PART TWO
Diagnostic Cytology
Fig. 25.73 (A) Aspirate of prostate carcinoma metastatic to the breast
showing a neoplastic epithelial cluster that would be indistinguishable
from a primary breast carcinoma (Papanicolaou x HP). (B) Positive
immunohistochemical staining for prostatic acid phosphatase confirming the
prostatic origin of the metastatic carcinoma (immunohistochemistry x HP).
Fig. 25.74 (A) Papillary carcinoma of the ovary metastatic to the breast.
Although most metastatic carcinomas have cytologic patterns unusual for
primary breast carcinoma, occasional cases are indistinguishable from a
breast primary (Papanicolaou x HP). (B) Histologic section proved metastatic
serous carcinoma to the breast (H&E x HP).
Cytologic Prognostication
T u m o r grading p e rform ed o n cytolog ic m a te ria l m ay be espe-
c ia lly use fu l in those p atients receiving chem otherap y before
resection o f th e ir tu m o rs .409 A n u m b e r o f studies have show ed
th a t grading o f breast carcinom a can be p e rform ed o n FN A
cytolog ic m a te ria l.409-418 Dabbs and S ilve rm a n proposed grad-
ing based o n nuclear grade a lo n e as a p rog nostic p aram eter in
FN A o f breast carcinom a w ith good results.409 N u cle ar grade I
is d efined as n uclei s im ila r to those o f n o rm a l duct e p ith e -
liu m , h avin g m in im a l enlarg em ent; ro u n d , s m o o th nuclear
m em branes;
u n ifo rm ,
fin e
c h ro m a tin ;
and
n o
n u c le o li
(Fig. 2 5.7 5 A ). N u cle ar grade I is c o m m o n ly observed in tu b u -
la r and p a p illa ry carcinom as.74 N u cle ar grade II reveals nuclei
th a t can be tw ice th e size o f nuclear grade I n uclei, w ith
s m o o th nuclear m em branes and u n ifo rm c h ro m a tin , and
m ay sh o w sm a ll n u c le o li (Fig. 2 5 .7 5 B). A m od erate degree
o f anisonucleosis m ay be present. N u cle ar grade III d e m o n -
strates m arked anisonucleosis in w h ic h th e nuc le i o fte n show
a th re e fo ld v a ria tio n in nuclear d iam eter.
O th e r features
o f nuclear grade III are m arked hyp erchrom asia, irre g u la r
nuclear contours, coarse c h ro m a tin w ith c h ro m a tin clearing,
and m a c ro n u c le o li (Figs 25.76 and 2 5 .7 7 ). In o u r experience,
nuclear grading can be p e rform ed o n b o th D iff-Q u ik -a n d
P a p anicolaou-stained sm ears.409 N u cle ar grading p e rform ed
o n FN A cytolog ic m a te ria l has sho w n good concordance w ith
h is to lo g ic nuclear grading and o th e r p rog nostic param eters
in c lu d in g tu m o r p lo id y .409,411,419-421
H o w e ll et al. attem pted to ap p ly the E lston and E llis-m o d ifie d
S c a rff-B loo d -R ich a rd so n grading system to FN A o f the breast
w ith little success, m a in ly because o f d ifficu ltie s in detecting
tu b ule fo rm a tio n and c ounting m itosis in cytologic smears.422
R ob inson and McKee proposed a cytologic grading included six
cytologic features: cell dissociation, nuclear size, cell u n ifo rm -
ity, nuc le oli, nuclear m argin, and c h ro m a tin p attern.421 They
fo u n d good c orrelation between th e ir cytologic grade and h is to -
logic grade.421 A recent study u tiliz e d cytologic features (nuclear
grade), architectural features (cellular dyscohesion), and back-
g round features (bare atypical nuclei) in to a one cytoprognos-
tic scoring system and fo u n d it to be associated w ith histolog ic
grade, lym p h node status, and p ositive expressions o f H E R 2/
neu, p53, and K i6 7.413
758
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