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. 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. 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. 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. 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. 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
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. Irregularity of nuclear shape
Intracytoplasmic lumina/mucin vacuoles/signet
ring cells
Few if any naked bipolar nuclei
Traumatised cell pattern
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
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. Problems and differential diagnosis
Metastatic malignancy to axillary nodes
Malignant lymphoma
High grade DCIS (comedocarcinoma)
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. 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
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. Problems and differential diagnosis
Minor deviation from the benign pattern
Mixed tubular and usual ductal carcinoma
Complex sclerosing lesion/radial scar,adenosis
Fibroadenoma
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. 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. 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
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
Notas del editor
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