A clinical, cyto-histopathological and immunohistochemical study of spindle cell lesions of breast in a tertiary care hospital

Abstract

Spindle cell lesions in the breast are a diverse group of entities that can be either benign or malignant. Spindle cell lesions often pose a challenge to the diagnosing clinician because of the vast differential diagnoses, the rarity of these lesions and the histological similarities. We aim to conduct this study to profile these rare lesions of the breast and correlate the cyto-histopathological features on FNAC with immunohistochemical characteristics to determine its efficacy.A total 260 patients, suffering from spindle cell lesions of the breast, attending the outpatient and in-patient services were included in this 5 year study (3 years of retrospective cases and 2 years of prospective cases) conducted at Department of Pathology, JNMCH, AMU, Aligarh.: Only Diagnosed cases of Spindle cell lesions of breast were included in the study. The study sample comprised of 260 cases (105 cytological cases and 220 histopathological cases with 65 cases that are common to both) Apart from diagnosed cases of Spindle cell lesions of breast all other breast lesions either reactive benign or malignant were excluded.Total number cases of breast lesions received in the Department of Pathology during 5 year study period were 15,270 out of which 9700 cases were of Histopathology and 5570 were of Cytopathology. Among 15,270 cases, a total number of 15,010 (98.29%) cases belonged to non-spindle cell lesions which were excluded from the study and the remaining cases i.e., 260 (1.7%) cases diagnosed as spindle cell lesions of breast constituted the study group. Of the total260 cases, 105 cases were of cytopathology and 220 cases were of histopathology and cases common to both i.e., those cases which had cyto-histopathological correlation were 65 cases (20%). The highest incidence of spindle cell lesions occurred in 4 decade of life comprising of 126/260 cases (48.46%).Spindle cell lesions are not so common in breast, accounts for 1.7% of cases only. The workup involves thorough histopathological examination due to considerable morphological overlap and an elaborate IHC studies since no single Immunohistochemical marker is sufficient/specific to clinch the final diagnosis. Hence, it is difficult to make the final diagnosis of spindle cell lesions of breast on histopathology alone in majority.