Meme Kistlerinin Patolojik Panoraması

Amaç:Kistik meme lezyonları yaşlı bayanlarda olduğu kadar gençlerde de yaygın bir bulgudur. Çoğunlukla benin olmalarına rağmen, zaman zaman malin de olabilirler. İnce İğne Aspirasyon Sitolojisi (İİAS) (FNAS) yardımıyla zamanında tanı mümkündür. Bu çalışma, kurumumuzda İİAS yöntemiyle çeşitli kistik meme lezyonlarınının panaromasının belirlenmesi amacıyla yapılmıştır. Materyal ve Metot: Bu çalışma 2010 Mayıs'tan 2014 Haziran'a kadar yürütülmüş 4 yıllık prospektif bir çalışmadır. Meme kütlesinde ki doğal kist Palpasyon ve sonomamogrofi ile belirlendikten sonra İİAS ile alınan doku MGG ve Papanicolaou boyası ile boyandı. Bulgular: Klinik olarak veya sonomamografi ile kistik meme lezyonu tanısı konmuş 72 vakanın İİAS yöntemi ile 64'ünde kistin benin, 8'inde ise malin olduğu bulunmuştur. Sekiz kistik lezyona ait görüntüler retrospektif olarak incelendiğinde, bunların yapı itibariyle kompleks kistik lezyonlar olduğu görülmüş olup, 3'ünde kalın septa, 4'ünde solid alanlar ve 1'inde ise yoğun içerik tespit edilmiştir. Bu kistik lezyonların malin tabiatı İİAS yöntemiyle tespit edilmiş olup bunların yalnızca palpasyon yaparak klinik muayene ile tanı alması mümkün değildir. Sonomamografi ile basit kistik lezyon olarak tanımlanan lezyonların hiç biri İİAS ile malign olarak değerlendirilmedi. Sonuçlar: İİAS, hissedilebilir kistik meme yumrularının malin veya benin olarak kategorize edilmesinde iyi bir yöntemdir. Kistik meme lezyonları içinde benin olanlar malin olanlara nazaran daha yaygındır. Tek başına palpasyon, herhangi bir kistik meme lezyonunun basit veya kompleks olarak belirleyemez; bu yüzden sonomamografi ve ultrason eşliğinde yapılan İİAS memedeki kompleks kistik lezyonlardaki temel belirleyicidir.

Anahtar Kelimeler:

Meme; Kist; İİAS; Palpasyon; Sonomamografi; Patoloji

Pathological Panorama of Breast Cysts

ABSTRACT Purpose: Cystic breast lesions are a common finding in young as well as elderly females. Although, mostly benign; they can at times be malignant too. Timely diagnosis is possible with help of Fine needle aspiration cytology (FNAC). This study was carried out with the aim of studying the panorama of various cystic breast lesions on FNAC in our setup. Materials and Methods: This was a four year prospective study carried out from May 2010 to January 2014. Cystic nature of breast mass was confirmed by palpation and by sonomammography. FNAC was then performed and the smears were stained with MGG and Papanicolaou stain. Results: Out of the 72 cases that were diagnosed to be cystic breast lesions clinically or on sonomammography, 64 were found to be benign and 08 were found to be malignant on FNAC. Retrospective imaging correlation of the 08 cystic cases revealed that they were of complex cystic nature and had either thick septae( 03), solid areas (04) or dense contents (01) within. This internal nature of cystic lesions that were found to be malignant on FNAC was not identifiable by clinical palpation alone. None of the lesions diagnosed as simple cystic lesion on sonomammography was found to be malignant on FNAC. Conclusions: FNAC is a satisfactory technique for the primary categorization of palpable cystic breast lumps into benign and malignant categories. Cystic breast lesions are more commonly benign than malignant. Palpation alone cannot identify the simple or complex nature of any palpable cystic lesion and hence sonomammography and ultrasound guided FNAC are indicated in complex cystic lesions of breast.

Keywords:

Breast; Cysts; FNAC; Palpation; Sonomammography; Pathology,

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Ciatto S, Cariaggi P, Bulgaresi P. The value of routine cytologic examination of breast cyst fluids. ActaCytol. 1987;31:301–4.
Smith DN, Kaelin CM, Korbin CD, et al. Impalpable breast cysts: utility of cytologic examination of fluid obtained with radiologically guided aspiration. Radiology. 1997;204:149–51.
Maleki D, Ghafari A. Cystic changes of breast in a family with autosomal dominant polycystic kidney disease. Iran J Kidney Dis. 2009;3:246-8.
Berg W, Campassi C, Ioffe O. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 2003;227:183–91. deiMalatesta ML Framarino, Piccioni MG, Felici A, et al. Intracystic carcinoma of the breast. Our experience. Eur J GynaecolOncol. 1992;13:40–4.
Robbins SL, Kumar V, Abbas AK et-al. Robbins and Cotran pathologic basis of disease. W.B. Saunders Company. (2010) ISBN:1416031219.
Hong AS, Rosen EL, Soo MS, et al. BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 2005;184:1260–5.
Lamb PM, Perry NM, Vinnicombe SJ, et al. Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. ClinRadiol. 2000;55:40–4.
Berg WA, Sechtin AG, Marques H, Zhang Z. Cystic breast masses and the ACRIN 6666 experience. RadiolClin North Am. 2010;48:931-87.
Burch JB, Walling M, Rush A, Hennesey M, Craven W, Finlayson C, Anderson BO, Cosma G, Wells RL. Melatonin and estrogen in breast cyst fluids. Breast Cancer Res Treat. 2007;103:331-41.
Tsung JS, Wang TY, Wang SM, Yang PS. Cytological and biochemical studies of breast cyst fluid. Breast. 2005;14:37-41.
Doshi DJ, March DE, Crisi GM, et al. Complex cystic breast masses: diagnostic approach and imagingpathologic correlation. Radiographics. 2007;27:53–
Lucas JH, Cone DL. Breast cyst aspiration. Am Fam Physician. 2003;68;1983-6.
Hindle WH, Arias RD, Florentine B, et al. Lack of utility in clinical practice of cytologic examination of nonbloody cyst fluid from palpable breast cysts. Am J Obstet Gynecol. 2000;182:1300–5.
Joshi A, Maimoon S. Limitations of fine needle aspiration cytology in subtyping breast malignancies– a report of three cases. J Cytol. 2007;24:203–6.
Dey P, Luthra UK. False Negative Cytologic Diagnosis of Breast Carcinoma. ActaCytol. 1999;43:801-5.
YazışmaAdresi / Address for Correspondence: Dr.SmitaSankaye Rural Medical College, PIMS(DU), Loni, Ta-Rahata, Ahmednagar Maharashtra, INDIA Email: smitasankaye@gmail.com G eliş tarihi/Received on: 12.02.2014
Kabul tarihi/Accepted on:14.03.2014