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31 Cards in this Set
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cytomorphology of benign nipple secretions
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-usually sparsely cellular
-ductal cells -foam cells -inflammatory cells -RBCs |
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cytomorphology of malignant nipple secretions and aspirations
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-clusters and SINGLE enlarged ductal cells
-variable nuclear size and shape -stripped nuclei -nucleoli -acute inflammation -blood -necrotic debris |
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cytomorphology of benign ductal lavage
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-isolated unremarkable columnar epithelial cells
-flat ductal cell sheets (with MYOEPS) -small nucleolus -mild variation in nuclear size |
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cytomorphology of mildly atypical ductal lavage
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-3-D micropapillary clusters
-moderate nuclear enlargement -mild anisonucleosis -more prevalent small nucleoli -increased N:C ratio in occasional cells -regular nuclear membrane and finely granular chromatin |
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cytomorphology of markedly atypical ductal lavage
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-moderate to marked cellular and nuclear enlargement
-irregular nuclear membrane -coarsely granular chromatin -large and variable nucleoli -consistent increased N:C -occasional multinucleation and mitoses -microcalcs and necrotic debris +/- |
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cytomorphology of nonproliferative fibrocystic change
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-apocrine cells
-foam cells -small ductal cells |
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cytomorphology of ductal proliferative lesion without atypia
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-sheets and tight clusters of cells WITHOUT significant nuclear overlap (with MYOEPS)
-regular cell spacing -finely granular chromatin -inconspicuous to small nucleolus |
Myoeps should stand out like sesame seeds on a bun, above or below the plane of the ductal sheet
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cytomorphology of ductal proliferative lesion WITH atypia
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-sheets and tight clusters of cells WITH significant nuclear overlap
-regular to irregular nuclear spacing -finely to coarsely granular chromatin -prominent to multiple nucleoli |
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differential diagnosis of ductal proliferative lesion WITHOUT atypia
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-intraductal papilloma
-fibroadenoma -carcinoma in situ |
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cytomorphology of fibroadenoma
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-hypercellular
-large sheets -3-D clusters with an ANTLER like configuration -bipolar cells (myoeps) and spindled or oval naked nuclei -fibrillar stromal fragments -bluish-gray with pap stain -intensely red-purple with MGG -nuclear atypia -some loss of epithelial cohesion -regular nuclear spacing -finely granular chromatin -small round nucleolus |
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cytomorphology of pregnancy and lactation change
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-moderately cellular
-numerous isolated epithelial cells or stripped nuclei -nuclear enlargement without variation in size or shape -prominent nucleolus -abundant delicate and wispy granular or finely vacuolated cytoplasm -cytoplasm easily strips away -foamy proteinaceous bkgs -many naked nuclei -occasional small ductal cell clusters and portions of lobules |
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cytomorphology of fat necrosis
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-hypocellular, predominantly HISTIOCYTES with round to coarse cytoplasmic vacuoles (foamy)
-round to kidney-bean nucleus -low N:C ratio -multinucleated and atypical cells -bkgd neutrophils, lymphocytes, and plasma cells |
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cytomorphology of radiation change
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-hypocellular
-proportionate nuclear and cellular enlargement with LOW N:C ratio -hyperchromatic nuclei with round, regular outline and prominent nucleoli -coarse cytoplasmic vacuoles, some containing inflammatory cells -bi- and multinucleation |
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cytomorphology of acute mastitis
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-abundant neutrophils
-occasional groups of reactive ductal cells with enlarged nuclei and prominent nucleoli |
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cytomorphology of chronic mastitis
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-abundant, amorphous, granular debris from inspissated ducts
-inflammatory infiltrate composed of lymphocytes and plasma cells |
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cytomorphology of granulomatous mastitis
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-clustered epithelioid histiocytes
-abundant vacuolated cytoplasm -round or folded nuclei -dispersed chromatin texture -large nucleoli -giant cells, lymphs, plasma cells, eos -rare clusters of benign ductal cells |
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cytomorphology of subareolar abscess
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-numerous anucleate squames admixed with neutrophils
-histiocytes and multinucleated giant cells -occasional groups of atypical reactive ductal cells -fragments of granulation tissue |
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cytomorphology of gynecomastia
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-resembles FA
-low, moderate, or rarely high cellularity -groups of ductal cells with small oval nuclei, scant cytoplasm, and little variation in size & shape -isolated bipolar cells -naked nuclei |
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cytomorphology of papillary neoplasm, favor BENIGN
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-mod to high cellularity
-3-D papillary groups with fibrovascular cores or flat sheets with myoepithelial cells -only rare isolated cells with intact cytoplasm -polymorphic small, cuboidal or columnar cells -round to oval nucleus w finely granular chromatin -nucleolus may be present -foam cells, apocrine metaplasia, and inflammation MAY be present |
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cytomorphology of papillary neoplasm, favor MALIGNANT
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-mod to marked cellularity
-papillary clusters and cribriform or tubular architecture with absence or paucity of myoeps -numerous isolated cells -often uniform tall & columnar cells -elongated uniform nuclei -many naked nuclei but no bipolar cells -blood- and hemosiderin-laden macrophages common |
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cytomorphology of phyllodes tumor
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-similar to FA but more cellular with more cellular stromal component
-sometimes marked stromal atypia with numerous MITOTIC figures -pronounced epithelial atypia mimicking carcinoma |
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cytomorphology of invasive ductal carcinoma
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-hypercellular
-isolated cells and poorly cohesive clusters of abnormal cells -eccentric nucleus often protruding from cytoplasm ("comet cells") -enlarged, variably hyperchromatic nuclei - can vary considerably in size -finely or coarsely granular chromatin pattern -small or large and prominent, irregularly shaped nucleolus -usually clean bkgd, but can see inflammation,blood, and granular debris |
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cytomorphology of invasive lobular carcinoma
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-often sparsely cellular because of marked stromal fibrosis
-predominantly isolated cells with small groups or linear arrays -small to mid-sized tumor cells -large cytoplasmic vacuole (signet ring appearance) -hyperchromatic, often kidney-bean-shaped nucleus -usually small nucleolus, but rarely large |
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cytomorphology of medullary carcinoma
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-hypercellular smears
-numerous isolated cells and loose clusters -markedly enlarged, vesicular nucleus -prominent and often irregular macronucleolus -numerous mitoses -granular scarce to abundant cytoplasm -many lymphs and some plasma cells |
clinically well-circumscribed
better prognosis than IDC triple negative |
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cytomorphology of mucinous carcinoma
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-tightly cohesive 3-D BALLS of cells
-mucinous background -red-violet with MGG -green-purple with pap -branching capillary structure -low-grade, uniform nucleus -small vacuoles in cytoplasm -plasmacytoid cells with eccentric nucleus -rarely psammoma bodies |
ddx mucocele: lack abundant 3-D balls of neoplastic cells
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cytomorphology of tubular carcinoma
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-hypocellular smear due to dense fibrosis
-predominantly cohesive, often angular clusters ("comma" or "cornucopia" shaped) -peripheral perpendicular cells around tubular clusters -some dyshesion -uniform, med-sized tumor cells with round uniform nucleolus -finely granular chromatin -small nucleolus -occasional large cytoplasmic vacuole |
must constitute >75% of tumor to be designated as tubular carcinoma
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cytomorphology of metaplastic carcinoma
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-moderate to marked cytologic atypia
-clusters of and isolated tumor cells -large pleomorphic and spindle-shaped cells -malignant squamous or glandular cells -benign multinucleated GCs -rarely malignant bone or cartilage -background amorphous debris and inflammatory cells |
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cytomorphology of apocrine carcinoma
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-generally hypercellular
-clusters, sheets, and isolated cells -abundant granular cytoplasm with indistinct cell borders -enlarged nucleus with irregular contours -prominent large nucleolus -necrotic debris |
rare - 4% of breast cancers
clinically indistinguishable from IDC marked nuclear atypia distinguishes from apocrine metaplasia |
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cytomorphology of adenoid cystic carcinoma
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-hypercellular smears
-nests of cohesive small cells -uniform round or oval nucleus and scant cytoplasm -hyperchromatic nucleus with coarsely granular chromatin and small nucleolus -round globules within the nests that stain: -bright red-purple on MGG -pale green on pap -p63 stains tumor cells in 85% -c-kit positive in epithelial cells |
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cytomorphology of Non-Hodgkin Lymphoma
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-single cell pattern with lymphoglandular bodies
-monomorphic, atypical cells - irregular nuclear contours and prominent nucleolus |
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cytomorphology of angiosarcoma
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-similar to soft tissue sarcoma
-cells singly and in clusters -hyperchromatic nuclei -coarsely granular chromatin pattern -nucleolus often prominent |
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