Psammoma bodies in fine needle aspiration cytology of the breast: A clinicopathological study of 30 cases

Psammoma bodies (PBs) in breast lesions are rare and little is known about the role of these structures in breast pathology. This study has looked in to the diagnostic significance of PBs in fine needle aspiration (FNAC) of breast lesions. Over a 5‐year period, FNACs of the breast were done in 4,563 subjects, of which 1,678 were diagnosed to be malignant. On review of all breast aspirates including non‐neoplastic lesions, 30 cases showed PBs to be associated with breast carcinoma (BC). Cytological features were correlated with clinical, radiological, histological, and immunohistochemical findings. All 30 aspirates and their corresponding histological sections showed varying number of PBs and nonpsammomatous bodies (NPBs). For comparison, 31 cases of age‐matched BC without PBs and NPBs in both aspirates and sections were studied. Statistical analysis using Chi‐square test was done to compare BC with and without PBs. BC with PBs was characterized by papillary pattern of malignant cells, mucin in the background, infiltration by macrophages, cellular degeneration, overexpression of estrogen receptor (ER), and progesterone receptor (PR) and moderate positivity (2+) for Her2/neu. Calcium deposition has long been implicated in the pathogenesis of many degenerative diseases; hence the formation of PBs may be relevant in breast oncology. The presence of PBs in FNAC of clinically suspected breast lesions which are cytologically negative for malignancy warrants further histological confirmation. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

Fine‐needle aspiration cytology of adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (ACC) of the breast is a rare variant of breast malignancy and has a better prognosis than its counterpart in the salivary glands. In this communication, our experience with seven cases of ACC of the breast is presented in which the diagnosis was established on fine‐needle aspiration cytology (FNAC). The cytologic samples in all cases were cellular and featured three‐dimensional clusters of uniform ductal epithelial cells with cystic spaces, bland nuclei, fine chromatin, and scanty cytoplasm arranged around spheres or cores of homogenous material. The cytodiagnosis of ACC in all cases correlated with subsequent examination of cell blocks of the aspirate and tissue. The cytodiagnostic criteria for ACC of the breast which are useful in a correct FNAC diagnosis are discussed. Diagn. Cytopathol. 1999;20:82–84. © 1999 Wiley‐Liss, Inc.     

Periductal mastitis in a male breast masquerading as lobular carcinoma on fine needle aspiration cytology

Fine needle aspiration cytology (FNAC) is quite successful in identifying specific benign and malignant breast lesions, but its role in the categorization of proliferative breast lesions has not been well defined. Mastitis/ breast abscess can lead to intense inflammatory response; however, its association with epithelial hyperplasia is rarely reported. At times, it may be difficult to differentiate dense lymphoplasmacytic infiltrate from non-Hodgkin's lymphoma. We present a case of periductal mastitis associated with epithelial hyperplasia, presenting as a subaerolar swelling in a male breast, which was misinterpreted as lobular carcinoma on FNAC.     

A comparative analysis of core needle biopsy and fine-needle aspiration cytology in the evaluation of palpable and mammographically detected suspicious breast lesions

The present study was undertaken to compare the efficacy of needle core biopsy (NCB) of the breast with fine-needle aspiration cytology (FNAC) in breast lesions (palpable and non-palpable) in the Indian set-up, along with the assessment of tumor grading with both the techniques. Fifty patients with suspicious breast lesions were subjected to simultaneous FNAC and ultrasound-guided NCB following an initial mammographic evaluation. Cases were categorized into benign, benign with atypia, suspicious and malignant groups. In cases of infiltrating duct carcinomas, grading was performed on cytological smears as well as on NCB specimens. Both the techniques were compared, and findings were correlated with radiological and excision findings. Out of 50 cases, 18 were found to be benign and 32 malignant on final pathological diagnosis. Maximum number of patients with benign diagnosis was in the fourth decade (42.11%) and malignant diagnosis in the fourth as well as fifth decade (35.48% each). Sensitivity and specificity of mammography for the diagnosis of malignancy was 84.37% and 83.33%, respectively. Sensitivity and specificity of FNAC for malignant diagnosis was 78.15% and 94.44%, respectively, and of NCB was 96.5% and 100%, respectively. But NCB had a slightly higher specimen inadequacy rate (8%). NCB improved diagnostic categorization over FNAC by 18%. Tumor grading in cases of IDC showed high concordance rate between NCB and subsequent excision biopsy (94.44%) but low concordance rate between NCB and FNAC (59.1%). NCB is superior to FNAC in the diagnosis of breast lesions in terms of sensitivity, specificity, correct histological categorization of the lesions as well as tumor grading.     

乳腺针吸细胞学假阴性诊断分析

目的 :提高乳腺癌针吸细胞学诊断的准确性。方法 :对 72 31例乳腺肿块进行针吸细胞学检查 ,获取病理组织学对照有744例 ,并作统计分析。结果 :本组针吸细胞学诊断敏感性 93 6 7% ,特异性 96 43% ,假阳性率 3 5 7% ,假阴性率 6 33% ,符合率 94 0 9%。结论 :针吸细胞学是乳腺肿块一种重要的辅助诊断方法。肿瘤实质细胞较少或细胞异型性不明显是假阴性诊断的主要原因。注意触诊和重复针吸是减少假阴性的主要措施     

Fine-needle aspiration cytology vs. core biopsy in the diagnosis of breast lesions

Fine-needle aspiration cytology (FNAC) is an established, highly accurate method for diagnosing breast lesions. However, in recent years there has been increased use of core biopsy (CB) in this setting. The aim of this study was to evaluate the accuracy of FNAC and compare the quality assessment parameters of FNAC and CB in palpable and nonpalpable breast lesions. Data regarding FNAC, CB, and excision biopsy (EB) diagnoses were retrieved from the archives of our department. A total of 4,367 FNAC samples from the years 1999-2001 was reviewed. Of these, corresponding histology results were available for 1,275 lesions, of which 1,248 were primary breast epithelial lesions (788 EB, 199 CB, 261 EB+CB). All cases were analyzed for sensitivity and specificity of FNAC. Cases with both FNAC and CB were compared and quality assessment parameters were calculated using the methodology detailed in the National Health Service Breast Screening Program guidelines. High specificity and sensitivity, as calculated for satisfactory specimens, were achieved with the use of both FNAC and CB. False-positive and false-negative diagnoses were seen in 7/404 (1.7%) and 45/635 (7.1%) of biopsy-proven specimens sampled by FNAC. The corresponding values for CB were 0% and 5.7%, respectively. Inadequate sampling (15.1%) with use of FNAC was particularly seen in collagenous lesions and in submitted specimens sampled by physicians lacking experience with the FNAC procedure. FNAC is a valuable method, although moderately less sensitive than CB. CB is the preferred method for preoperative diagnosis when sampling FNAC provides scarce material and suspicion of a fibrotic and collagenous lesion such as lobular carcinoma and radial scar arises. FNAC is most accurate when experienced cytologists are available and when immediate assessment by professionals is performed for evaluation of material adequacy, so that additional aspirations can be done when needed.     

Fine‐needle aspiration cytology and immunohistology of low‐grade adenosquamous carcinoma of the breast

Low‐grade adenosquamous carcinoma of the breast (LASCB) is a relatively recently‐described, rare histotype of breast cancer that has a favorable prognosis. Its principal microscopic features are the presence of “syringoid” (“tadpole”‐shaped) ductal profiles of tumor cells, a bland and modestly cellular stromal background, and the variable presence of keratinizing (“epidermoid”) cell groups. As such, the basic image of LASCB is quite similar to that of microcystic adnexal or adenosquamous carcinoma of the skin or “syringomatous adenoma” of the nipple. We report the fine‐needle aspiration cytologic (FNA) attributes of this neoplasm, as well as its immunohistochemical characteristics and differential diagnosis. Diagn. Cytopathol. 1999;20:13–18. © 1999 Wiley‐Liss, Inc.     

Fine needle aspiration cytology of lobular carcinoma in situ on ThinPrep

Lobular carcinoma in situ (LCIS) of the breast is a recognized marker for increased risk of invasive carcinoma and has well-established histologic criteria. However, its detection and diagnosis on FNA of breast has not been well defined. Cytology slides (all ThinPrep) of 11 cases with biopsy-proven LCIS at Beth Israel Deaconess Medical Center were reviewed. All 11 cases showed tight and/or loosely cohesive clusters of crowded mildly enlarged nuclei and ten of 11 showed at least moderate cellularity. Single epithelial cells, small but prominent nucleoli, intracytoplasmic lumina, and two distinct epithelial-cell populations were also noted in some cases. As none of these features is specific for LCIS, it would be prudent to report such lesions as atypical so that a core biopsy or excisional biopsy will be performed before definitive treatment. The original FNA diagnosis of the 11 cases ranged from epithelial proliferation without atypia to carcinoma. Three of the 11 cases had fibroadenomas on histology with extensive involvement by LCIS. Since management for LCIS is different from that for invasive carcinoma or DCIS, it should be considered and distinguished from the latter two in cases suspicious for carcinoma on FNA.     

Fine‐needle aspiration cytology of solid papillary carcinoma of the breast

We report a case of solid papillary carcinoma (SPC) of the breast, of which the cytologic findings of the nipple discharge and the fine needle aspiration (FNA), and the pathology of the resected tumour are described in detail. Imaging studies demonstrated an intra‐ductal tumour of the breast, which seemed responsible for the bloody nipple discharge. The cytologic features of the nipple discharge and the FNA targeted to the intra‐ductal tumour suggested low‐grade carcinoma. Additional findings of mucin production and rosette‐formation (possibly neuroendocrine differentiation) indicated SPC as a major differential diagnosis. Histologically, the lesion consisted of mainly ductal proliferation of low‐grade carcinoma associated with prominent rosette formation within the tumour and mucin production. Permeation of mucin with cancer cell clusters into the adjacent adipose tissue was also noted. Immunohistochemically, the tumour cells, especially those forming rosettes, were partially positive for CD56. Histological diagnosis was SPC with invasion. SPC is a rare tumour, and its cytologic and pathologic features have only been sporadically reported. Our case was unique in that there was a good correlation between cytologic and histologic findings. The cytologic findings that are important to predict the histologic diagnosis are emphasized. A brief review of the relevant literature is also included.     

Tubulolobular carcinoma of the breast with grooved and cerebriform nuclei: failure to identify this specific subtype in a case during routine fine needle aspiration cytology and histopathological diagnosis

Tubulolobular carcinoma (TLC) is a rare tumor of the breast in which histologic features of both tubular and lobular carcinoma are combined. We report a case of TLC, in which the specific subtype was missed at routine cytologic and histopathological examination. A 69-year-old woman presented with a right breast lump. Imaging studies indicated a malignant lesion in right upper quadrant. Routine fine needle aspiration (FNA) cytology diagnosis was a duct cell carcinoma (small cell type). In a setting of cystic thyroid lesions, presence of excessive nuclear grooves, and rare intranuclear cytoplasmic inclusion, metastatic papillary thyroid carcinoma was also considered. However, both these possibilities were not supported by immunocytochemical findings (estrogen receptor+, thyroglobulin-, and chromogranin-). The histopathology diagnosis was invasive duct cell carcinoma. Review of FNA smears and paraffin sections led to the diagnosis of TLC, which was supported by positive immunohistochemical stainings for markers like e-cadherin and β-catein.     

Adrenal histoplasmosis: a diagnosis on fine needle aspiration cytology

Histoplasmosis is a fungal disease endemic in central and eastern states of United States, South America, Africa, and Asia. It may present as chronic pulmonary infection or in disseminated form of infection. The disseminated form of histoplasmosis frequently affects the adrenal gland and is more likely to affect immunocompromised patients as compared to immunocompetent individuals. There are very few cases of adrenal histoplasmosis diagnosed on fine needle aspiration cytology. In the present era when fine needle aspiration has become popular modality for diagnosis, adrenal fine needle aspiration is still a less commonly practiced technique. We report eight cases of adrenal histoplasmosis diagnosed on fine needle aspiration cytology in patients with bilateral adrenal masses. The present case series supports the role of fine needle aspiration cytology of adrenal gland infections where surgery can be prevented and a definitive diagnosis can be made on which treatment can be offered.     

Fine needle aspiration cytology of invasive micropapillary carcinoma of the breast

AIM: To determine the pathognomonic diagnostic cytological features of invasive micropapillary carcinoma of the breast which is a poor prognostic subtype of infiltrating ductal carcinoma. METHODS: A series of 20 histologically proven tumours were reviewed retrospectively to evaluate the various cytological features, including tumour morules, isolated malignant cells, staghorn epithelial structures, mucinous background and apocrine metaplasia. RESULTS: Tumour morules formation and isolated malignant cells were the two most reliable and constant cytological features, being present in 75% (15/20 cases) of cases. Staghorn epithelial structures were present in 35% (7 cases). Mucinous background (2 cases, 10%) and apocrine metaplasia (4 cases, 20%) of the tumour cells were seen in a few cases only and did not appear very helpful. CONCLUSION: Tumour morules formation, isolated malignant cells and staghorn epithelial structures are the most reliable cytological features, and the presence of these should raise suspicion of invasive micropapillary carcinoma.     

Fine-needle aspiration cytology of metastatic nasopharyngeal carcinoma

Cytological features of nasopharyngeal carcinoma (NPC) were reviewed in an attempt to select cytological criteria that permit a specific recognition of metastases. For this purpose, 54 fine-needle aspiration (FNA) procedures from 43 patients with NPC were analyzed. Thirty-two (59.3%) procedures were performed before the histological diagnosis. In 25 (46.3%) procedures, smears showed many neoplastic single cells, clusters, and abundant lymphoid cells (mixed pattern). A dissociated (single cell) pattern consisting of individual neoplastic and lymphoid cells was seen in 18 (33.3%) cases. Finally, 11 (20.4%) cases showed cohesive epithelial clusters (cohesive pattern) without relevant cellular dissociation or lymphoid cells. Squamous-cell differentiation was seen in three of these cases. Most single neoplastic cells presented as large, pleomorphic naked nuclei. Other interesting findings were granulomas (n = 3), prominent eosinophilic infiltrates (n = 4), and suppurative changes (n = 5). In most smears with mixed and dissociated patterns, a nasopharyngeal origin could be suggested. On the contrary, those smears with a cohesive pattern were indistinguishable from other head and neck carcinomas.The presence (on cervical lymph nodes) of a dissociated or mixed (single cells and groups) architectural pattern of large, anaplastic cells and naked nuclei accompanied by an abundant lymphoid component is highly suggestive of undifferentiated NPC. Cytology offers a rapid diagnosis, establishes the necessity of a complete cavum examination, and helps in avoiding unnecessary and harmful biopsies.     

Fine needle aspiration cytology of breast cancer in women aged 70 years and older

Aims: Elderly breast cancers are associated with a more favourable biological marker profile and higher proportion of specific subtypes, some of which are of low histological grade. We reviewed the fine needle aspiration cytology (FNAC) to assess the cytological characteristics and any clues to assist in the diagnosis. Methods: The aspirates of 140 cancers of various histological types and grades and 39 benign lesions were evaluated for 13 cytological parameters including cellularity of the direct and cytospin smears, epithelial cell clusters, cellular atypism, cytoplasmic features, vacuoles, mitotic figures, presence of myoepithelial cells, single background epithelial cells, the presence of naked nuclei, stromal fragments and necrosis. Results: We found that the presence of background single epithelial cells, atypism of such cells, absence of benign appearing epithelial fragments, nuclear atypism of the epithelial cells within the fragments, presence of moderate amount of cytoplasm of these cells, absence of myoepithelial cells within the cluster, and absence of bipolar nuclei in the background have a strong association with malignancy. Scoring only the presence of single cells in the background, single cell atypism and the absence of bipolar nuclei in a scoring system can differentiate between benign and malignant aspirates with high (>90%) sensitivity and specificity. Conclusions: Assessing the presence of single cells in the background, single cell atypism and the absence of bipolar nuclei facilitates identification of malignancy in the aspiration of breast lesions from elderly patients.     

A comparision of aspiration cytology and core needle biopsy according to tumor size of suspicious breast lesions

The purpose of the study was to compare the accuracy of FNAC, CNB, and combined biopsy according to tumor size of suspicious breast lesions. FNAC and CNB were performed in 264 patients with suspicious breast lesions from August, 1997 to August, 2002. The procedures were guided by ultrasound and performed in the same session by the same operator. The lesions were divided in four groups according to the tumor size in the histopathology report: lesions smaller than 1 cm, between 1 and 2 cm, between 2 and 5 cm, and lesions greater than 5 cm. The final surgical histopatology results identified 222 (84%) malignant cases and benign lesions summed 42 (16%). For lesions smaller than 1 cm, FNAC, CNB, and combined biopsy were equivalent for all parameters. For lesions between 1 and 2 cm, FNAC and CNB were equivalent. Combined biopsy showed higher absolute sensitivity (P = 0.007) and lower inadequate rate (P = 0.03) when compared to FNAC. However, when combined biopsy and CNB were compared, no difference were found. For lesions between 2 and 5 cm, CNB showed higher absolute sensitivity (P < 0.001) and lower inadequate rate (P < 0.007) when compared to FNAC. Combined biopsy showed higher sensitivity compared to FNAC and CNB alone (P < 0.05) in this group. For lesions greater than 5 cm, FNAC and CNB were equivalent for all parameters. Combined biopsy only showed higher absolute sensitivity (P = 0.04) when compared with FNAC alone. The combination of FNAC and CNB can improve the diagnosis of suspicious breast lesions higher than 1 cm. However, for lesions smaller than 1 cm, our results showed no difference between FNAC, CNB, and combined biopsy, for these lesions any modality has technical limitations.     

Primary peripheral pulmonary adenoid cystic carcinoma: Report of a case diagnosed by fine needle aspiration cytology

Adenoid cystic carcinoma (ACC) arising from anatomic sites other than the salivary gland is rare and those occurring in the lung are extremely rare. When arising from the lung, the tumor generally arises from extrapulmonary bronchi, originating from bronchial glands. Primary ACC of the lung located peripherally within lung parenchyme is an even rarer event. To the best of our knowledge, this is the first case of primary peripheral pulmonary ACC preoperatively diagnosed by fine needle aspiration cytology (FNAC). We report a case of primary peripheral ACC of the anterior segment of the right upper lobe in a 46‐year‐old woman diagnosed by FNAC and a brief review of the literature. Diagn. Cytopathol. 2011;39:283–287. © 2010 Wiley–Liss, Inc.     

Male breast lesions: gynecomastia and its distinction from carcinoma by aspiration biopsy cytology

Gynecomastia is a benign proliferative lesion of the male breast. It may present as a diffuse bilateral process or a unilateral, discrete mass, clinically suggestive of carcinoma. We examined the aspiration biopsy cytology of 50 cases of gynecomastia to define the cytologic criteria and to distinguish it from carcinoma. The parameters of cellularity, architecture, single columnar cells, naked nuclei, nuclear and cell size, nuclear and cytoplasmic characteristics, and extraneous cells were accessed. Diagnostic confusion with carcinoma may occur because of cellularity with loose groups and single cells; however, the mixed cell population, composed of cohesive sheets or groups of bland cells, bipolar naked nuclei, and single tall columnar cells, delineates gynecomastia from carcinoma of the male breast.