C2 (benign)

This category indicates an adequate sample without evidence of significant atypia or malignancy.

Benign cases consist of monolayers of uniform ductal cells with round-oval shaped nuclei whose size is similar to that of red blood cells.

Dispersed individual and paired naked nuclei can be seeni in the background

If a cyst has been aspirated, then a mixture of foamy macrophages and regular apocrine cells may be part of the cytological picture.

Fragments of fibro-fatty tissue are also common findings.

Monolayers of uniform ductal cells...

with round-oval shaped nuclei whose size is similar to that of red blood cells.

Remember: Ductal cells are responsive to hormonal changes. In pregnancy hypercellularity may be associated with enlarged and sometimes pleomorphic nuclei with prominent nucleoli

Remember: Ductal cells are responsive to hormonal changes. In pregnancy hypercellularity may be associated with enlarged and sometimes pleomorphic nuclei with prominent nucleoli

Myoepithelial cells are elements of small size with dark hyperchromatic nuclei. They can be observed on the surface of epithelial cells layers in benign cases. They represent an important element in benign cases as they are usually lost in malignant cases

Benign cases are also characterized by the presence of stromal elements which can be isolated or arranged in layers; they present as oval or elongated nuclei and cytoplasmic projections;

Benign cases are also characterized by the presence of stromal elements which can be isolated or arranged in layers; they present as oval or elongated nuclei and cytoplasmic projections;

Or they may be detected as naked bipolar nuclei due to the loss of cytoplasm

It is important to remember that naked bipolar nuclei represent an important benign sign while isolated or loose clusters of epithelial elements tend to lean towards malignancy.

It is important to remember that naked bipolar nuclei represent an important benign sign while isolated or loose clusters of epithelial elements tend to lean towards malignancy.

Fat tissue is another breast component. It tends to be arranged in layers in FNA.

WRONG SAMPLE!

LIPOMA

Intramammary node aspiration usually yields a preponderance of lymphocytes, with some tingible body macrophages and few plasma cells

SUTURE FIBRE

SILICONE GRANULOMA

BIO MARKER

FAT NECROSIS

In breast granulomatous disease it is often possible to detect the causes

In case where a residual mass is present after cystic aspiration a FNA on the residual mass must be performed

Simple cysts contain mainly foamy macrophages and debris

The epithelial cells lining cystic walls may undergo apocrine metaplasia.

The epithelial cells lining cystic walls may undergo apocrine metaplasia.

Foamy macrophages and epithelial cell layers with clear cut regular borders and active nuclei are detected in complex proliferative lesions

Foamy macrophages and epithelial cell layers with clear cut regular borders and active nuclei are detected in complex proliferative lesions

To summarise

The main cytological criteria of benign lesions are:

Monolayer of uniform ductal cells
Appropriate cellular orientation
Good intercellular cohesion
Small sized nuclei (size similar to that of red blood cells)
Myoepithelial/stromal elements/naked bipolar nuclei