Jiwan Thursday Breast Lump Fna
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Transcript of Jiwan Thursday Breast Lump Fna
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History
1 Giemsa stained slide from a 66 yrs female
with breast mass
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Slide description
Cellular smears
Small to large clusters of cells
Some cells are also found scattered in thesmear
Lakes of extracellular mucin visible in different
areas Branching blood vessels present in many areas
giving chicken wire appearance
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Cell description
Abundant mildly granular cytoplasm with
well-defined borders in scattered cells
Cellular borders are predominantly distinct
Most cells have large hyperchromatic nuclei
placed centrally to eccentrically
Mild pleomorphism Nucleoli inconspicuous in most of the nuclei
Some cells show binucleation
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No mitoses/necrosis visible
Background contains macrophages.
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Points helping in diagnosis
Elderly patient
Abundant background mucin
Clusters of cells Chicken wire blood vessels
Relatively mild nuclear abnormalities
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Diagnosis
Mucinous carcinoma breast
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Discussion
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Other conditions simulating
Mucinous carconoma breast
Mucocele-like lesion
Mucinous fibroadenoma
Mucinous DCIS
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Mucinous carcinoma breast
WHO: a tumor that contains large amount of
extracellular epithelial mucous, sufficient to
be visible grossly, and recognizable
microscopically surrounding and within thetumor cells.
Other names: gelatinous, colloid, mucous and
mucoid carcinoma
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Epidemiology
Occur throughout the age range of ca breast
Mean age of women with pure mucinous
carcinoma is greater than those with
nonmucinous carcinoma
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G/F
Usually round and well-circumscribed
May be clinically and mammographically
mistaken for a benign lesion such as
fibroadenoma or cyst
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Cytology
Characteristic: abundant mucus forming the
background of the smear and dispersed
clusters of cancer cells.
Clusters are coheisve, and show only slight
nuclear abnormalities such as nuclear
enlargement and small nucleoli
Small clusters and single isolated cells also
seen.
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Diagnosis based on the presence of mucus
bathing the clusters and
Chicken wire blood vessels are often very
prominently present in smears (suggestive but
not diagnostic of mucinous carcinoma as they
occur in other lesions too, particularly
fibroadenoma.)
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Histology
Pure mucinous carcinoma is characterized by
the accumulation of abundant EC mucin
around invasive tumor cells
The relative proportions of mucin and
neoplastic epithelium vary from one case to
another but the distribution in any one tumor
tends to be constant
Infiltrating duct carcinoma with focal
mucinous fratures have a lower mean
proportion of EC mucin.
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Mucinous carcinomas are variants of invasive
duct carcinoma and intraductal carcinoma is
found associated with app. 75% of cases,
generally at the periphery.
Tumor cells are arranged in a variety of
patterns in the mucinous secretion
Usually the epithelial arrangement duplicates
the pattern of associated intraductal
carcinoma
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i.e. tumor cells in strands, alveolar nests and
papillary clusters as well as larger sheets that
may have cribriform areas or focal
comedonecrosis
Tubule and gland formation are uncommon.
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Mucocele-like lesions
The lesions occur in the setting of fibrocystic
disease
Abundant mucus
Smaller cell population compared to mucinous
carcinoma
All breast lesions containing abundant mucus
should be excised for H/E because FNA of
these lesions may be highly misleading
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Summary of other types of Ca
breast
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Infiltrating ductal carcinoma of No
Special type
Criteria for diagnosis:
More or less cell-rich smears
Single population of epithelial cells; nomyoepithelial cells, no single bare bipolar
nuclei
Variable loss of cell cohesionirregular
clusters and single cells
Single epithelial cells with intact cytoplasm
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Moderate to severe nuclear atypia:
enlargement, pleomprphism, irregular nuclear
membrane, and chromatin
Fibroblasts and fragments of collagen (stromal
dysplasia) associated with atypical cells
Intracytoplasmic neolumina in some cases
Necrosis unusual, more s/o DCIS
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DCIS
High nuclear grade DCIS, solid or comedo
growth pattern:
Usual findings:
Usually cell reach smears
Neoplastic cells in sheets, irregular aggregates and
single
Large pleomorphic cells showing obviousmalignant nuclear features
Necrotic debris , granular calcium, lymphocytes
and vacuolated macrophages
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The cells of DCIS higher nuclear grade (large
cell, solid and comedo) are large, pleomorphic
and show standard cytological criteria of
malignancy.
The soft, boggy, palpable mass with a highly
cellular aspirate usually indicates a significant
intraductal lesion worthy of excision.
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Low grade DCIS, cribriform, solid or
micropapillary, non-invasive intracystic
papillary carcinoma:
Epithelial cells mainly cohesive forming large
sheets, often with holes or papillary fragments
Bare bipolar nuclei absent
Variable, mild to moderate epithelial atypia Necrotic debris, often calcium granules
macrophages
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Tubular carcinoma
Moderately cellular smears
Cells predominantly in cohesive clusters
Epithelial fragments with an angular or
tubular shape
Relatively uniform, mildly to moderately
atypical epithelial cells
Single bipolar nuclei of benign type often
present in small numbers
Fibroblastic cells, fragments of fibromyxoid or
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A cytological challenge
High false negative rate
But most lesions are stellate on
mammography and suspicious by ultrasound
and are selected for excision
Core biopsy useful for confirmation of dx.
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Medullary carcinoma
Highly cellular smears
Poorly cohesive cells in clusters and single
Large, pleomorphic and obviously malignant
nuclei
Many lymphocytes
Tends to be mammogrphically rounded and well
circumscribed and has a soft feel to the needle
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Pagets disease of nipple
Background of keratin, squamous cells,
inflammatory cells and debris
Large malignant cells, single and in small
groups, closely a/w sq and infl. Cells.
Abundant pale cytoplasm with distinct
borders
Obvious nuclear features of malignancy
Scrape smears from the nipple are an excellent
way to doagnose Pagets disease.
I fil i l b l i
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Infiltrating lobular carcinoma
A variable, often poor cell yield
Cells single and in small clusters, single files
characteristic
Scanty cytoplasm, many naked nuclei, nuclear
moulding in cell clusters
Small hyperchromatic nuclei of relatively
uniform size
Irregularity of nuclear shape
I/C lumina/mucin vacules/signet ring cells
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Few if any naked bipolar nuclei
Traumatized cell pattern
The stroma is abundant, desmoplastic or fibrous
separating small groups and single files of
neoplastic epithelial cells
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Thank you