fna of breast slide session the 6th arab-british school of pathology nina s shabb aubmc
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Fibroepithelial lesionsCases 1-3 Fibroadenoma 3 components Phyllodes tumor vs FA
Older women Larger/cystic Adequate sampling Cellular stromal fragments Cytologic atypia/mitosis (malignant)
Epithelial discohesion and atypia? Adenocarcinoma arising in FA PT misdiagnosed as adenocarcinoma (proper preparation)
Fibroadenoma Most common cause of false positive dx Cellular smear, may find single cells with
atypia and discohesion Do not spend too much time on high
power looking for discohesive single cells.
Helpful feature: Numerous ME cells Do not call malignant with numerous ME
cells in background
Final dx Case 1:
FNA dx: Cellular FA vs Benign PT. Final dx: FA
Case 2: FNA dx: Cellular FA vs Benign PT. Final dx: PT
Case 3: PT/C4 (low grade carcinoma) Final dx: PT
Ductal adenocarcinoma NOSCases 4 and 5
Cytologic features? Tumor cellularity Discohesion Single cells with features of malignancy
Grading Nuclear grade 1-3
Final dx
Case 4: FNA dx: Adenoca NG 2/3 Final DX: Adenoca nos Grade 2/3
Case 5 FNA dx: Adenoca NG 1/3 Final DX: Adenoca nos Grade 1/3
Mucinous/colloid carcinomaCases 6 and 7
Gross can mimic benign disease. Mucin seen grossly while aspirating and
smearing Extracellular mucin on pap and DQ Round balls of low grade tumor cells If pure mucinous, has better prognosis
but FNA can not determine that. FNA: Suggestive of mucinous ca
Tubular caCase 10
Angular, rigid, bent tubular clusters, sharp borders
Crowded nuclei Minimal tumor discohesion Dispersed single cells, minimal atypia Absence/paucity of ME cells Peripheral perpendicular cells
FNA of axillary LNCase 11
Metastatic adenocarcinoma c/w breast primary
False negative? Other malignancy?
FNA of DCISCase 12
DCIS Grade 3: Pleomorphic carcinoma cells, calcium,
necrosis, macrophages casting Calcification on mammogram
DCIS cribriform Low grade carcinoma punched out holes in cell clusters
DCIS grades 1 and 2: No distinguishing features