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Cancer Breast case presentation in cytology and pathology. Dr. Neveen Samir Tahoun National Cancer Institute Pathology Department Cytology Unit. Histopathological criteria are not easily agreed on; which may be even worse on cytological material Sidway et al., 1961.

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Cancer Breast case presentation in cytology and pathology

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Cancer breast case presentation in cytology and pathology l.jpg

Cancer Breast case presentation in cytology and pathology

Dr. Neveen Samir Tahoun

National Cancer Institute

Pathology Department

Cytology Unit


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Histopathological criteria are not easily agreed on; which may be even worseon cytological material Sidway et al., 1961


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Simple invasive diagnostic technique

Applied to most organs and tissues

Rapid results

No apparent complications

High experience

Fine Needle Aspiration Cytology


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The aim of preoperative FNAC is to reduce TIME, SURGERY and ANXIETY on the way to correct diagnoses without causing delay in treatment or overtreatment.


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“ one can never feel quite sure regarding the nature of palpable abnormalities in the female breast without a biopsy, but for

practical reasons excision cannot be used unrestrictedly”.

Nils et al., 1933


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“Diagnosis by aspiration is as reliable as the combined intelligence of the clinician and pathologist makes it”.

Stewart, 1965


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“So continuous communication between the clinician and the cytologist is always has an important role as regards accurate diagnosis of the aspirated mass”.


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In another meaning microscopic diagnosis using FNAC could give a lot when combined with the case story, the clinical examination, palpation, radiological picture, the consistency of the lesion when needled and macroscopic appearance of the aspirated material.


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“ FNAC today is an important tool as regards preoperative diagnoses, not only in differentiation between benign and malignant lesions but in many cases, the experienced cytopathologist with good knowledge in histopathology could go as far as to the type specific histopathological diagnosis by cytology.

Malin et al., 2001


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Diagnostic

Inconclusive

Inadequate / non-representative

FNAC Reporting


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Malignant

Benign

Atypical / dysplastic

Inflammatory

Non-neoplastic

Diagnostic Categories


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Not enough diagnostic criteria

Difficult case

Not enough experience

Inconclusive


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No cells of organ or tissue

Necrotic or bloody aspirate

Cells of other organ or tissue

Very small or large lesion.

Non-representative


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When the lesion is very small and the palpable findings is questionable you better ask for a guided aspiration. The opposite is however also true; very large tumor with reactive changes, could give poor material.


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Hypocellular due to nature of the lesion e.g. excessive fibrosis

Crushed material

Air dried due to bad fixation

Inadequate


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Simple and quick initial diagnostic procedure for palpable & non-palpable masses

Distinguish between a cyst and solid mass

Must be confirmed by histopathologic diagnosis in suspected cases

Breast FNAC


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Material is suitable for ER, PR, Her-2, flow cytometry, FISH, PCR, etc.

The accuracy depends on the skill of the cytologist


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Confirm by biopsy

Treat infection and repeat

Follow-up required

Suggest primary site in metastasis

Markers

Recommendations


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Female patient 74 years old

Presented by breast mass.

Case No. 1


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Cytological diagnosis

Mucoid carcinoma


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The cellularity of FNAC smears from mucoid carcinoma is variable and may yield only a few drops of mucoid material. In this setting, the presence of a remaining palpable mass after initial aspiration is an indication for further aspiration attempts of the residual solid lesion.


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FNAC can successfully diagnose cancer breast and more over it can suggest the specific type of different breast carcinoma.


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Female patient 40 years old

Presented by ill defined breast mass

Case No. 2


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Cytological diagnosisApocrine carcinoma


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Female patient 55 years old

Presented by well defined breast mass

Case No. 3


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Cytological diagnosisPositive consistent with adenoid cystic carcinoma


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Female patient 62 years old

Presented by well defined breast mass

Case No. 4


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Cytological diagnosisPositive consistent with papillary carcinoma


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Female patient 45 years old

Presented by well defined breast mass

Case No. 5


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Cytological diagnosisPositive consistent with medullary carcinoma


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Extremely well differentiated as well as certain types of breast carcinoma e.g. tubular and lobular carcinoma may cause great difficulties for the cytologist to diagnose malignant lesion.


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Female patient 55 years old

Presented by breast mass

Case No. 6


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Cytological diagnosisPositive consistent with lobular carcinoma


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Female patient 65 years old

Presented by breast mass

Case No. 7


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Cytological diagnosisAtypical lymphoid cells, for excision


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Female patient 72 years old

Presented by breast mass

Case No. 7


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Cytological diagnosisMetastatic malignant melanoma


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So clinical data and any previous pathology of the patients is very helpful for the cytologists on the way for correct and conclusive diagnoses.


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Thank You


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