Infarcted intraduct papilloma diagnosed by fine-needle biopsy: a cytologic, clinical, and mammographic pitfall

Necrosis is a worrisome cytologic feature in breast aspirates which, when paired with suspicious clinical and mammographic findings, could potentially result in a false positive diagnosis. A 66-yr-old female presented with clinical evidence of stage 1 breast carcinoma supported by the mammographic and ultrasound findings. A fine-needle biopsy (FNB) revealed extensive necrosis with scattered degenerate columnar cells, occasional clusters of hyperchromatic epithelial cells, and a few sheets of ductal cells. A cytologic diagnosis of an infarcted intraduct papilloma was made. This uncommon diagnosis was subsequently confirmed by open biopsy. Cytologic features to distinguish infarcted, necrotic, and papillary breast lesions are discussed.