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. 2021 Jan 22;9(3):119-124.
doi: 10.4103/JMAU.JMAU_19_20. eCollection 2021 Jul-Sep.

Gray Lesions of the Breast and its Diagnostic Significance: A Retrospective Study from Rural India

Seema Dayal  1 , Mani Krishna  1 , Sanjay Kumar Kannaujia  1 , Seema Singh  1
Affiliations

Gray Lesions of the Breast and its Diagnostic Significance: A Retrospective Study from Rural India

Seema Dayal et al. J Microsc Ultrastruct. .

Abstract

Background: Breast lesions extend from benign to malignant ones. The National Cancer Institute recommended categories for the diagnosis of breast cytology. There are some lesions in the breast which are called intermediate or gray lesions. It includes C3 (atypical, probably benign) and C4 (suspicious, favor malignant) which needs to be evaluated.

Materials and methods: This study was conducted in the Department of Pathology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (Uttar Pradesh). Fine-needle aspiration cytopathology (FNAC) was the diagnostic tool. The present study was undertaken to determine the gray lesions of the breast and its correlation with histopathology and other associated parameters. Immunohistochemistry was applied where ever necessary. One hundred and fifty one cases of gray lesions of the breast were included.

Results: C3 was seen in 85 (56.29%) and C4 in 66 (43.70%) patients. The maximum number of patients was of 31-40, (33.77%) years age group, the youngest patient was 12-year-old female, whereas the oldest was 86 years male. Histopathology evaluation confirmed malignancy in 35 (23.17%) cases, and infiltrating ductal carcinoma was the frequent malignancy (24 [68.5%]). Sensitivity, specificity, positive predictive value, and negative predictive value of C4 category for the diagnosis of malignancy were, respectively, 81.48%, 50%, 68.7%, and 64.2%.

Conclusion: FNAC is an excellent diagnostic tool. It has some limitations, especially with the gray lesions, which may lead to miss interpretation in diagnosis, so a scope of mistake to the cytopathologist is always there. These lesions need to be evaluated because of the risk of malignancy. However, gray lesions can be reduced by cytology followed by histopathology examination along with ancillary radiological investigations such as mammography and ultrasonography.

Keywords: Breast; fine needle aspiration cytopathology (FNAC); gray lesions; histopathology.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
May Grunwald stain stained smear of C3 showing sheet of ductal cells with myoepithelial cells in the back ground. Some cells are showing enlarged cell with nuclear changes
Figure 2
Figure 2
H and E-stained section of ductal carcinoma of the breast showing loosely arranged ductal cells. Cells are hyperchromatic, having vesicular nucleus, prominent nucleoli and some nucleoli are multiple in number, with frequent mitosis
Figure 3
Figure 3
H and E-stained smear of C4 showing loosely and singly arranged spindle cells with enlarged hyperchromatic nucleus and prominent nucleoli
Figure 4
Figure 4
H and E-stained section of malignant phyllodes tumor showing spindle cells with elongated nucleus, prominent nucleoli, and mitosis
Figure 5
Figure 5
Section of malignant phyllodes tumor showing marked positivity for vimentin
Figure 6
Figure 6
Section of malignant phyllodes tumor showing CD-117 positivity
See this image and copyright information in PMC

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