Histopathology

Low-grade cribriform cystadenocarcino-mas (LGCCC) are unencapsulated, consisting of single or multiple cysts, accompanied by adjacent intraductal proliferation. The cysts are lined by small, multi-layered, proliferating, bland ductal cells with finely dispersed chromatin and small nucleoli. Within the cystic areas, they typically are arranged in a cribriform pattern and frequently have anastomosing, intracystic micropapillae lining the cavity, which may contain fibrovascular cores. Separate, smaller ductal structures are variably filled by proliferating ductal epithelium with cribriform, micropapillary and solid areas. The overall appearance is very similar to breast atypical ductal hyperplasia and low-grade ductal carcinoma in-situ. Many superficial cells contain cytoplasmic apocrine-type microvacuoles (PAS- positive/diastase-resistant) and/or fine yellow to brown pigment resembling lipofuscin. Focal invasion into the surrounding tissue can be seen, characterized by small solid islands and reactive inflammation and desmoplasia. Perineural or vascular invasion typically is not present. Cellular pleomorphism and mitotic figures are usually absent and necrosis is extremely uncommon. Occasional tumours may demonstrate transition from low to intermediate or high-grade cytology, with scattered mitotic figures and focal necrosis.

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