发表于 2008-10-8 22:36 {
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- 乳腺肿快FNA
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liguoxia71 离线
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Thank Dr. Chen for sharing the interesting case and main points for GCT.
It is true the third photo is good for GCT. However, one cell cluster with few cells make it difficult for dx. I once saw four breast GCT cases by FNA. They were more classical and easier to make the dx. There are a lot differences between reading true slides and few photos online, especially for cytology cases. Anyway whenever you consider GCT, S-100 stain (positive) in cell blocks can be helpful. We should always try to get a good cell block when FNAs are performed by pathologists or radiologists or surgens.
cqz
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本帖最后由 于 2008-10-08 23:08:00 编辑
Granular cell tumour involving the breast parenchyma is a
rare benign lesion. Typically, the smears are
cellular with a prominent degree of dissociation comprising a uniform population of voluminous cells with fragile membranes, abundant eosinophilic, finely granular cytoplasm, some nuclear atypia and bare nuclei. Bare nuclei are frequently encountered; however, these are stripped nuclei with a vesicular or granular chromatin
pattern quite different from the small ovoid bare bipolar nuclei with a homogeneous smudged chromatin pattern of presumed myoepithelial origin typical of benign breast lesions. Factors that can contribute to misinterpretation are: a) rarity of lesion; b) clinical and radiological features of malignancy ‘misleading’ (false Triple Test); c) grittiness of mass to needle tip; d) failure to consider the lesion in the differential diagnosis; e) dispersal of the very fragile cytoplasm leaving nuclei stripped; f) nuclear atypia; and g) the absence of bare bipolar benign nuclei of myoepithelial/ stromal origin. Reference:
ARNOLDUS S. PIETERSE, ANNABELLE MAHAR AND SVANTE ORELL. ARNOLDUS S. PIETERSE, ANNABELLE MAHAR AND SVANTE ORELL. Granular cell tumour: a pitfall in FNA cytology of breast lesions. Pathology (February 2004) 36(1), pp. 58–62 Note: I have the pictures of the final histology on this case. Unfortunately, I don't know how to post them on the web at this time.
Unlike the previous two cases of Salivary gland and pancreas FNA cases, I got a lot of good responses. You considerations are all very good. For those of you who are not very familiar with the Diff-Quick (air-dryed) stain, please pay attention to the THIRD picture (the Pap stain picture) and concentrate on the feature of the cytoplasm? This was a case I saw when I was a cytopathology fellow, the diagnosis was made by my Mentor (Dr. Richard mac DeMay) on cytology, the clinician did not believe him and took the tumor out, and it was what exactly he predicted. It is a rare tumor of the breast. Now I gave you many hints.
CAN YOU GUESS WHAT IT IS???
re-read the photos again. Hope to know if patient has pregnancy. If yes, lactating adenoma should be considered. If no hx of pregnancy, I will call this case as atypical cell present in true clinical pratice even though it may turn out to be a bengin lesion. Clinical correlation with imaging is needed. Breast core biopsy is suggested.
Answer to 197: I think fig 3 is Pap stain.
I am ok with Fig 1 and 3, but feel a little unconfortable about Fig 2. Fig 2 exhibits discohesive clusters of ductal epithelial cells with round nuclei and increased N/C ratio. I cannot appreciate the myoepithelial cells in these clusters. My cytologic dx is proliferative breast lesion (PBL). I am not sure it should be PBL or PBL with atypia. Biopsy may turn out to be fibroadenoma (FA). FA is the most common cause of false positive and also false negative. Waiting to see the final bx dx.
Thanks
