Read on Twitter
#Breastpath #cytopath
52 Year old female; multifocal right sided breast cancer undergoing mastectomy with SLN bx.
Intraoperative sentinel node touch prep shown. If cancer —> axillary dissection.
3 pages of pics, and a poll.
1/4
52 Year old female; multifocal right sided breast cancer undergoing mastectomy with SLN bx.
Intraoperative sentinel node touch prep shown. If cancer —> axillary dissection.
3 pages of pics, and a poll.
1/4
2/4
Tagging some breast/cyto folks:
@Jbird42077503 @RoncinMD @KaravelicMD @ADamronMD @GuzmanArocho @MComptonMD @Sara_Jiang @MauroSaieg @ZMaleki_cyto @mdlozanoe @ac_pathgal @VandaTorousMD @sza_jhcyto @VarshaManuchaMD @LizaMQuintana @ADamronMD @oreoimc @doc_kartik @cjvand
Tagging some breast/cyto folks:
@Jbird42077503 @RoncinMD @KaravelicMD @ADamronMD @GuzmanArocho @MComptonMD @Sara_Jiang @MauroSaieg @ZMaleki_cyto @mdlozanoe @ac_pathgal @VandaTorousMD @sza_jhcyto @VarshaManuchaMD @LizaMQuintana @ADamronMD @oreoimc @doc_kartik @cjvand
3/4
4/4
Diagnosis? Comments encouraged. Histology correlation and discussion to follow.
Diagnosis? Comments encouraged. Histology correlation and discussion to follow.
1. Discussion: Interesting voting trend. “Benign” held the early slight majority, then some astute people suggested metastatic lobular carcinoma. The voting them swung decidedly towards “cancer”!
2. Atypical cells on touch prep prompted the following frozen section:
3. Corresponding permanents:
Let’s look back at the cytology. I’ve included a cytology: histology correlation slide.
4. From Rosen 4th edition. Challenge accepted: let’s get better at cytology!
5. Let’s start by identifying the normal nodal constituents:
6. Some annotated images showing the atypical features of the red box cells above.
None of these are specific; histiocytes may resemble lobular cancer cells. However, taken together, these atypical features should raise concern for malignancy, and prompt a frozen section.
None of these are specific; histiocytes may resemble lobular cancer cells. However, taken together, these atypical features should raise concern for malignancy, and prompt a frozen section.
7. Click the pictures to expand, to make sure you see all the annotations.
8. Also welcome any input form #cytopath experts, I am definitely not one ( @doc_kartik @Sara_Jiang @DCSkipperDO @oreoimc @DrGeeONE @VandaTorousMD and anyone else)
9. Our approach is similar to that outlined by @MComptonMD et al:
https://pubmed.ncbi.nlm.nih.gov/29566947/
If you are less than 100% sure of 1) diagnosis of metastatic ca, and 2) size of focus, defer. Axillary dissection has significant morbidity, and can’t be undone!
Thanks all!
https://pubmed.ncbi.nlm.nih.gov/29566947/
If you are less than 100% sure of 1) diagnosis of metastatic ca, and 2) size of focus, defer. Axillary dissection has significant morbidity, and can’t be undone!
Thanks all!
