopathol 1992;8:643-648.
49.
Rogers LA, Lee KR: Breast carcinoma simulating fibroadenoma or fibrocystic change by fine-needle aspiration. A study of 16 cases. Am J Clin Pathol 1992;98:155-160.
50.
Lopez-Ferre P, Jimenez-Heffernan JA, Vicandi B, Orthega L, Viguer JM: Fine needle aspiration of the breast fibroadenoma. A cytohistologic correlation study of 405 cases. Acta Cytol 1999;43:579-586.
51.
Shabb NS: Phyllodes tumor. Fine needle aspiration cytology of eight cases. Acta Cytol 1997;41:321-326.
52.
Krishnamurthy S, Ashfaq R, Shin HJ, Sneige N: Distinction of Phyllodes tumor from fibroadenoma: a reappraisal of an old problem. Cancer 2000;90:342-349.
53.
Bhattarai S, Kapila K, Verma K: Phyllodes tumor of the breast. A cytohistologic study of 80 cases. Acta Cytol 2000;44:790-796.
54.
Dusenbery D, Frable WJ: Fine needle aspiration cytology of Phyllodes tumor. Potential diagnostic pitfalls. Acta Cytol 1992;36:215-221.
55.
Saad RS, Richmond L, Nofech-Mozes S, Ghorab Z: Fine-needle aspiration biopsy of breast adenomyoepithelioma: a potential false positive pitfall and presence of intranuclear cytoplasmic inclusions. Diagn Cytopathol 2012;40:1005-1009.
56.
Iyengar P, Ali SZ, Brogi E: Fine-needle aspiration cytology of mammary adenomyoepithelioma: a study of 12 patients. Cancer 2006;108:250-256.
57.
Mercado CL, Toth H K, Axelrod D, Cangriella J: Fine-needle aspiration biopsy of benign adenomyoepithleioma of the breast. Radiologic and pathologic correlation in four cases. Diagn Cytopathol 2007;35:690-694.
58.
Aydin O, Cinel L, Egilmez R, Ocal K, Ozer C: Adenomyoepithlioma of the breast. Diagn Cytopathol 2001;25:194-196.
59.
Kurashina M: Fine-needle aspiration cytology of benign and malignant adenomyoepithelioma: report of two cases. Diagn Cytopathol 2002;26:29-34.
60.
Ng WK: Adenomyoepithelioma of the breast. A review of three cases with reappraisal of the fine needle aspiration biopsy findings. Acta Cytol 2002;46:317-324.
61.
Chang A, Bassett L, Bose S: Adenomyoepithelioma of the breast: a cytologic dilemma. Report of a case and review of the literature. Diagn Cytopathol 2002:26:191-196.
62.
Lee WY: Fine needle aspiration cytology of adenomyoepithelioma of the breast: a case indistinguishable from Phyllodes tumor in cytologic findings and clinical behavior. Acta Cytol 2000;44:488-490.
63.
Laforga JB, Aranda FI, Sevilla F: Adenomyoepithelioma of the breast: report of two cases with prominent cystic changes and intranuclear inclusions. Diagn Cytopathol 1998;19:55-58.
64.
Niemann TH, Benda JA, Cohen MB: Adenomyoepithelioma of the breast: fine-needle aspiration biopsy and histologic findings. Diagn Cytopathol 1995;12:245-250.
65.
Nilsson B, Wee A, Rauff A, Raju GC: Adenomyoepithelioma of the breast. Report of a case with fine needle aspiration cytology and histologic, immunohistochemical and ultrastructural correlation. Acta Cytol 1994;38:431-434.
66.
Valente PT, Stuckey JH: Fine-needle aspiration cytology of mammary adenomyoepithelioma: report of a case with intranuclear cytoplasmic inclusions. Diagn Cytopathol 1994;10:165-168.
67.
Harada O, Hoe R, Lin J, Thike AA, Jara-Lazaro AR, Petersson F, Tan PH: Intranuclear inclusions in epithelial cells of benign proliferative breast lesions. J Clin Pathol 2011;64:776-80.
68.
Iwa N, Baba M, Kanai T, Kobayashi TK, Yutani C: Presence of intranuclear cytoplasmic inclusions and cytoplasmic eosinophilic granules diagnosed by fine needle aspiration cytology in male breast cancer. Diagn Cytopathol 2009;37:143-145.
69.
Landeyro J, Díaz ML, Raventós A, Vadillo J, Martínez MS: Cytological diagnostic clues in fine needle aspiration of breast myofibroblastoma: a case report. Diagn Cytopathol 2012;40:1107-1111.
70.
Klopcic U, Lamovec J, Luzar B: Fine needle aspiration biopsy of primary breast myxofibrosarcoma: a case report. Acta Cytol 2009;53:109-112.
71.
Sneige N, Staerkel GA: Fine-needle aspiration cytology of ductal hyperplasia with and without atypia and ductal carcinoma in situ. Hum Pathol 1994;25:485-492.
72.
McKee GT, Tildsley G, Hammond S: Cytologic diagnosis and grading of ductal carcinoma in situ. Cancer 1999;87:203-209.
73.
Cangiarella J, Waisman J, Simsir A: Cytologic findings with histologic correlation in 43 cases of mammary intraductal adenocarcinoma diagnosed by aspiration biopsy. Acta Cytol 2003;47:965-972.
74.
Sidawy MK, Stoler MH, Frable WJ, Frost AR, Masood S, Miller TR, Silverberg SG, Sneige N, Wang HH: Interobserver variability in the classification of proliferative breast lesions by fine-needle aspiration: results of the Papanicolaou Society of Cytopathology study. Diagn Cytopathol 1998;18:150-165.
75.
Lilleng R, Hagmar BM, Farrants G: Low-grade cribriform ductal carcinoma in situ of the breast. Fine needle aspiration cytology in three cases. Acta Cytol 1992;36:48-54.
76.
Sauer T, Lømo J, Garred O, Naess O: Cytologic features of ductal carcinoma in situ in fine-needle aspiration of the breast mirror the histopathologic growth pattern heterogeneity and grading. Cancer 2005;105:21-27.
77.
Silverman JF, Masood S, Ducatman BS, Wang HH, Sneige N: Can FNA biopsy separate atypical hyperplasia, carcinoma in situ, and invasive carcinoma of the breast? Cytomorphologic criteria and limitations in diagnosis. Diagn Cytopathol 1993;9:713-728.
78.
Abendroth CS, Wang HH, Ducatman BS: Comparative features of carcinoma in situ and atypical ductal hyperplasia of the breast on fine-needle aspiration biopsy specimens. Am J Clin Pathol 1991;96:654-659.
79.
Thomas PA, Raab SS, Cohen MB: Is the fine-needle aspiration biopsy diagnosis of proliferative breast disease feasible? Diagn Cytopathol 1994;11:301-306.
80.
Cho EY, Oh YL: Fine needle aspiration cytology of sclerosing adenosis of the breast. Acta Cytol 2001;45:353-359.
81.
Kundu UR, Guo M, Landon G, Wu Y, Sneige N, Gong Y: Fine-needle aspiration cytology of sclerosing adenosis of the breast: a retrospective review of cytologic features in conjunction with corresponding histologic features and radiologic findings. Am J Clin Pathol 2012;138:96-102.
82.
Khirwadkar N, Clark AH: Fine needle aspiration cytology of tubular carcinoma of the breast. Acta Cytol 2005;49:344-345.
83.
Cangiarella J, Waisman J, Shapiro RL, Simsir A: Cytologic features of tubular adenocarcinoma of the breast by aspiration biopsy. Diagn Cytopathol 2001;25:311-315.
84.
Gupta RK, Dowle CS: Fine needle aspiration cytology of tubular carcinoma of the breast. Acta Cytol 1997;41:1139-1143.
85.
Dei Tos AP, Della Giustina D, De Martin V, Della Libera D, Bittesini L: Aspiration biopsy cytology of tubular carcinoma of the breast. Diagn Cytopathol 1994;11:146-150.
86.
Bondeson L, Lindholm K: Aspiration cytology of tubular breast carcinoma. Acta Cytol 1990;34:15-20.
87.
Bonzanini M, Gilioli E, Brancato B, Pellegrini M, Mauri MF, Dalla Palma P: Cytologic features of 22 radial scar/complex sclerosing lesions of the breast, three of which associated with carcinoma: clinical, mammographic, and histologic correlation. Diagn Cytopathol 1997;17:353-362.
88.
Greenberg ML, Camaris C, Psarianos T, Ung OA, Lee WB: Is there a role for fine-needle aspiration in radial scar/complex sclerosing lesions of the breast? Diagn Cytopathol 1997;16:537-542.
89.
Lamb J, McGoogan E: Fine needle aspiration cytology of breast in invasive carcinoma of tubular type and in radial scar/complex sclerosing lesions. Cytopathology 1994;5:17-26.
90.
Field A, Mak A: The fine needle aspiration biopsy diagnostic criteria of proliferative breast lesions: a retrospective statistical analysis of criteria for papillomas and radial scar lesions. Diagn Cytopathol 2007;35:386-397.
91.
de la Torre M, Lindholm K, Lindgren A: Fine needle aspiration cytology of tubular breast carcinoma and radial scar. Acta Cytol 1994;38:884-890.
92.
Mak A, Field AS: Positive predictive value of the breast FNAB diagnoses of epithelial hyperplasia with atypia, papilloma, and radial scar. Diagn Cytopathol 2006;34:818-823.
93.
Ng WK: Fine needle aspiration cytology of invasive cribriform carcinoma of the breast with osteoclastlike giant cells: a case report. Acta Cytol 2001;45:593-598.
94.
Cai G, Simsir A, Cangiarella J: Invasive mammary carcinoma with osteoclast-like giant cells diagnosed by fine-needle aspiration biopsy: review of the cytologic literature and distinction from other mammary lesions containing giant cells. Diagn Cytopathol 2004;30:396-400.
95.
Phillipson J, Ostrzega N: Fine needle aspiration of invasive cribriform carcinoma with benign osteoclastlike giant cells of histiocytic origin. A case report. Acta Cytol 1994;38:479-482.
96.
Vicandi B, Jiménez-Heffernan JA, López-Ferrer P, Hardisson D, Pérez-Campos A, González-Peramato P, Viguer JM: Fine needle aspiration cytology of mammary carcinoma with osteoclast-like giant cells. Cytopathology 2004;15:321-325.
97.
Saqi A, Mercado CL, Hamele-Bena D: Adenoid cystic carcinoma of the breast diagnosed by fine-needle aspiration. Diagn Cytopathol 2004;30:271-274.
98.
Kasagawa T, Suzuki M, Doki T, Fujimori T, Itami M, Takenouchi T, Yamamoto N: Two cases of adenoid cystic carcinoma: preoperative cytological findings were useful in determining treatment strategy. Breast Cancer 2006;13:112-116.
99.
Gupta RK, Green C, Naran S, Lallu S, Fauck R, Dowle C, Simpson J: Fine-needle aspiration cytology of adenoid cystic carcinoma of the breast. Diagn Cytopathol 1999;20:82-84.
100.
Stanley MW, Tani EM, Rutquist LE, Skoog L: Adenoid cystic carcinoma of the breast: diagnosis by fine-needle aspiration. Diagn Cytopathol 1993;9:184-187.
101.
Duane GB, Kanter MH, Branigan T, Chang C: A morphologic and morphometric study of cells from colloid carcinoma of the breast obtained by fine needle aspiration. Distinction from other breast lesions. Acta Cytol 1987;31:742-750.
102.
Fisher CJ, Millis RR: A mucocoele-like tumour of the breast associated with both atypical ductal hyperplasia and mucoid carcinoma. Histopathology 1992;21:69-71.
103.
Ro JY, Sneige N, Sahin AA, Silva EG, del Junco GW, Ayala AG: Mucocelelike tumor of the breast associated with atypical ductal hyperplasia or mucinous carcinoma. A clinicopathologic study of seven cases. Arch Pathol Lab Med 1991;115:137-140.
104.
Stanley MW, Tani EM, Skoog L: Mucinous breast carcinoma and mixed mucinous-infiltrating ductal carcinoma: a comparative cytologic study. Diagn Cytopathol 1989;5:134-138.
105.
Weaver MG, Abdul-Karim FW, al-Kaisi N: Mucinous lesions of the breast. A pathological continuum. Pathol Res Pract 1993;189:873-876.
106.
Simsir A, Waisman J, Thorner K, Cangiarella J: Mammary lesions diagnosed as ‘papillary' by aspiration biopsy: 70 cases with follow-up. Cancer 2003;99:156-165.
107.
Michael CW, Buschmann B: Can true papillary neoplasms of breast and their mimickers be accurately classified by cytology? Cancer 2002;96:92-100.
108.
Ishihara A, Kobayashi TK: Infarcted intraductal papilloma of the breast: cytologic features with stage of infarction. Diagn Cytopathol 2006;34:373-376.
109.
Greenberg ML, Middleton PD, Bilous AM: Infarcted intraduct papilloma diagnosed by fine-needle biopsy: a cytologic, clinical, and mammographic pitfall. Diagn Cytopathol 1994;11:188-191.
110.
Jayaram G, Elsayed EM, Yaccob RB: Papillary breast lesions diagnosed on cytology. Profile of 65 cases. Acta Cytol 2007;51:3-8.
111.
Haji BE, Das DK, Al-Ayadhy B, Pathan SK, George SG, Mallik MK, Abdeen M: Fine-needle aspiration cytologic features of four special types of breast cancers: mucinous, medullary, apocrine, and papillary. Diagn Cytopathol 2007;35:408-416.
112.
Bardales RH, Suhrland MJ, Stanley MW: Papillary neoplasms of the breast: fine-needle aspiration findings in cystic and solid cases. Diagn Cytopathol 1994;10:336-341.
113.
Abd el-All HS: Breast spindle cell tumours: about eight cases. Diagn Pathol 2006;1:13.
114.
Álvarez-Rodriguez F, Gimeno-Aranguez M, López-Varela C, González-Peramato P, Tortoledo-Bruni A, Rodríguez-Costa J, Perna C, Jiménez-Heffernan JA: Fine-needle aspiration cytology of mammary myofibroblastoma: a report of six cases. Acta Cytol 2012;56:501-505.
115.
Magro G: Mammary myofibroblastoma: a tumor with a wide morphologic spectrum. Arch Pathol Lab Med 2008;132:1813-1820.
116.
Gobbi H, Tse G, Page DL, Olson SJ, Jensen RA, Simpson JF: Reactive spindle cell nodules of the breast after core biopsy or fine-needle aspiration. Am J Clin Pathol 2000;113:288-294.
117.
Garijo MF, Val-Bernal JF, Vega A, Val D: Postoperative spindle cell nodule of the breast: pseudosarcomatous myofibroblastic proliferation following endo-surgery. Pathol Int 2008;58:787-791.
118.
Lui PC, Tse GM, Tan PH, Jayaram G, Putti TC, Chaiwun B, Chan NH, Lau PP, Mak KL, Khin AT: Fine-needle aspiration cytology of metaplastic carcinoma of the breast. J Clin Pathol 2007;60:529-533.
119.
Chhieng DC, Cangiarella JF, Waisman J, Fernandez G, Cohen JM: Fine-needle aspiration cytology of spindle cell lesions of the breast. Cancer 1999;87:359-371.
120.
Nogueira M, André S, Mendonça E: Metaplastic carcinomas of the breast - fine needle aspiration (FNA) cytology findings. Cytopathology 1998;9:291-300.
121.
Davis WG, Hennessy B, Babiera G, Hunt K, Valero V, Buchholz TA, Sneige N, Gilcrease MZ: Metaplastic sarcomatoid carcinoma of the breast with absent or minimal overt invasive carcinomatous component: a misnomer. Am J Surg Pathol 2005;29:1456-1463.
122.
Rosa M, Masood S: Cytomorphology of male breast lesions: diagnostic pitfalls and clinical implications. Diagn Cytopathol 2012;40:179-184.
123.
Singh R, Anshu, Sharma SM, Gangane N: Spectrum of male breast lesions diagnosed by fine needle aspiration cytology: a 5-year experience at a tertiary care rural hospital in central India. Diagn Cytopathol 2012;40:113-117.
124.
Westenend PJ, Jobse C: Evaluation of fine-needle aspiration cytology of breast masses in males. Cancer 2002;96:101-104.
125.
Kapila K, Verma K: Cytomorphological spectrum in gynaecomastia: a study of 389 cases. Cytopathology 2002;13:300-308.
126.
Siddiqui MT, Zakowski MF, Ashfaq R, Ali SZ: Breast masses in males: multi-institutional experience on fine-needle aspiration. Diagn Cytopathol 2002;26:87-91.
127.
Amrikachi M, Green LK, Rone R, Ramzy I: Gynecomastia: cytologic features and diagnostic pitfalls in fine needle aspirates. Acta Cytol 2001;45:948-952.
128.
Pinedo F, Vargas J, de Agustín P, Garzón A, Pérez-Barrios A, Ballestín C: Epithelial atypia in gynecomastia induced by chemotherapeutic drugs. A possible pitfall in fine needle aspiration biopsy. Acta Cytol 1991;35:229-233.
129.
Martin-Bates E, Krausz T, Phillips I: Evaluation of fine needle aspiration of the male breast for the diagnosis of gynaecomastia. Cytopathology 1990;1:79-85.
130.
Russin VL, Lachowicz C, Kline TS: Male breast lesions: gynecomastia and its distinction from carcinoma by aspiration biopsy cytology. Diagn Cytopathol 1989;5:243-247.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.