Diagnosis of Infarcted Breast Lesions on FNAC, a Blustering Fool: Short Case Series

Abstract

Introduction: Fine-needle aspiration cytology (FNAC) is often used as a screening tool. Cytopathologist should be aware of various mimickers of the malignancy. One of these is infarction of benign breast lesions. Careful examination of cytomorphological features will avoid the misdiagnosis of malignancy in such cases.

Material and methods: Six cases were diagnosed as benign breast lesion for 4 years and 5 months in our newly established tertiary referral center. Histopathology follow-up was available in one case.

Results: Of six cases, three cases (50%) were reported as fibroadenoma with infarction, two cases (33%) as benign breast lesion with infarction favor fibroadenoma, and one as breast lesion with infarction favor phyllodes tumor in view of recurrence. Most were in the second or third decade of their life. All cases showed dyscohesive cells with pyknotic nuclei. Monolayered sheets of necrotic cells were seen in the four cases (66%). Viable cells were seen in four cases.

Conclusions: FNAC provides a rapid and accurate diagnosis of benign breast lesions with infarction in the hands of experienced pathologists who can help in better patient care. Small-sized uniform pyknotic nuclei of dyscohesive cells and regular nuclear membranes help to differentiate them from inflammatory and malignant lesions.

Keywords: Ghost cells; infarcted breast lesion; infarcted fibroadenoma.

Figure 1

Hematoxylin- and eosin-stained smear on low power. The smear is hypercellular and shows occasional monolayered sheets of viable epithelial cells. The background shows dyscohesive singly scattered elongated cells

Figure 2

Hematoxylin- and eosin-stained smear under oil immersion showed singly scattered cells having densely stained rounded pyknotic nuclei with regular nuclear borders. Few cells showed faintly staining small nuclei indicative of ghost cell change

Figure 3

Papanicolaou-stained smear in high power showed a necrotic monolayered sheet in the center. It shows cells with small pyknotic faintly stained nuclei indicative of infarction. A few tiny sheets with densely stained nuclei are seen above

Figure 4

Schematic representation of the viable and necrotic cells