A 17-year-old female underwent a fine needle aspiration cytology (FNAC) for a lump in the breast which was well defined, non-tender and mobile. The diagnosis of a benign lesion can be considered by which of the following pathological features -
Ans. is 'b' i.e., Tightly arranged ductal epithelial cells with dyscohesive bare nucleiDifferentiation of benign and malignant breast lesions on cytological features o Dispersal of cells Lack of cell-to-cell cohesion is a characteristic malignant features.Biphasic pattern with bipolar cellsThis is the nearest criterion to an absolute indication of beningnancy.Nuclear size and pleomorphismo Benign breast lesion are categorized as such by the relative lack of nuclear enlargement or pleomorphism. Nucleolar size and plelomorphismo Except for apocrine metaplastic cells, it is unusual for benign epithelial cells to have prominent nucleoli. The presence of multiple large and variable nucleoli within a nucleus is paicularly suspiciousNuclear membrane irregularity and extranuclear chromatinThese features can be very helpful in difficult cases.Where robust, regular, relatively small cells with viually no cytoplasm are seen linked in sho, straight or slightly curved chains the diagnosis of lobular carcinoma should be enterained.Mitotic figuresThese are rarely seen in breast aspirates except those of high-grade ductal carcinomas.They can be a feature of benign lesions such as fibroepithelial neoplasm.Unless frequent and atypical, they should not be given a heavy diagnostic bias.Contents of the backgroundo Abundant necrotic material in an otherwise cellular smear is usually attributable to tumour necrosis.70. Ans. is 'b' i.e., Abundant clear cytoplasm o Pagets cells are large and have abundant clear or lightly staining cytoplasm and nuclei with prominent nucleus.o Malignant nuclei almost invariably show nuclear profiles in which there are small indentations or projections. o Box-shaped and angular nuclei are also suspicious.o Extranuclear chromatin is very much a malignant feature but tends to be seen more commonly in higher-grade carcinomas where diagnosis is not a problem.Nuclear/cytoplasmic ratio and cytoplasmic featuresThis is of less help than at any other site in the body as normal breast epithelial cells can have scanty cytoplasm and carcinoma cells showing apocrine differentiation may have a great abundance.o Intracytoplasmic lumina are an occasional feature of both lobular and ductal carcinoma cells but are only very rarely seen in benign breast epithelium.Chromatin textureThis is extremely impoant in difficult cases in papanicolaou stained preparation, the appearance of a coarsely and unevenly stippled nucleus with variable and is seldom marked in breast aspirates unless excessive pressure is used.The relationship of nucei to each othero Marked nuclear moulding is a feature of some breast carcinomas but in others. Where there is little cell cohesion it may be completely absent.Crowded nuclei may show moulding and overlapping but this can also be a feature of benign epithelial groups.
Dyscohesive ductal epithelial cells without cellular fragments
Tightly arranged ductal epithelial cells with dyscohesive bare nuclei
Stromal predominance with hyperplasia of spindle cells
Polymorphism with single or arranged ductal epithelial cells