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Kasus 5 FNAC kurs
Årsmøte i Den Norske Patologforening Vika Atrium 17.03.2011
Torill Sauer
Torill Sauer, Department of Pathology, Ullevaal University Hospital!
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Clinical history • Male • Diagnosed with low-grade malignant non-
Hodgkin lymphoma of the neck in 2002. Treated with cytostatic drugs for 1 ! yrs.
• In April 2006 detected 1 cm palpable, tumour in the right breast at the age of 65 yrs
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Radiological findings
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abundant cell material!
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micropapillary!
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fibroblasts!
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What is your diagnosis?
1. Benign papilloma 2. Cellular papilloma (borderline) 3. Papillary carcinoma in situ 4. DCIS, partly micropapillary 5. Papillary carcinoma, invasive 6. IDC
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(Original) histological diagnosis • Solid papillary carcinoma in situ grade 2 • Tumour diameter 14 mm
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Epidemiology • Approximately 1 % of breast carcinomas occur in
men • < 0.1 % of male cancer deaths
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Clinical presentation • Centrally/retroareolar position • Eccentric location (upper/outer quadrant)
reported • May on rare occations arise in the nipple • Synchronous, bilateral carcinoma exceedingly
unusual • 75 % painless palpable,mass • If there is no mass:
– nipple ulceration – nipple retraction – nipple discharge
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Gross pathology • Carcinomas in men appear identical grossly to
carcinomas arising in women • Cystic papillary carcinomas may present as
striking tumours grossly
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Microscopic pathology • Approximately 85 % IDC • DCIS component found in 35% - 50 % of IDC • Growth patterns duplicate those encountered in
women: – cribriform – comedo – papillary – solid – tubular
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Papillary carcinomas • Often with a prominent cystic component • Relatively more common among men than
among women: – 3 - 5% of male breast carcinomas – 1 – 2 % of carcinomas in women
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Intracystic papillary carcinomas of the breast: a reevaluation using a panel of myoepithelial markers Collins LC et al; Am J Surg Pathol 2006; 30: 1002-1007
• Some of the solid lesions probably represent circumscribed or encapsulated nodules of invasive papillary carcinomas – Lack of myoepithelial cells at the periphery of the nodules
using the following markers: ! Smooth muscle myosin heavy chain ! Calponin ! P63 ! CD10 ! Cytokeratin 5/6
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actin!
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CK 5/6!
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”Encapsulated papillary carcinoma”
• Excellent prognosis with local therapy alone
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Conclusions • These lesions fullfill all criteria for a cytological
diagnosis of ”carcinoma”
• In order to recognise that these lesions are papillary, we have to find the vessel bearing (papillary) stromal stalks
• When we aspirate radiological suspicious, rounded lesions, always keep in mind the solid papillary (encapsulated) carcinomas
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Thank you for your attention!