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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

Cancer Breast case presentation in cytology and pathology

Dr. Neveen Samir Tahoun

National Cancer Institute

Pathology Department

Cytology Unit

slide2

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

fine needle aspiration cytology
Simple invasive diagnostic technique

Applied to most organs and tissues

Rapid results

No apparent complications

High experience

Fine Needle Aspiration Cytology
slide4
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.
slide5
“ 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

slide6
“Diagnosis by aspiration is as reliable as the combined intelligence of the clinician and pathologist makes it”.

Stewart, 1965

slide7
“So continuous communication between the clinician and the cytologist is always has an important role as regards accurate diagnosis of the aspirated mass”.
slide8
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.
slide9
“ 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

fnac reporting
Diagnostic

Inconclusive

Inadequate / non-representative

FNAC Reporting
diagnostic categories
Malignant

Benign

Atypical / dysplastic

Inflammatory

Non-neoplastic

Diagnostic Categories
inconclusive
Not enough diagnostic criteria

Difficult case

Not enough experience

Inconclusive
non representative
No cells of organ or tissue

Necrotic or bloody aspirate

Cells of other organ or tissue

Very small or large lesion.

Non-representative
slide14
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.
inadequate
Hypocellular due to nature of the lesion e.g. excessive fibrosis

Crushed material

Air dried due to bad fixation

Inadequate
breast fnac
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
slide17
Material is suitable for ER, PR, Her-2, flow cytometry, FISH, PCR, etc.

The accuracy depends on the skill of the cytologist

recommendations
Confirm by biopsy

Treat infection and repeat

Follow-up required

Suggest primary site in metastasis

Markers

Recommendations
case no 1
Female patient 74 years old

Presented by breast mass.

Case No. 1
slide22
Cytological diagnosis

Mucoid carcinoma

slide24
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.
slide25
FNAC can successfully diagnose cancer breast and more over it can suggest the specific type of different breast carcinoma.
case no 2
Female patient 40 years old

Presented by ill defined breast mass

Case No. 2
case no 3
Female patient 55 years old

Presented by well defined breast mass

Case No. 3
case no 4
Female patient 62 years old

Presented by well defined breast mass

Case No. 4
case no 5
Female patient 45 years old

Presented by well defined breast mass

Case No. 5
slide49
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.
slide69
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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