Fine Needle Aspiration Cytologic Features of Medullary Carcinoma of the Breast A Study of 20 Cases with Histologic Correlation
Pamukkale University, Denisli, Denizli, Turkey Acta cytologica
(Impact Factor: 1.56).
To analyze fine needle aspiration cytology (FNAC) material from 20 cases of histologically verified medullary carcinoma (MC) of the breast and correlate the cytomorphologic features with histologic appearance to improve the diagnostic sensitivity and specificity of FNAC.
We reviewed the cytologic features of 20 cases of MC of the breast in the archives of Ege University Hospital between 1994 and 2006.
Twenty patients with an aspirate and confirmed diagnosis of MC were identified. Patient age was 30-74 years (mean, 48). The initial cytologic diagnoses were positive for cancer in 17 cases, atypical/suspicious for cancer in 2 cases and negative for cancer in 1 case. The cytologic picture was characterized by cellular smears composed of highly atypical epithelial tumor cells in loosely cohesive sheets and lying singly, admixed with polymorphous lymphocytes, plasma cells and neutrophils. Tumor cells had predominantly abundant finely granular, eosinophilic cytoplasm and moderate to marked nuclear pleomorphism with prominent nudcleoli. Histologic examination confirmed that 11 cases were atypical MC and 9 were pure MC.
Breast MC is a rare, distinct category that appears to have rather characteristic cellular features. Familiarity with the cell components is a prerequisite in cytologic accuracy.
Available from: Murali Dhar
- "The cytological features to diagnose them are well defined. Now, diagnosis of other uncommon types of breast carcinomas like lobular carcinoma (Jayaram et al., 2000), secretory carcinoma (Mardi et al., 2007), colloid carcinoma (Krishnamurthy et al, 2010), medullary carcinoma (Akbulut et al., 2009) and signet ring carcinoma (Kelten et al., 2009) based on specific cytological features are also well defined. The Modified Bloom-Richardson (MBR) histological grading system is the gold standard in grading breast "
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ABSTRACT: With increase in the incidence of breast carcinoma, fine needle aspiration cytology (FNAC) has began to play a major role in diagnosing and grading. The study was aimed at validating the different cytological grading systems like Hunt's cytological grading (HCG), modified black grading (MBG), Robinson's cytological grading (RCG) and Masood's cytology index (MCI) in comparison with a modified Bloom-Richardson (MBR) histopathological grading.
Fifty breast carcinoma cases were prospectively studied by comparing various cytological grading methods with histopathological grading over a period of three years. All statistical analyses were carried out with the Epi-info package.
The concordance rate of RCG was 82% which is highest of all, while that of MBG was 68%. HCG and MCI were not comparable with MBR due to insufficient grading.
RCG for breast carcinoma is validated. A consensus for a standard cytological grading method similar to the gold standard MBR histological grading must be arrived at based on conducted comparative studies and has to be inculcated in routine cytology reports.
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Triple-negative breast cancer (TNBC) is distinct from other breast cancers, because the tumor cells lack estrogen and progesterone receptors (hormone receptors) and also are negative for human epidermal growth factor receptor 2 (HER2). They comprise a heterogeneous group of tumors with various histologic features and clinical behaviors. High-grade, invasive ductal carcinoma not otherwise specified is the most frequent type, and a substantial fraction of TNBCs belongs to the basal-like tumor type. The purpose of this study was to determine whether some cytologic features could predict the triple phenotype of breast carcinoma.
Fine-needle aspiration cytology samples of 62 TNBCs were compared with samples of 82 hormone receptor-positive, high-grade, invasive carcinomas (HRBC) and with samples of 33 hormone receptor-negative, HER2 positive, invasive carcinomas (HER2BC) for the following cytomorphologic features: cellularity, necrosis, lymphocytes, syncytial clusters, tubular/ductal-like clusters, large bare nuclei, streaming within the clusters, and calcifications. Moreover, single cell features, such as cellular borders, cytoplasm, cytoplasmic vacuoles, nuclear pleomorphism, nucleoli, and type of chromatin pattern, were evaluated. Descriptive analyses and 2 multivariate regression models were performed to compare TNBC, HRBC, and HER2BC and to identify the cytologic factors that were associated with tumor type.
TNBCs were more likely to have an abundant necrotic background, many lymphocytes, many syncytial clusters, and ill defined cell borders than non-TNBCs. A tubular/ductal pattern was observed only rarely in TNBCs. Multivariate logistic analysis indicated a 90.8% probability of identifying TNBC versus HRBC by the following cytologic variables: lymphocytes, ill defined cell borders and syncytial clusters, tubular/ductal clusters, cytoplasmic vacuoles, and cellular pleomorphism; whereas there was a 77.5% probability of identifying TNBC rather than HER2BC by the following variables: cellularity, ill defined cellular borders and syncytial clusters, and tubular/ductal clusters.
Although TNBCs embrace a heterogeneous group of tumors, in this study, they exhibited some common cytologic features that can help to distinguish them from other high-grade breast carcinomas in daily practice.
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