Low power: Pap stain
Numerous spherical cannon balls of breast ductal carcinoma
Medium power: Pap stain
Malignant cell balls with smooth community borders
High power: Pap stain
Malignant cells of breast ductal carcinoma. Note high N:C ratio, irregular enlarged nuclei, coarse chromatin and occasional prominent nucleoli.
Medium power: DQ stain
Cluster of large malignant cells with enlarged nuclei, coarse chromatin, prominent nucleoli and moderate amounts of vacuolated cytoplasm.
Medium power: Pap stain
Cluster of large malignant cells with enlarged nuclei, coarse chromatin, prominent nucleoli and moderate amounts of vacuolated cytoplasm.
Cell block: H&E stain
Cluster of large malignant cells with enlarged nuclei, prominent nucleoli, and moderate amounts of vacuolated cytoplasm in an acinar-like architecture. Note inflammatory background.
Features
• Most common cause of malignant effusions with adenocarcinomas being the most frequent.
• Foreign population of cells that stand out from mesothelial cells and histiocytes
• Exception:
- cells that mimic native cells
- all tumor cells so they all look alike
• Carcinomas typically form cohesive clusters and ball up to form spheres with smooth community borders ; however some tumors shed as single cells (lobular breast carcinoma, gastric signet ring cells). May or may not have malignant features (enlarged irregular nuclei with pleomorphism) but usually have high N:C ratios and coarse chromatin.
• Large spherical cell balls or cannonballs
• Scant to moderate cytoplasm
• May have cytoplasmic mucin vacuoles
• High N:C ratio
• Enlarged round nuclei
• May have eccentrically located nuclei
• Prominent nucleoli
• IHC: Tumor cells typically express GATA-3, BerEP4, MOC31, may express mammaglobin or GCDFP-15, while negative for calretinin (D/D mesothelial cells) and CD68 or CD163 (histiocytes)