Ch. 9 - Breast Flashcards
What is the role of FNA in breast evaluation?
Used for palpable masses and cysts. In most cases it is superceded by core needle biopsy which offers architecture and staining.
What uses does nipple discharge cytology have?
Can be used to evaluate papilloma, carcinoma, or hormonal abnormality. Generally not very accurate.
What is the “triple test” of breast FNA?
FNA + Mammography + Clinical findings.
What kinds of lesions can cause hypocellular aspirates?
Fibroadenoma
Fibrocystic changes
Fat necrosis
Radiation
What could background necrosis on an FNA represent?
Could represent carcinoma, but also apocrine metaplasia or lactation.
What are the normal elements of breast on cytology?
Lactiferous ducts, connective tissue & glands, sometimes foam cells.
How many breast cysts are malignant? What are some high-risk radiologic features?
2%; more concerning if complex, thick-walled, or with thick septae. Especially if solid with cystic degeneration.
In cytology, how are the many fibrocystic changes categorized?
Nonproliferative: Apocrine metaplasia, foam cells…
Proliferative: ADH, ALH, UDH, etc.
Describe the cytology of fibroadenoma.
Hypercellular large sheets with an antler-like configuration, bipolar cells and spindled nuclei.
How can fibroadenoma be distinguished from phyllodes tumor on cytology?
Phyllodes tumor will have more spindled nuclei and “fibroblastic pavements”.
Describe the cytology of pregnancy/lactational changes.
Isolated cells or stripped nuclei with prominent nucleolus but little size variation. Foamy.
Describe the cytology of fat necrosis.
Hypocellular specimen with histiocytes and a low N:C ratio.
Describe the cytology of radiation change.
Hypocellular specimen with large nuclei with large cytoplasm (preserved N:C ratio) and multinucleation.
What are the different types of mastitis?
Acute: Neutrophilic, generally not sampled.
Chronic: Sequelae of acute
Granulomatous: Many causes
Granulomatous lobular mastitis: Distinct entity..
Describe the cytology of subareolar abscess
Acute inflammatory exudate plus keratin plugs
Describe the cytology of papillary neoplasms. How can you distinguish papilloma from papillary carcinoma?
Papillary architecture with accompanying blood. Hard to distinguish the two; look for cribriforming, isolated cells, more atypia in general.
Describe the cytology of phyllodes tumor.
Hypercellular specimen with many stromal elements and variable atypia. “Fibroblastic pavements”.
What consistency does IDC have on FNA? What role does FNA play?
Feels gritty. Grading cannot be done on FNA and should be reserved for CNB. Maybe FNA is useful for checking nodes.
Describe the cytology of IDC.
Poorly cohesive clusters of “comet cvells” with intracytoplasmic lumina pushing eccentric nuclei. Irregular nucleolus.
Describe the cytology of ILC.
Isolated medium-sized relatively uniform cells often with signet ring morphology. Quite hard to diagnose by FNA.
Describe the cytology of medullary carcinoma.
Numerous highly atypical cells with bizarre nuclei and background lymphocytes & plasma cells.
Describe the cytology of mucinous (colloid) carcinoma.
Tightly cohesive 3D balls of uniform cells in a mucinous background. May have some branching, plasmacytoid morphology, or psammoma bodies.
Describe the cytology of tubular carcinoma.
Hypocellular specimen (densely firbotic). May see tubular clusters with peripheral perpendicular cells.
Describe the cytology of metaplastic carcinoma.
Pleomorphic, large, sometimes spindled cells which may appear squamous or glandualr. Reactive multinucleated giant cells. May see cartilage or bone.
Describe the cytology of apocrine carcinoma.
Hypercellular specimen with abundant granular cytoplasm, indistinct cell borders, and enlarged nucleus with prominent nucleolus.
Describe the cytology of adenoid cystic carcinoma.
Hypercellular nests of cohesive small cells with round globules. Basaloid. Cells surround basement membrane material.
What lymphomas may be found in the breast?
MALT lymphoma, DLBCL, implant-associated ALCL.
What sarcomas may be found in the breast?
Angiosarcoma, lymphangiosarcoma, liposarcoma, leiomyosarcoma and osteosarcoma?
How can DCIS be distinguished from IDC on cytology?
They cannot be distinguished; this is an architectural feature.
What should be considered in the differential with medullary carcinoma?
Chronic mastitis, lymphoma, intramammary lymph node.
