FNAC of breast


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  • Fnac of normal breast
  • Fnac findings of breast carcinoma (1) ductal carcinoma
  • NOS(NO SPECIAL TYPE) Showing Clustered and single malignant epithelial cells,mild nuclear enlargement and atypia,absence of bipolar nuclei
  • Showing Poorly cohesive malignant cells,single and in clusters,obvious nuclear enlargement and pleomorphism;irregular chromatin
  • Mainly dispersed malignant cells,prominent nuclear enlargement and pleomorphism,coarsechromatin,an occasion mitotic figure,some lymphocytes and fibroblast in the background no bipolar nuclei
  • Fnac usual findings
  • ShowingPoorly cohesive cell clusters,uniformly small nuclei with irregular shapes nuclear moulding indistinct cytoplasm
  • Single file of cells with small nuclei of irregular shape
  • Cellular smear of poorly cohesive clusters of malignant cells with moderate nuclear atypia
  • Fnac findings
  • Numerous dispersed malignant cells with large pleomorphicnuclei,many scattered lymphoid cells
  • Fnac findings
  • Showing Moderately cohesive epithelial cells with abundant cytoplasm and moderate nuclear enlargement
  • Chicken wire blood vessels with a background of stringy mucin
  • Clusters of epithelial cells variable nuclei atypia,,a few single bipolar nuclei can be seen
  • Another case showing tubular and angular epithelial fragments,fibrousstroma ,spindle cells
  • This grading icludes 3 criteria..(1)tubule formation.(2)nuclear pleomorphism).mitotic count
  • Grade 1 (well differentiated) cancers have relatively normal-looking cells that do not appear to be growing rapidly and are arranged in small tubules.Grade 2 (moderately differentiated) cancers have features between grades 1 and 3.Grade 3 (poorly differentiated) cancers, the highest grade, lack normal features and tend to grow and spread more aggressively
  • FNAC of breast

    2. 2. NORMAL BREAST FNAC • Usually yields scanty cellularity. • Following cells can be seen in FNAC of a nonneoplastic breast  DUCTAL CELLS – Cells are small round with monomorphic nuclei. nuclear membrane is regular with homogeneous chromatin.
    3. 3.  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.
    4. 4.  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.
    5. 5. DUCTAL CARCINOMA  FNAC FINDINGS More or less cell rich smears Single population of epithelial cells; no myoepithelial cells, no single bare bipolar nuclei Variable loss of cell cohesion-irregular clusters and single cells Single epithelial cells with intact cytoplasm
    6. 6. 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 cases Necrosis unusual, more suggestive of DCIS.
    7. 7. Problems and differential diagnosis  Representative sampling  Smearing artifacts  Carcinoma with small cells  Fibrosclerotic lesions In situ and low grade carcinoma Nuclear atypia in other lesions Gynaecomastia Metastatic carcinoma
    8. 8. Ductal carcinoma NOS,low grade
    9. 9. Ductal carcinoma NOS,intermediate grade
    10. 10. Invasive duct carcinoma NOS,high grade
    11. 11. LOBULAR CARCINOMA  Usual findings 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.
    12. 12. Irregularity of nuclear shape Intracytoplasmic lumina/mucin vacuoles/signet ring cells Few if any naked bipolar nuclei Traumatised cell pattern
    13. 13. Problems and differential diagnosis Sparse cellularity Resemblance to non-neoplastic breast tissue in low power Component of benign epithelium Lobular hyperplasia in pregnancy and lactation Distinction from low-grade ductal carcinoma Intracytoplasmic lumina in other lesions
    14. 14. Lobular carcinoma (classic type)
    15. 15. Infiltrating lobular carcinoma,classic type
    16. 16. Lobular carcinoma,alveolar type
    17. 17. 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
    18. 18. Problems and differential diagnosis Metastatic malignancy to axillary nodes Malignant lymphoma High grade DCIS (comedocarcinoma)
    19. 19. Medullary carcinoma
    20. 20. MUCINOUS CARCINOMA Large amount of mucinous material Floating malignant cells in the pool of mucin Cells with abundant cytoplasm Mild to moderately pleomorphic nuclei Bland nuclear chromatin “Chicken wire” blood vessels are often present in smears of mucinous carcinoma
    21. 21. Problems and differential diagnosis Lack of nuclear pleomorphism Mucinous DCIS Mucinous fibroadenoma Myxoid stromal matrix resembling mucin Metastatic carcinoma Hemorrhage and necrosis induced by FNB Ultrasound gel
    22. 22. Colloid carcinoma
    23. 23. Colloid carcinoma
    24. 24. 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.
    25. 25. Problems and differential diagnosis Minor deviation from the benign pattern Mixed tubular and usual ductal carcinoma Complex sclerosing lesion/radial scar,adenosis Fibroadenoma
    26. 26. Tubular carcinoma
    27. 27. Tubular carcinoma
    28. 28. METAPLASIC CARCINOMA – Predominant cell component is other than glandular or epithelial – Population of spindle cells, multinucleated giant cells or squamous cells may be seen.
    29. 29. 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
    30. 30. 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
    31. 31. Scarff-Bloom-Richardson (SBR) Grade Grade 1 Tubule Formation Nuclear Pleomorphism Mitotic Count Grade 2 Grade 3
    32. 32. 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