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Case 08

View the images and select the correct diagnosis from the list below.

Stromal rigmarole

FNA of an ill-defined mass in the left breast from a 45-year-old female:


 

 

 

 

 

Select the correct diagnosis:

You answered: Fibroadenoma
Sorry, that is INCORRECT

The correct diagnosis is: Phyllodes tumour

CYTOPATHOLOGY:

  • This is a cellular specimen with fragments of hypercellular stroma, clusters of ductal epithelium some showing apocrine metaplastic change. The stroma contains spindle cells with enlarged mildly pleomorphic nuclei. The background contains dispersed single spindled cells and naked spindle nuclei, many of which are enlarged.
  • These findings are suspicious for phyllodes tumour.

DISCUSSION:

  • The core biopsy reveals localized proliferation of breast ducts and stroma. The stroma is hypercellular with mild atypia and occasional mitosis. The ducts are hyperplastic. This is consistent with a low grade phyllodes tumour.
  • Phyllodes is a rare tumour (1% of breast neoplasms) and mainly occurs in women 40-50 years old, whereas fibroadenomas tend to occur in the 20-30 age range.
  • Phyllodes is most commonly benign but can recur and infrequently metastasize to distant sites
  • Benign phyllodes consists of cohesive duct cells and abundant stromal cells which can be single intact cells, naked nuclei or fragments.
  • Malignant phyllodes usually contains larger, more cellular stromal fragments and single, intact spindle-shaped stromal cells, both with pleomorphic nuclei.
  • Phyllodes may be commonly mistaken as a fibroadenoma. Very cellular stromal fragments with atypical nuclei as seen in phyllodes tumours is the main cytologic feature used to help distinguish the two, however this distinction is often impossible and the differentiation depends on the histologic appearance of the stroma.
  • Adenoid cystic carcinoma is also a very cellular smear composed of duct cells and stromal-like fragments, but the cells are usually arranged around non-fibrillary balls and cylinders of homogenous, myxoid material.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996.



Ramzy I. Clinical Cytopathology and Aspiration Biospy. New York: McGraw-Hill, 2001.

You answered: Adenoid cystic carcinoma
Sorry, that is INCORRECT

The correct diagnosis is: Phyllodes tumour

CYTOPATHOLOGY:

  • This is a cellular specimen with fragments of hypercellular stroma, clusters of ductal epithelium some showing apocrine metaplastic change. The stroma contains spindle cells with enlarged mildly pleomorphic nuclei. The background contains dispersed single spindled cells and naked spindle nuclei, many of which are enlarged.
  • These findings are suspicious for phyllodes tumour.

DISCUSSION:

  • The core biopsy reveals localized proliferation of breast ducts and stroma. The stroma is hypercellular with mild atypia and occasional mitosis. The ducts are hyperplastic. This is consistent with a low grade phyllodes tumour.
  • Phyllodes is a rare tumour (1% of breast neoplasms) and mainly occurs in women 40-50 years old, whereas fibroadenomas tend to occur in the 20-30 age range.
  • Phyllodes is most commonly benign but can recur and infrequently metastasize to distant sites
  • Benign phyllodes consists of cohesive duct cells and abundant stromal cells which can be single intact cells, naked nuclei or fragments.
  • Malignant phyllodes usually contains larger, more cellular stromal fragments and single, intact spindle-shaped stromal cells, both with pleomorphic nuclei.
  • Phyllodes may be commonly mistaken as a fibroadenoma. Very cellular stromal fragments with atypical nuclei as seen in phyllodes tumours is the main cytologic feature used to help distinguish the two, however this distinction is often impossible and the differentiation depends on the histologic appearance of the stroma.
  • Adenoid cystic carcinoma is also a very cellular smear composed of duct cells and stromal-like fragments, but the cells are usually arranged around non-fibrillary balls and cylinders of homogenous, myxoid material.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996.



Ramzy I. Clinical Cytopathology and Aspiration Biospy. New York: McGraw-Hill, 2001.

You answered: Nodular Fasciitis
Sorry, that is INCORRECT

The correct diagnosis is: Phyllodes tumour

CYTOPATHOLOGY:

  • This is a cellular specimen with fragments of hypercellular stroma, clusters of ductal epithelium some showing apocrine metaplastic change. The stroma contains spindle cells with enlarged mildly pleomorphic nuclei. The background contains dispersed single spindled cells and naked spindle nuclei, many of which are enlarged.
  • These findings are suspicious for phyllodes tumour.

DISCUSSION:

  • The core biopsy reveals localized proliferation of breast ducts and stroma. The stroma is hypercellular with mild atypia and occasional mitosis. The ducts are hyperplastic. This is consistent with a low grade phyllodes tumour.
  • Phyllodes is a rare tumour (1% of breast neoplasms) and mainly occurs in women 40-50 years old, whereas fibroadenomas tend to occur in the 20-30 age range.
  • Phyllodes is most commonly benign but can recur and infrequently metastasize to distant sites
  • Benign phyllodes consists of cohesive duct cells and abundant stromal cells which can be single intact cells, naked nuclei or fragments.
  • Malignant phyllodes usually contains larger, more cellular stromal fragments and single, intact spindle-shaped stromal cells, both with pleomorphic nuclei.
  • Phyllodes may be commonly mistaken as a fibroadenoma. Very cellular stromal fragments with atypical nuclei as seen in phyllodes tumours is the main cytologic feature used to help distinguish the two, however this distinction is often impossible and the differentiation depends on the histologic appearance of the stroma.
  • Adenoid cystic carcinoma is also a very cellular smear composed of duct cells and stromal-like fragments, but the cells are usually arranged around non-fibrillary balls and cylinders of homogenous, myxoid material.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996.



Ramzy I. Clinical Cytopathology and Aspiration Biospy. New York: McGraw-Hill, 2001.

You answered: Phyllodes tumour
That is CORRECT!

The correct diagnosis is: Phyllodes tumour

CYTOPATHOLOGY:

  • This is a cellular specimen with fragments of hypercellular stroma, clusters of ductal epithelium some showing apocrine metaplastic change. The stroma contains spindle cells with enlarged mildly pleomorphic nuclei. The background contains dispersed single spindled cells and naked spindle nuclei, many of which are enlarged.
  • These findings are suspicious for phyllodes tumour.

DISCUSSION:

  • The core biopsy reveals localized proliferation of breast ducts and stroma. The stroma is hypercellular with mild atypia and occasional mitosis. The ducts are hyperplastic. This is consistent with a low grade phyllodes tumour.
  • Phyllodes is a rare tumour (1% of breast neoplasms) and mainly occurs in women 40-50 years old, whereas fibroadenomas tend to occur in the 20-30 age range.
  • Phyllodes is most commonly benign but can recur and infrequently metastasize to distant sites
  • Benign phyllodes consists of cohesive duct cells and abundant stromal cells which can be single intact cells, naked nuclei or fragments.
  • Malignant phyllodes usually contains larger, more cellular stromal fragments and single, intact spindle-shaped stromal cells, both with pleomorphic nuclei.
  • Phyllodes may be commonly mistaken as a fibroadenoma. Very cellular stromal fragments with atypical nuclei as seen in phyllodes tumours is the main cytologic feature used to help distinguish the two, however this distinction is often impossible and the differentiation depends on the histologic appearance of the stroma.
  • Adenoid cystic carcinoma is also a very cellular smear composed of duct cells and stromal-like fragments, but the cells are usually arranged around non-fibrillary balls and cylinders of homogenous, myxoid material.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996.



Ramzy I. Clinical Cytopathology and Aspiration Biospy. New York: McGraw-Hill, 2001.

From the Cytopathology files of BC Cancer
Submitted by: Carla Gibbons, B.SC., cytotechnology student and Tom Thomson, MD
SOURCE: Case 08 ( )
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