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'''[[Breast]] cytopathology''' is a relatively small part of cytopathology, as core biopsies are more in style. | '''[[Breast]] cytopathology''', also '''breast cytology''', is a relatively small part of cytopathology, as core biopsies are more in style. | ||
This article deals only with breast cytopathology. An introduction to cytopathology is in the ''[[cytopathology]]'' article. | This article deals only with breast cytopathology. An introduction to cytopathology is in the ''[[cytopathology]]'' article. | ||
=Overview= | |||
===Common indications=== | ===Common indications=== | ||
#FNA done for a clinically benign lesion - unusual to find malignancy. | #FNA done for a clinically benign lesion - unusual to find malignancy. | ||
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*If there are stripped bipolar nuclei (these represent normal stromal cell) - cannot call overt malignancy.<ref>SB. 27 January 2010.</ref> | *If there are stripped bipolar nuclei (these represent normal stromal cell) - cannot call overt malignancy.<ref>SB. 27 January 2010.</ref> | ||
=Normal breast= | |||
Features: | Features: | ||
*Sheets of flat cells. | *Sheets of flat cells. | ||
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*Adipose tissue may represent a [[lipoma]]. | *Adipose tissue may represent a [[lipoma]]. | ||
=Breast cytopathology in a table= | |||
The common entities in breast cytopathology and their features: | The common entities in breast cytopathology and their features: | ||
{| class="wikitable" | {| class="wikitable" | ||
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| Flat sheets & fluffy paucicellular (fibrous) tissue | | Flat sheets & fluffy paucicellular (fibrous) tissue | ||
| '''Mixed pop. in cluster'''; nuclei: oval/spindle (myoepi.) and round (epi.). | | '''Mixed pop. in cluster'''; nuclei: oval/spindle (myoepi.) and round (epi.). | ||
| [ | | [[Image:Breast_fibroadenoma_by_fine_needle_aspiration_%282%29_PAP_stain.jpg | thumb | 150px | center | Fibroadenoma - FNA (WC)]] | ||
|- | |- | ||
| Fibrocystic change | | Fibrocystic change | ||
| Line 54: | Line 54: | ||
| May have flat sheets of cells | | May have flat sheets of cells | ||
| Oncocytic change (apocrine change) common, histocytes (foamy cytoplasm), [[nucleoli]], large NCR | | Oncocytic change (apocrine change) common, histocytes (foamy cytoplasm), [[nucleoli]], large NCR | ||
| [ | | [[Image:Fibrocystic_changes_of_breast_-_cytology_1.jpg |thumb|150px | center | Oncocytes in FCC. (WC)]] | ||
|- | |- | ||
| Papillary neoplasm | | Papillary neoplasm | ||
| Line 60: | Line 60: | ||
| Sheets, usu. flat? | | Sheets, usu. flat? | ||
| Variable size, nucleolus | | Variable size, nucleolus | ||
| [ | | [[Image:Breast_papillary_neoplasm_1.jpg|thumb|150px| center | Papillary neoplasm. (WC)]] | ||
|- | |- | ||
| Ductal carcinoma | | Ductal carcinoma | ||
| Line 66: | Line 66: | ||
| '''3-D clusters''' | | '''3-D clusters''' | ||
| Nuclear size variation, '''membrane irreg.''', nucleoli (prominent) - every cell, cell size var. | | Nuclear size variation, '''membrane irreg.''', nucleoli (prominent) - every cell, cell size var. | ||
| [ | | [[Image:Ductal_carcinoma_2_-_cytology.jpg |thumb|150px |center | Ductal carcinoma. (WC)]] | ||
|} | |} | ||
=Diagnoses= | |||
==Fat necrosis of the breast== | ==Fat necrosis of the breast== | ||
===General=== | ===General=== | ||
Etiology:<ref name=pmid19234281/> | Etiology - various:<ref name=pmid19234281/> | ||
*Trauma | *Trauma. | ||
*Surgery. | |||
*Radiation. | *Radiation. | ||
=== | ===Cytology=== | ||
Features:<ref name=pmid19234281>{{Cite journal | last1 = Taboada | first1 = JL. | last2 = Stephens | first2 = TW. | last3 = Krishnamurthy | first3 = S. | last4 = Brandt | first4 = KR. | last5 = Whitman | first5 = GJ. | title = The many faces of fat necrosis in the breast. | journal = AJR Am J Roentgenol | volume = 192 | issue = 3 | pages = 815-25 | month = Mar | year = 2009 | doi = 10.2214/AJR.08.1250 | PMID = 19234281 | URL = http://www.ajronline.org/content/192/3/815.full }}</ref> | Features:<ref name=pmid19234281>{{Cite journal | last1 = Taboada | first1 = JL. | last2 = Stephens | first2 = TW. | last3 = Krishnamurthy | first3 = S. | last4 = Brandt | first4 = KR. | last5 = Whitman | first5 = GJ. | title = The many faces of fat necrosis in the breast. | journal = AJR Am J Roentgenol | volume = 192 | issue = 3 | pages = 815-25 | month = Mar | year = 2009 | doi = 10.2214/AJR.08.1250 | PMID = 19234281 | URL = http://www.ajronline.org/content/192/3/815.full }}</ref> | ||
*Dying/dead adipocytes: | *Dying/dead adipocytes: | ||
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**#*Macrophages: multinucleated giant-cells. | **#*Macrophages: multinucleated giant-cells. | ||
**#*Calcification. | **#*Calcification. | ||
*+/-[[Myospherulosis]] - granulomatous reaction of fat & blood. | |||
**Round aggregate of [[RBC]]s ~10-20 RBCs in diameter. | |||
Notes: | Notes: | ||
*Healthy adipocytes - large cells, clear cytoplasm. | *Healthy adipocytes - large cells, clear cytoplasm. | ||
*Myospherulosis - due to exposure to fat, may be seen in the context of malignancy.<ref name=pmid11035579>{{Cite journal | last1 = Chau | first1 = KY. | last2 = Pretorius | first2 = JM. | last3 = Stewart | first3 = AW. | title = Myospherulosis in renal cell carcinoma. | journal = Arch Pathol Lab Med | volume = 124 | issue = 10 | pages = 1476-9 | month = Oct | year = 2000 | doi = 10.1043/0003-9985(2000)1241476:MIRCC2.0.CO;2 | PMID = 11035579 }}</ref> | |||
Images | ====Images==== | ||
*[http://www.ajronline.org/content/192/3/815/F1.expansion.html Early fat necrosis (ajronline.org)]. | *[http://www.ajronline.org/content/192/3/815/F1.expansion.html Early fat necrosis (ajronline.org)]. | ||
*[http://www.ajronline.org/content/192/3/815/F4.expansion.html Mid fat necrosis (ajronline.org)]. | *[http://www.ajronline.org/content/192/3/815/F4.expansion.html Mid fat necrosis (ajronline.org)]. | ||
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*[http://www.ajronline.org/content/192/3/815/F6.expansion.html Late fat necrosis - calcifications (ajronline.org)]. | *[http://www.ajronline.org/content/192/3/815/F6.expansion.html Late fat necrosis - calcifications (ajronline.org)]. | ||
== | ==Ductal carcinoma== | ||
*By convention one usually calls everything ''ductal carcinoma''. | *By convention one usually calls everything ''ductal carcinoma''. It is the same as ''mammary carcinoma''. | ||
=== | ===Cytology=== | ||
Features: | |||
#Cellular size variation. | *Classic five:<ref>{{Ref FNAC|137}}</ref> | ||
#Nuclear size variation. | *#Cellular size variation. | ||
#*May be marked adjacent cells different by factor of 2. | *#Nuclear size variation. | ||
#*Typically ''not'' marked - often ~1.5. | *#*May be marked adjacent cells different by factor of 2. | ||
#Nucleoli. | *#*Typically ''not'' marked - often ~1.5. | ||
#*Should be in every cell. | *#Nucleoli. | ||
#*Multiple suggestive of malignant. | *#*Should be in every cell. | ||
#Irregular chromatin pattern. | *#*Multiple suggestive of malignant. | ||
#Lack of singular bipolar nuclei (in the background), '''key negative'''. | *#Irregular chromatin pattern. | ||
Other features: | *#Lack of singular bipolar nuclei (in the background), '''key negative'''. | ||
*3-D clusters - strong indicator. | *Other features: | ||
*Cytoplasmic vacuoles - considered a classic finding. | **3-D clusters - strong indicator. | ||
**Cytoplasmic vacuoles - considered a classic finding. | |||
Notes: | Notes: | ||
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**Exceptions are ''tubular carcinoma'' and ''colloid carcinoma''; these have cells found in clusters or tubules/glands.<ref name=Ref_APBR678>{{Ref APBR|678}}</ref> | **Exceptions are ''tubular carcinoma'' and ''colloid carcinoma''; these have cells found in clusters or tubules/glands.<ref name=Ref_APBR678>{{Ref APBR|678}}</ref> | ||
*Intracytoplasmic "lumens"/inclusions (think ''lobular carcinoma''). | *Intracytoplasmic "lumens"/inclusions (think ''lobular carcinoma''). | ||
*A useful rule of thumb: strongly suggestive of malignant ~3x RBC diameter & dyscohesive.<ref>Chan, S. 26 April 2012.</ref> | |||
DDx: | |||
*[[Breast cytopathology#Fibroadenoma|Fibroadenoma]]. | |||
====Images==== | |||
<gallery> | |||
Image:Ductal_carcinoma_-_cytology.gif | Ductal carcinoma - animation showing 3-D nature. (WC) | |||
Image:Ductal_carcinoma_2_-_cytology.jpg | Ductal carcinoma. (WC) | |||
</gallery> | |||
==Lobular carcinoma== | |||
* | {{Main|Invasive lobular carcinoma}} | ||
* | ===Cytology=== | ||
Features: | |||
*Discohesive, small, plasmacytoid cells. | |||
*Targetoid mucin - '''key features'''. | |||
==Tubular carcinoma== | |||
{{Main|Tubular carcinoma of the breast}} | |||
===Cytology=== | |||
Features: | |||
*Tubular structure with sharp point - '''key feature'''. | |||
==Mucinous carcinoma== | |||
{{Main|Mucinous carcinoma of the breast}} | |||
===Cytology=== | |||
Features: | |||
*Mucin - blue/gray acellular material. | |||
*Nuclear atypia. | |||
DDx: | |||
*Mucocele. | |||
==Fibroadenoma== | ==Fibroadenoma== | ||
{{Main|Fibroadenoma}} | |||
===General=== | |||
*Pitfall #1 for a malignant diagnosis, i.e. ''ductal carcinoma''. | |||
===Cytology=== | |||
Features:<ref name=Ref_APBR676>{{Ref APBR|676}}</ref> | Features:<ref name=Ref_APBR676>{{Ref APBR|676}}</ref> | ||
*Flat | *Flat sheets of cells with finger-link projections (called "antler horns") with a mixed cell population: | ||
**Cells with round nuclei (epithelium). | **Cells with round nuclei (epithelium). | ||
**Cells with oval nuclei (myoepithelium). | **Cells with oval nuclei (myoepithelium). | ||
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**Spindle cells. | **Spindle cells. | ||
**Fluffy appearance - relatively paucicellular. | **Fluffy appearance - relatively paucicellular. | ||
*Naked bipolar nuclei. | |||
**Represent myoepithelial cells stripped of their cytoplasm. | |||
***Nuclei typically ovoid, may be spindle-shaped. | |||
Images | ====Images==== | ||
<gallery> | |||
Image:Breast_fibroadenoma_by_fine_needle_aspiration_%282%29_PAP_stain.jpg | Fibroadenoma - FNA (WC) | |||
Image:Breast_fibroadenoma_by_fine_needle_aspiration_%281%29_DG_stain.jpg | Fibroadenoma FNA - Diff-Quik (WC) | |||
</gallery> | |||
www: | |||
*[http://www.flickr.com/photos/jian-hua_qiao_md/3975095095/ Fibroadenoma (flickr.com)]. | |||
==Apocrine metaplasia/fibrocystic changes== | ==Apocrine metaplasia/fibrocystic changes== | ||
{{Main|Fibrocystic changes}} | |||
===Cytology=== | |||
Features:<ref name=Ref_APBR677>{{Ref APBR|677}}</ref> | Features:<ref name=Ref_APBR677>{{Ref APBR|677}}</ref> | ||
*Architecture - pretty much anything (flat, single, papillary, clusters, sheets). | *Architecture - pretty much anything (flat, single, papillary, clusters, sheets). | ||
| Line 147: | Line 196: | ||
**Vacuolated cytoplasm + round/oval nuclei. | **Vacuolated cytoplasm + round/oval nuclei. | ||
Image | ====Image==== | ||
<gallery> | |||
Image:Fibrocystic_changes_of_breast_-_cytology_1.jpg | Oncocytes in FCC. (WC) | |||
</gallery> | |||
==Paget's disease== | ==Paget's disease== | ||
{{Main|Paget disease of the breast}} | {{Main|Paget disease of the breast}} | ||
===Cytology=== | |||
Features:<ref name=Ref_APBR677>{{Ref APBR|677}}</ref> | Features:<ref name=Ref_APBR677>{{Ref APBR|677}}</ref> | ||
*Usually large cells with: | *Usually large cells with: | ||
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==Papillary neoplasm== | ==Papillary neoplasm== | ||
===General=== | |||
*Location: retroareolar. | |||
===Cytology=== | |||
Features:<ref name=ouhsc_35>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-035-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-035-M.htm]. Accessed on: 9 April 2012.</ref> | |||
*Fibrovascular core - may not be evident. | |||
*Cohesive cell clusters. | |||
*+/-Single cells with cytoplasm. | |||
DDx: | |||
*Fibroadenoma - has single cells without cytoplasm. | |||
====Image==== | |||
<gallery> | |||
Image:Breast_papillary_neoplasm_1.jpg | Papillary neoplasm. (WC) | |||
</gallery> | |||
==Apocrine metaplasia== | |||
===Cytology=== | |||
Features: | Features: | ||
* | *Nucleoli. | ||
*Granular cytoplasm. | |||
Image: | Image: | ||
*[http:// | *[http://www.womenshealthsection.com/content/art_images/20-47b.jpg Apocrine metaplasia (womenshealthsection.com)].<ref name=whs>URL: [http://www.womenshealthsection.com/content/print.php3?title=gynpc004&cat=60&lng=english http://www.womenshealthsection.com/content/print.php3?title=gynpc004&cat=60&lng=english]. Accessed on: 31 March 2012.</ref> | ||
==See also | ==Lactational changes== | ||
{{Main|Lactational changes}} | |||
===General=== | |||
*May mimic ''ductal carcinoma''. | |||
===Cytology=== | |||
Features: | |||
*Nucleoli. | |||
*Cytoplasmic vacuolization. | |||
*Myoepithelial cells (bipolar cells) - '''important'''. | |||
Notes: | |||
*May for 3-D structures. | |||
DDx: | |||
*Ductal carcinoma. | |||
=See also= | |||
*[[Cytopathology]]. | *[[Cytopathology]]. | ||
*[[Basics]]. | *[[Basics]]. | ||
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*[[Breast cancer]]. | *[[Breast cancer]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
=External links= | |||
*[http://www.womenshealthsection.com/content/print.php3?title=gynpc004&cat=60&lng=english Breast cytopathology (womenshealthsection.com)]. | |||
[[Category:Cytopathology]] | [[Category:Cytopathology]] | ||