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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. 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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  1. Cancer Breast case presentation in cytology and pathology Dr. Neveen Samir Tahoun National Cancer Institute Pathology Department Cytology Unit

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

  3. Simple invasive diagnostic technique Applied to most organs and tissues Rapid results No apparent complications High experience Fine Needle Aspiration Cytology

  4. 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.

  5. “ 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

  6. “Diagnosis by aspiration is as reliable as the combined intelligence of the clinician and pathologist makes it”. Stewart, 1965

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

  8. 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.

  9. “ 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

  10. Diagnostic Inconclusive Inadequate / non-representative FNAC Reporting

  11. Malignant Benign Atypical / dysplastic Inflammatory Non-neoplastic Diagnostic Categories

  12. Not enough diagnostic criteria Difficult case Not enough experience Inconclusive

  13. No cells of organ or tissue Necrotic or bloody aspirate Cells of other organ or tissue Very small or large lesion. Non-representative

  14. 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.

  15. Hypocellular due to nature of the lesion e.g. excessive fibrosis Crushed material Air dried due to bad fixation Inadequate

  16. 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

  17. Material is suitable for ER, PR, Her-2, flow cytometry, FISH, PCR, etc. The accuracy depends on the skill of the cytologist

  18. Confirm by biopsy Treat infection and repeat Follow-up required Suggest primary site in metastasis Markers Recommendations

  19. Female patient 74 years old Presented by breast mass. Case No. 1

  20. Cytological diagnosis Mucoid carcinoma

  21. 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.

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

  23. Female patient 40 years old Presented by ill defined breast mass Case No. 2

  24. Cytological diagnosisApocrine carcinoma

  25. Female patient 55 years old Presented by well defined breast mass Case No. 3

  26. Cytological diagnosisPositive consistent with adenoid cystic carcinoma

  27. Female patient 62 years old Presented by well defined breast mass Case No. 4

  28. Cytological diagnosisPositive consistent with papillary carcinoma

  29. Female patient 45 years old Presented by well defined breast mass Case No. 5

  30. Cytological diagnosisPositive consistent with medullary carcinoma

  31. 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.

  32. Female patient 55 years old Presented by breast mass Case No. 6

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