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FNA of breast Slide session The 6th Arab-British School of Pathology

FNA of breast Slide session The 6th Arab-British School of Pathology. Nina S Shabb AUBMC. Fibroepithelial lesions Cases 1-3. Fibroadenoma 3 components Phyllodes tumor vs FA Older women Larger/cystic Adequate sampling Cellular stromal fragments Cytologic atypia/mitosis (malignant)

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FNA of breast Slide session The 6th Arab-British School of Pathology

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  1. FNA of breast Slide sessionThe 6th Arab-British School of Pathology Nina S Shabb AUBMC

  2. 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)

  3. 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

  4. 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

  5. Ductal adenocarcinoma NOSCases 4 and 5 • Cytologic features? • Tumor cellularity • Discohesion • Single cells with features of malignancy • Grading • Nuclear grade 1-3

  6. 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

  7. 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

  8. Lobular carcinomaCase 8 and 9 • What are the FNA features of classic lobular carcinoma?

  9. Case 8 • Classic lobular carcinoma

  10. Case 9 • Pleomorphic lobular ca • Intraductal papilloma • How do we deal with papillary lesions on FNA?

  11. 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

  12. FNA of axillary LNCase 11 • Metastatic adenocarcinoma c/w breast primary • False negative? • Other malignancy?

  13. 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

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