Kasus 5 FNAC kurs

Årsmøte i Den Norske Patologforening Vika Atrium 17.03.2011

Torill Sauer

Torill Sauer, Department of Pathology, Ullevaal University Hospital!

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

Radiological findings

abundant cell material!

micropapillary!

fibroblasts!

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

(Original) histological diagnosis •  Solid papillary carcinoma in situ grade 2 •  Tumour diameter 14 mm

Epidemiology •  Approximately 1 % of breast carcinomas occur in

men •  < 0.1 % of male cancer deaths

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

Gross pathology •  Carcinomas in men appear identical grossly to

carcinomas arising in women •  Cystic papillary carcinomas may present as

striking tumours grossly

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

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

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

actin!

CK 5/6!

”Encapsulated papillary carcinoma”

•  Excellent prognosis with local therapy alone

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

Thank you for your attention!