Definition/General

Introduction:
-Fine needle aspiration cytology (FNAC) of breast ductal carcinoma represents a minimally invasive diagnostic procedure
-It provides rapid diagnosis of invasive ductal carcinoma
-FNAC shows cellular atypia with loss of dual cell population
-It demonstrates nuclear pleomorphism and increased cellularity.
Origin:
-Ductal carcinoma arises from epithelial cells lining mammary ducts
-FNAC samples show malignant epithelial cells without myoepithelial cells
-The cytological features reflect the invasive nature of the tumor
-Loss of basement membrane integrity is characteristic.
Classification:
-Classified according to Bethesda System for reporting breast cytopathology
-C5 category (malignant) diagnosis
-Grading follows Robinson grading system
-High-grade features indicate poor differentiation.
Epidemiology:
-Peak incidence in 5th-6th decades
-Most common malignant breast cytology diagnosis
-FNAC sensitivity for ductal carcinoma is 85-95%
-Specificity approaches 98-99%
-False negative rate 5-15%.

Clinical Features

Presentation:
-Palpable breast mass (most common indication)
-Mammographic abnormality
-Skin changes or nipple retraction
-Axillary lymphadenopathy
-Bloody nipple discharge
-Previous imaging showing BI-RADS 4 or 5 lesion.
Symptoms:
-Breast lump (80-90% cases)
-Breast pain (30% cases)
-Nipple discharge (10-15%)
-Skin dimpling or puckering
-Peau d'orange changes
-Weight loss (advanced cases).
Risk Factors:
-Age >50 years
-Family history of breast cancer
-BRCA1/2 mutations
-Previous atypical hyperplasia
-Hormone replacement therapy
-Nulliparity
-Early menarche
-Late menopause.

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Gross Description

Microscopic Description

Immunohistochemistry

Molecular/Genetic

Genetic Mutations:
-TP53 mutations (30-40%)
-PIK3CA mutations (25-30%)
-GATA3 mutations (10-15%)
-CDH1 mutations (5-10%)
-BRCA1/2 mutations (hereditary cases).

Differential Diagnosis

Sample Pathology Report

Template Format

Sample Pathology Report

Complete Report: This is an example of how the final pathology report should be structured for this condition.

Specimen Information

FNAC [breast location], [number] passes with [gauge] needle

Adequacy

Specimen is [adequate/inadequate] for evaluation

Cellularity

Cellularity: [high/moderate/low]

Cellular Morphology

Shows [architectural pattern] with [nuclear features]

Nuclear Features

Nuclear pleomorphism: [grade], chromatin: [pattern], nucleoli: [prominent/inconspicuous]

Background

Background shows [inflammatory cells/proteinaceous material/blood]

Bethesda Category

Category: [C1/C2/C3/C4/C5]

Diagnosis

[Benign/Atypical/Suspicious/Malignant] cytological features

Recommendations

Recommend: [histological correlation/clinical correlation/repeat FNAC]

Final Diagnosis

Final diagnosis: [specific diagnosis], Bethesda Category [X]