Upload
saurav-singh
View
573
Download
2
Tags:
Embed Size (px)
Citation preview
FNAC OF BREAST CANCER
DR SAURAV
NORMAL BREAST FNAC
• Usually yields scanty cellularity.
• Following cells can be seen in FNAC of a non-neoplastic breast
DUCTAL CELLS – Cells are small round with monomorphic nuclei. nuclear membrane is regular with homogeneous
chromatin.
MYOEPITHELIAL CELLS – These are elongated spindle-shaped naked cells. presence of such cells is hallmark of benign nature of lesion.
APOCRINE CELLS – These are large cells having abundant granular cytoplasm with central
to eccentric monomorphic round nuclei. These cells are usually present in fibrocystic disease or fibroadenoma.
• • •
•
FOAM CELLS – These cells have abundant vacuolated cytoplasm
and centrally placed monomorphic round nucleus. phagocytosed material may be found in the
cytoplasm presence of foam cells usually indicates cystic
degeneration.
DUCTAL CARCINOMA
FNAC FINDINGSMore or less cell rich smearsSingle population of epithelial cells; no
myoepithelial cells, no single bare bipolar nucleiVariable loss of cell cohesion-irregular clusters and
single cellsSingle epithelial cells with intact cytoplasm
Moderate to severe nuclear atypia;enlargement,pleomorphism,irregular nuclear membrane and chromatin
Fibroblasts and fragments of collagen associated with atypical cells
Intracytoplasmic neolumina in some casesNecrosis unusual, more suggestive of DCIS.
Problems and differential diagnosis
Representative sampling Smearing artifacts Carcinoma with small cells Fibrosclerotic lesionsIn situ and low grade carcinomaNuclear atypia in other lesionsGynaecomastiaMetastatic carcinoma
Ductal carcinoma NOS,low grade
Ductal carcinoma NOS,intermediate grade
Invasive duct carcinoma NOS,high grade
LOBULAR CARCINOMA
Usual findingsA variable, often poor cell yield Cells single and in small clusters, single files
characteristicScanty cytoplasm; many naked nuclei; nuclear
moulding in cell clustersSmall hyperchromatic nuclei of relatively uniform
size.
Irregularity of nuclear shapeIntracytoplasmic lumina/mucin vacuoles/signet
ring cellsFew if any naked bipolar nucleiTraumatised cell pattern
Problems and differential diagnosis
Sparse cellularityResemblance to non-neoplastic breast tissue in
low powerComponent of benign epitheliumLobular hyperplasia in pregnancy and lactationDistinction from low-grade ductal carcinomaIntracytoplasmic lumina in other lesions
Lobular carcinoma (classic type)
Infiltrating lobular carcinoma,classic type
Lobular carcinoma,alveolar type
MEDULLARY CARCINOMA
– Abundant dissociated cells along with syncytial clusters of malignant cells
– Round to oval large cells with moderate nuclear pleomorphism
– Large prominent nucleoli– Lymphocytes and plasma cells
Problems and differential diagnosis
Metastatic malignancy to axillary nodesMalignant lymphomaHigh grade DCIS (comedocarcinoma)
Medullary carcinoma
MUCINOUS CARCINOMALarge amount of mucinous materialFloating malignant cells in the pool of mucinCells with abundant cytoplasm Mild to moderately pleomorphic nucleiBland nuclear chromatin“Chicken wire” blood vessels are often present in
smears of mucinous carcinoma
Problems and differential diagnosis
Lack of nuclear pleomorphismMucinous DCIS Mucinous fibroadenomaMyxoid stromal matrix resembling mucinMetastatic carcinomaHemorrhage and necrosis induced by FNBUltrasound gel
Colloid carcinoma
Colloid carcinoma
TUBULAR CARCINOMA• Usual findings: 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 elastotic
stroma.
Problems and differential diagnosisMinor deviation from the benign patternMixed tubular and usual ductal carcinomaComplex sclerosing lesion/radial scar,adenosisFibroadenoma
Tubular carcinoma
Tubular carcinoma
METAPLASIC CARCINOMA
– Predominant cell component is other than glandular or epithelial
– Population of spindle cells, multinucleated giant cells or squamous cells may be seen.
Scarff-Bloom-Richardson (SBR) Grade in Breast Cancer
– Histologic grading system for breast cancer– The cells and tissue structure of the breast cancer
are examined histopathologically to determine how aggressive the cancer is
– Correlates well with prognosis– Adopted by World Health Organization in 1968– Also referred to as Nottingham modification
Scarff-Bloom-Richardson (SBR) Grading
• Tubule Formation– Majority of tumor (>75%) – 1 point– Moderate degree (10-75%) – 2 points– Little or none (<10%) – 3 points
• Nuclear pleomorphism (compare to adjacent normal epithelium)– Small, regular uniform cells – 1 point– Moderately increased size and variability – 2 points– Marked variation – 3 points
• Mitotic Count (must adjust for microscope field)– Low – 1 point– Moderate – 2 points– High – 3 point
Scarff-Bloom-Richardson (SBR) Grade
TubuleFormation
Nuclear Pleomorphism
MitoticCount
Grade 1 Grade 2 Grade 3
Overall Grade is Sum of Scores
Grade 1 – well differentiated – 3 to 5 points
Grade 2 – moderately differentiated – 6 to 7 points
Grade 3 – poorly differentiated – 8 to 9 points