Cellular Pleomorphism Research Articles

Malignant transformation of pleomorphic xanthoastrocytoma

A 31-year-old woman presented with a pleomorphic xantho-astrocytoma (PXA) manifesting as epilepsy. The tumour was partially resected. Histological examination revealed cellular pleomorphism and cytoplasmic vacuolation consistent with PXA, but no mitoses, necrosis, or endothelial proliferation. Follow-up neuro-imaging showed the residual tumour had grown rapidly with dissemination in the spinal cord. The recurrent lesion was totally resected and was shown to be glioblastoma. The patient has survived without signs of recurrence for 36 months after adjuvant radiochemotherapy. The biological behaviour of PXA cannot be predicted based on the histological features and careful follow up is essential.

Clinicopathologic characteristics of myopericytoma

To investigate the clinicopathologic characteristics and differential diagnosis of myopericytoma. Six cases of myopericytomas were analyzed by light microscopy and immunohistochemistry (LSAB detection method). Tumors from 3 females and 3 males were found on the extremities and chest wall. The ages of these 6 patients ranged from 16 to 58 years. Histologically, all tumors were unencapsulated. The neoplastic cells were oval to spindle shaped with eosinophilic cytoplasm, had a myoid appearance and showd areas of concentric perivascular proliferation around lesional blood vessels which were present with focal myxoid stroma. Morphologically in some cases the tumor overlap myofibroma, hemangiopericytoma or glomus tumor. One tumor was located entirely within the lumen of a vein. In another case, the tumor displayed cellular pleomorphism, mitotic activity, necrosis should be diagnosed as malignant myopericytoma. The neoplastic cells were positive for SMA and negative for CD31, CD34, S-100, and CK. Myopericytoma is composed of oval to spindle shaped myoid cells with a striking tendeny for concentric perivascular growth. These cells differentiate towards perivascular myoid cells or myopericytes. Extremely rare malignant myopericytoma exist.

Multiple hepatic masses in a 38-year-old male 10 years after renal transplantation

The patient is a 38-year-old male, diagnosed with IgA nephropathy at age 24, who underwent renal allograft transplantation 10 years ago. He presented with complaints of fever and non-productive cough. Clinical examination was notable for a low grade temperature (99.5 F), bibasilar crackles and a distended abdomen with overlying varices. Laboratory studies showed anaemia of chronic disease and normal liver function tests, except for a mildly depressed serum albumin level. Serum creatinine was elevated from his baseline of 2.5mg/dl to 4.2mg/dl. Additional past medical history includes former heavy use of alcohol, with none following his transplant. A right sided pulmonary infiltrate was detected on chest X-ray. Following antibiotic therapy for presumed pneumonia, his clinical symptoms resolved and his creatinine reverted to baseline level. An out-patient computed tomography (CT) scan was performed to evaluate the abdominal findings. Massive liver nodules in the lobes were present, replacing the hepatic parenchyma. The largest measured 13.5 cm in the left lobe, with a separate 12.5 cm mass in the right lobe (Figure 1). Radiologically, the lesions were perplexing, with a broad differential diagnosis including abscesses, haemangiomas, benign cystic lesions, metastases or hepatocellular carcinoma. Percutaneous core needle biopsy yielded a moderately cellular spindle cell neoplasm with minimal cellular pleomorphism and no mitotic activity (Figure 2). The spindle cells contained elongated, blunt-ended nuclei with finely stippled chromatin. Immunohistochemistry by the standard avidin–biotin–peroxidase complex method demonstrated myogenic differentiation of the tumour cells, which were immunoreactive to smooth muscle actin. In situ hybridization for EBV virus was strongly positive in >90% of the spindle cell nuclei (Figure 3). These findings are indicative of an EBV-associated myogenic tumour. A reduction of the immunosuppressive agents was recommended to the patient, who declined for fear of impending rejection. Currently he is being followed, with slow expansion in the size of the liver nodules. Six months following diagnosis of the liver lesions, a palpable 4 cm nodule in the right gluteal region developed. Additional smaller nodules in the same region were noted by imaging studies. Percutaneous needle core biopsy illustrated a histologically identical EBV-associated myogenic tumour.

Fumonisin B−Glucose Reaction Products Are Less Toxic When Fed to Swine

The effects of fumonisin B-glucose reaction products in swine diets was examined. Pigs were fed diets containing 528 micromol of total fumonisin B/kg (FB), 528 micromol of total FB-glucose adducts/kg (FB-G, 122 micromol of unreacted FB/kg), or 0 micromol of total FB/kg for 15 days to test the efficacy of the FB-G reaction products in detoxifying FB. Weight gain in FB pigs was lower than in FB-G or controls, which was correlated with feed intake reduction in FB pigs. Serum aspartate aminotransferase, gamma-glutamyltransferase, and total bilirubin in FB pigs were higher than in FB-G or control pigs. Serum sphinganine/shingosine ratios in FB pigs were higher than in FB-G or control pigs. Microscopic examination of tissues from FB pigs showed generalized liver necrosis and apoptosis with marked cellular pleomorphism and disorganized hepatic cords. The liver and kidneys in the FB-G group appeared to be normal. Tissues of controls were free of lesions. Results suggest that dietary FB-G products are less toxic to swine and may provide an detoxification approach in instances of widespread FB grain contamination (p < 0.05).

The Ecology and Evolutionary Biology of Cancer: A Review of Mathematical Models of Necrosis and Tumor Cell Diversity

Recent evidence elucidating the relationship between parenchyma cells and otherwise "healthy" cells in malignant neoplasms is forcing cancer biologists to expand beyond the genome-centered, "one-renegade-cell" theory of cancer. As it becomes more and more clear that malignant transformation is context dependent, the usefulness of an evolutionary ecology-based theory of malignant neoplasia becomes increasingly clear. This review attempts to synthesize various theoretical structures built by mathematical oncologists into potential explanations of necrosis and cellular diversity, including both total cell diversity within a tumor and cellular pleomorphism within the parenchyma. The role of natural selection in necrosis and pleomorphism is also examined. The major hypotheses suggested as explanations of these phenomena are outlined in the conclusions section of this review. In every case, mathematical oncologists have built potentially valuable models that yield insight into the causes of necrosis, cell diversity, and nearly every other aspect of malignancy; most make predictions ultimately testable in the lab or clinic. Unfortunately, these advances have gone largely unexploited by the empirical community. Possible reasons why are considered.

Plexiform Fibrohistiocytic Tumor: A Rare Low‐Grade Myofibroblastic Tumor of Children and Young Adults

We describe a 7‐year old male with a 7‐month history of a plexiform fibrohistiocytic tumor (PFT) presenting as an innocuous 0.5 × 0.5 cm nodule on the nasal dorsum. Following diagnostic sampling, Mohs’ micrographic surgery was performed to ensure adequate removal and patient continues to do well 1 year post‐surgery. PFT is a rare neoplasm described initially by Enzinger and Zhang in 1988. It afflicts children and young adults (median age: 14.5 years) and has a strong female predisposition. It typically occurs on the upper extremity. Histologically, the tumor has a bland appearance consisting of a biphasic population of varying numbers of fibroblast and histiocyte‐like cells. Cellular atypia and pleomorphism are lacking and mitotic activity is low. Immunohistochemically and ultrastructurally, the tumor demonstrates myofibroblastic differentiation. The constituent cells have a diploid DNA content. Unique cytogenetic aberrations have been anecdotally identified. PFT behaves in a locally aggressive fashion and regional nodal disease can occur despite adequate excision. In rare instances, metastasis to the lungs has been described. No association between specific clinicopathologic features and outcome has been identified. In summary, PFT is a rare but distinct low‐grade myofibroblastic tumor of children and young adults with a misleading clinical and histological appearance.

Scalp Histology in RAPP‐Hodgkin Syndrome

We report unique histologic findings in scalp biopsies from two family members with Rapp‐Hodgkin syndrome. Rapp‐Hodgkin and the related AEC syndrome show a primary scarring alopecia and pili torti. The syndromes, which are related to ectodactyly, ectodermal dysplasia and cleft lip/palate syndrome, have been credited to mutations in the TP63 gene. Most notable on biopsy is a primary scarring alopecia and abnormal hair shaft shape. Calcification in the outer root sheath epithelium, the basement membrane of the lower segment and within naked hair shafts is present. Neutrophils and bacterial rods and cocci are adjacent to the hair shaft in the superior segment, associated with dilated follicular ostia. Perifollicular fibrosis is associated with a variety of inflammatory cell types, mostly lymphocytic. One sample shows interfollicular irregular psoriasiform epidermal hyperplasia with parakeratosis, compact orthokeratosis, hypergranulosis, and intraepidermal neutrophils. Follicular architecture is abnormal with abrupt and linear loss of nucleated matrical cells (B fringe of Adamson). The line of Ayber measures 0.30 mm on average. Hair shafts measure up to 0.16 mm, with variable abnormal cross sectional shape, usually square. Outer root sheath epithelium is disorganized with slight cellular pleomorphism, and the cuticle of the inner and outer root sheath is irregular in thickness.

Neurothekeoma

The purpose of this study was to investigate and share the experiences at The University of Texas M. D. Anderson Cancer Center in diagnosing, treating, and following patients with neurothekeoma. We report 13 cases. Case series. The clinical, surgical, and pathology records of the 7 patients with neurothekeoma treated at M. D. Anderson Cancer Center were retrospectively reviewed. In addition, the pathology records of 6 patients reviewed by the Department of Pathology for diagnosis only were retrospectively reviewed. Nine patients were women. Their mean age was 30 years (median, 24 years). Six of the lesions were on the head or neck, 4 were on extremities, and 2 were on the trunk, and the location of 1 was not recorded. Two lesions had been previously diagnosed, histologically, as leiomyosarcomas, 1 as a malignant nodular hidradenoma, and 1 as a clear cell hidradenoma. All the lesions had the characteristic nested pattern of growth, with various degrees of myxoid background. Mitotic figures and marked cellular pleomorphism were not common. Six cases were treated with wide local excision. A lesion of the nasal ala was excised by using Mohs micrographic surgery. Most cases were limited to the dermis, but 2 lesions infiltrated subcutaneous tissue and skeletal muscle. All patients were without evidence of disease at 8 months median follow-up range (0 to 35 months). Neurothekeoma is a benign neoplasm occurring usually in women and commonly in the head and neck. Because it may be locally invasive, treatment with wide local excision using frozen section control of margins is recommended. Care must be taken in the pathologic diagnosis of cutaneous neoplasms, and neurothekeoma should be considered in the differential diagnosis for spindle cell lesions. Neurothekeoma is commonly misdiagnosed, pathologically and clinically, and it can be treated successfully with surgical excision. C.

Ecotoxicological evaluation of the additive butylated hydroxyanisole using a battery with six model systems and eighteen endpoints

The occurrence and fate of additives in the aquatic environment is an emerging issue in environmental chemistry. This paper describes the ecotoxicological effects of the commonly used additive butylated hydroxyanisole (BHA) using a test battery, comprising of several different organisms and in vitro test systems, representing a proportion of the different trophic levels. The most sensitive system to BHA was the inhibition of bioluminescence in Vibrio fischeri bacteria, which resulted in an acute low observed adverse effect concentration (LOAEC) of 0.28 μM. The next most sensitive system was the immobilization of the cladoceran Daphnia magna followed by: the inhibition of the growth of the unicellular alga Chlorella vulgaris; the endpoints evaluated in Vero (mammalian) cells (total protein content, LDH activity, neutral red uptake and MTT metabolization), mitotic index and root growth inhibition in the terrestrial plant Allium cepa, and finally, the endpoints used on the RTG-2 salmonid fish cell line (neutral red uptake, total protein content, MTS metabolization, lactate dehydrogenase leakage and activity, and glucose-6-phosphate dehydrogenase activity). Morphological alterations in RTG-2 cells were also assessed and these included loss of cells, induction of cellular pleomorphism, hydropic degeneration and induction of apoptosis at high concentrations. The results from this study also indicated that micronuclei were not induced in A. cepa exposed to BHA. The differences in sensitivity for the diverse systems that were used (EC 50 ranged from 1.2 to >500 μM) suggest the importance for a test battery approach in the evaluation of the ecological consequences of chemicals. According to the results, the levels of BHA reported in industrial wastewater would elicite adverse effects in the environment. This, coupled with its potential to bioaccumulate, makes BHA a pollutant of concern not only for acute exposures, but also for the long-term.

Fine needle aspiration cytology of mammary carcinoma with osteoclast‐like giant cells

Carcinoma with osteoclast-like giant cells (OCGC) is an uncommon neoplasm characterized by giant cells, prominent vascularization, haemorrhage and areas of cribriform epithelial growth with moderate atypia. Multinucleated giant cells (MGC) have been described in several other breast lesions raising an interesting differential diagnosis, mainly with benign disorders. Due to its rarity few cases have been described cytologically. We retrospectively reviewed 13 fine needle aspiration samples from nine patients with this variant of carcinoma. Nine corresponded to breast tumours and four to axillary, liver, subcutaneous and mediastinal metastatic lesions. The expression of CD68 by giant cells was evaluated immunocytochemically in six cases. All patients had a complete pathological study of the breast neoplasm. Smears showed a double component of epithelial and giant cells. Epithelial clusters were predominantly of intermediate size with irregular contours. Most were cohesive but others showed cellular dissociation with scarce to moderate cellular pleomorphism. Giant cells had well defined, deeply stained cytoplasm and round to elongated morphology. Two metastatic cases were devoid of them. Haemosiderin-laden macrophages were common in smears from breast tumours. In the six cases tested CD68 was expressed in MGC. Cytological features of mammary carcinoma with OCGC correlate closely with the histological ones. Most cases are clearly recognizable as malignant but in others cytological atypia may be minimal, mimicking a benign lesion. In difficult cases the presence of haemosiderin-laden macrophages and the histiocytic nature of the MGC are helpful diagnostic features.

Forearm Mass in an Adolescent

Forearm Mass in an Adolescent

Spontaneous epithelial plaques in the uterus of a non-pregnant cynomolgus monkey ( Macaca fascicularis)

Two epithelial plaques were observed in the uterus of a 4 years 8 month old non-pregnant cynomolgus monkey. Normally, epithelial plaques occur near the implantation site of primates during early pregnancy but can also be induced by various procedures. Both plaques consisted of clusters and nest of cells with large nuclei and a faintly basophilic cytoplasm. Marked cellular pleomorphism was seen, including cells with giant nuclei and binucleated cells. Further histological features were vacuolation, mitosis and PAS-positive granules in several cells and polymorphonuclear infiltration in the periphery of the plaque. This is the second description of a spontaneous epithelial plaque in a primate and the first in a cynomolgus monkey.

Effects of ovulation induction on ovarian morphology: an animal study.

The aim of this study was to investigate whether the ovulation induction has relation with postneoplastic lesions. Seventy-eight female, 90-day-old rats were enrolled for the trial. They were divided into three groups. In the first group, 13 rats received one cycle of ovulation induction with Follitropin Beta and human chorionic gonadotropin. The second group of 13 rats received three cycles of ovulation induction, and the third study group consisted of 13 rats which received six cycles of ovulation induction. Each group had a control group consisting of same number of rats that had not received ovulation induction. At the 12th month after the ovulation induction protocols ended, rat ovaries were extirpated for histopathological examination. In histopathological examination, malignant lesions, ovarian cyst and cyst diameter, epithelial stratification, epithelial tufting, mitotic index, polymorphism of epithelial cells and nucleus, epithelial cell nuclear diameter, chromatin density nuclear atypia, and mitotic activity in ovarian cyst epithelium were evaluated. No malignant ovarian lesion was found in the three groups. Ovarian cyst development was most frequent in the rats that underwent six cycles of ovulation induction. Epithelial stratification and tufting were most frequent in the rats which underwent ovulation induction six times. Significant difference was found between induction and control groups in second and third groups for cellular and nuclear polymorphism, presence of nucleolus, and nuclear chromatin density. Although development of malignant lesion were not found in any of the rat ovaries after ovulation induction, increase in the prevalence of epithelial dysplasia especially with increase in the number of induction cycles shows that some ovarian pathologies can occur subsequent to ovulation induction.

Effects of ovulation induction on ovarian morphology: an animal study

ObjectiveThe aim of this study was to investigate whether the ovulation induction has relation with postneoplastic lesions.Materials and methodsSeventy-eight female, 90-day-old rats were enrolled for the trial. They were divided into three groups. In the first group, 13 rats received one cycle of ovulation induction with Follitropin Beta and human chorionic gonadotropin. The second group of 13 rats received three cycles of ovulation induction, and the third study group consisted of 13 rats which received six cycles of ovulation induction. Each group had a control group consisting of same number of rats that had not received ovulation induction. At the 12th month after the ovulation induction protocols ended, rat ovaries were extirpated for histopathological examination. In histopathological examination, malignant lesions, ovarian cyst and cyst diameter, epithelial stratification, epithelial tufting, mitotic index, polymorphism of epithelial cells and nucleus, epithelial cell nuclear diameter, chromatin density nuclear atypia, and mitotic activity in ovarian cyst epithelium were evaluated.ResultsNo malignant ovarian lesion was found in the three groups. Ovarian cyst development was most frequent in the rats that underwent six cycles of ovulation induction. Epithelial stratification and tufting were most frequent in the rats which underwent ovulation induction six times. Significant difference was found between induction and control groups in second and third groups for cellular and nuclear polymorphism, presence of nucleolus, and nuclear chromatin density.ConclusionsAlthough development of malignant lesion were not found in any of the rat ovaries after ovulation induction, increase in the prevalence of epithelial dysplasia especially with increase in the number of induction cycles shows that some ovarian pathologies can occur subsequent to ovulation induction.

Telomere Lengths of Translocation-Associated and Nontranslocation-Associated Sarcomas Differ Dramatically

Sarcomas can be divided into those with specific translocations displaying monotonous cytomorphology, and those with complex karyotypes and marked cellular pleomorphism. Telomeres contain terminal DNA sequence repeats that maintain chromosomal stability. Telomeres shorten with cell division and may become dysfunctional leading to chromosomal instability. Using a fluorescence in situ hybridization/immunofluorescence method to assess telomere lengths in archival tissues we analyzed these two types of sarcomas using paraffin-embedded primary tumor specimens. Tissues from nine sarcomas with characteristic translocations (two synovial sarcomas, two alveolar rhabdomyosarcomas, two desmoplastic round cell tumors, and one each of infantile fibrosarcoma, myxoid liposarcoma, cellular congenital mesoblastic nephroma) and nine without (four malignant fibrous histiocytomas, two leiomyosarcomas, one pleomorphic rhabdomyosarcoma, one dedifferentiated chondrosarcoma, and one malignant peripheral nerve sheath tumor) were analyzed. In all (nine of nine) cases with specific translocations, which generally have few karyotypic abnormalities, telomere lengths were similar to or reduced compared to surrounding nonneoplastic tissues. In contrast, telomeres in cases lacking specific translocations, which generally contain complex karyotypes, were often found to be dramatically lengthened and heterogeneous. In addition to markedly elongated telomeres, seven of nine (78%) complex cases exhibited large brightly stained regions corresponding to a specific type of promyelocytic leukemia nuclear body found in immortalized cells that maintain telomeres in a telomerase-independent manner [alternative lengthening of telomeres (ALT) pathway]. This phenotype is unlike that of epithelial neoplasms that typically display complex karyotypes with abnormally short telomeres maintained by the enzyme telomerase. The discovery of heterogeneous telomere lengths and evidence of the ALT pathway in the majority of sarcomas with complex karyotypes supports the existence of a telomere maintenance pathway incapable of full karyotypic stabilization in pleomorphic sarcomas. These findings provide additional molecular-genetic evidence supporting the dichotomous grouping of sarcomas into those with characteristic signature translocations without extensive additional karyotypic abnormalities, and those without such signature translocations that typically display very complex karyotypes, and point to telomere dysfunction as a plausible contributor to the chromosomal aberrations found in complex sarcomas.

Video-Assisted Thoracoscopic Surgery Is a Promising Treatment for Solitary Fibrous Tumor of the Pleura

Solitary fibrous tumors of the pleura (SFTPs) are slow-growing neoplasms. Approximately 800 cases have been reported in the literature to date. The aim of this study was to address our experience with the management of SFTPs and to evaluate the advantage of video-assisted thoracoscopic surgery (VATS) in SFTP treatment. Retrospective analysis of our experience. Department of Thoracic and Cardiovascular Surgery, Nara Medical University. From January 1992 to August 2002, 13 patients with a SFTP were referred to us for surgical resection after VATS was adopted in our hospital. The study group consisted of seven men and six women with a mean age of 49.8 years (age range, 37 to 72 years). Surgical excision was performed with VATS only in nine patients, with VATS plus a small thoracotomy in three patients, and by a posterolateral thoracotomy without VATS in one patient. The mean chest-drain duration was 1.3 days (range, 1 to 3 days), and the mean duration of hospital stay was 8.6 days (range, 3 to 30 days). Eleven tumors, originating from the visceral pleura, were pedunculate, and 2 tumors from the parietal pleura were not pedunculate. Two cases were focally characterized by a mitotic count in excess of four mitoses per 10 high-power fields and by cellular pleomorphism. Follow-up periods ranged from 6 to 120 months, with a mean of 49.7 months and a median of 42 months. All patients have remained well with no recurrence or metastasis. Complete surgical resection is the treatment of choice for SFTPs. For the pedunculate tumors, therefore, VATS is a powerful and useful approach. Even when it is necessary to perform a small thoracotomy in addition to VATS for the removal of a large tumor, VATS may play an important role in reducing the size of the thoracotomy incision, which results in less invasive surgery. To minimize postoperative morbidity, VATS may be the most promising surgical approach for the resection of SFTPs.

Stromal infiltration as a predictor of tumor invasion in breast fine-needle aspiration biopsy.

Clinical management of in situ carcinoma of the breast is different from invasive carcinomas. Thus, it is important to find cytomorphologic criteria to distinguish between these two entities. The current study is designed to assess whether, by applying strict cytologic criteria, the status of stromal invasion can be predicted. In this retrospective study, 223 consecutive nonpalpable tumors sampled by ultrasound-guided breast fine-needle aspirates with diagnosis of in situ and invasive carcinoma with histologic follow-up evaluation were retrieved. Ten cytologic parameters were evaluated, which included cellular clustering, eosinophilic differentiation, necrosis, tubular structures, dirty background, nuclear anisonucleosis, cellular pleomorphism, cribriform pattern, tubular structures, and stromal infiltration. Among all the parameters examined, stromal infiltration was the most powerful predictor of status of invasion. Stromal infiltration was significantly higher in invasive (88%) than in situ (11%), P < 0.0001. In contrast, cribriform pattern (16% vs 36%) and necrosis (19% vs 59%) were more frequently seen in situ than in invasive carcinomas with P-values of 0.0008 and <0.0001, respectively. This study demonstrates that stromal infiltration defined by strict criteria may predict the status of tumor invasion in breast fine-needle aspirates. The combination of stromal infiltration and cribriform pattern and necrosis in aspirates may provide an opportunity in introducing a "predictive index" to differentiate between an in situ versus an invasive process.

Histological characteristics of oral leukoplakia

Leukoplakia (LKP) is defined as a white patch or plaque on the mucosa of oral cavity, vulva, vagina etc., which cannot be removed and cannot be clinically or microscopically explained by presence of a disease. LKP is included in the group of lesions with malignant potential. Basic microscopic characteristics of oral LKP include hyperkeratosis of ortho- or parakeratotic type and acanthosis of the epithelium, with various degrees of chronic inflammatory infiltrates in lamina propria. Also, various degrees of epithelial dysplasia may occur. Some of the most important microscopic characteristics of dysplasia are: loss of polarity of basal cells, increased nuclear cytoplasmic ratio, irregular epithelial stratification, increased number of abnormal mitotic figures and their presence in the superficial epithelium, cellular and nuclear pleomorphism, keratinization of single cell groups. LKP is the most common oral mucosal lesion (evident in 3% of adults). At the same time, up to 85% of all precancerous lesions are manifested as LKP. Overall malignant potential of LKP does not exceed 4%, but some authors found that even 16% LKP with some degree of dysplasia, have a potential to transform to carcinoma. The most important differential diagnostic criteria are listed for lesions with similar microscopic appearance. Nowdays LKP is diagnosed more frequently than before, probable due to a better patients' education and dentists' caution, but not due to real increase in incidence.

Osteosarcoma with cytokeratin expression: a clinicopathological study of six cases with an emphasis on differential diagnosis from metastatic cancer

Aims: To clarify the clinicopathological profile of osteosarcomas showing an intensely positive immunoreaction for cytokeratin. Methods: Clinicopathological and immunohistochemical features were analysed in 131 patients with non-metastatic, conventional osteosarcoma, treated...

Cytopathological grading, as a predictor of histopathological grade, in ductal carcinoma (NOS) of breast, on air-dried Diff-Quik smears.

Fine-needle aspiration cytology (FNAC) is a widely practiced technique in the diagnosis of breast carcinoma, and it is the only diagnostic procedure performed before definitive treatment, at most institutions. While the histological grading of breast carcinoma has become routine in many centers worldwide, the cytopathological grading of breast carcinoma is not commonly used. Grading of breast carcinoma, while the tumor is still in vivo, would be the most ideal and desirable situation, as it would be helpful in the selection of patients for appropriate therapy. The objective of this study, therefore, was to devise a simple system for grading breast carcinoma, based on the cytological features alone. We reviewed 125 cases of breast carcinoma retrospectively, which were initially diagnosed by FNAC, with subsequent histopathological confirmation. These included 105 ductal, 6 lobular, 2 tubular, 1 papillary, and 1 medullary carcinoma. There was 1 ductal carcinoma in situ. Nine cases were rendered insufficient for grading. Thus 105 cases of ductal carcinoma (NOS) were evaluated for final cytological grading. Air-dried Diff-Quik-stained smears were reviewed at least twice independently by four histopathologists and were then compared with the original histological grades. Six cytological features used for grading were found to be statistically significant: cellular pleomorphism, nuclear size, nuclear margin, nucleoli, naked tumor nuclei, and mitoses. A scoring system based on these six essential parameters was used, to classify ductal carcinoma into three cytological grades, which showed close correlation with the established histological grades. In addition, two less consistent, but still important, features were the presence or absence of necrosis and stromal invasion. Another six parameters, including smear cellularity, degree of cell dispersion or clustering, lymphoplasmacytic infiltrate, presence of tubular structures, cytoplasmic appearance of the tumor cells, and smear background, were not statistically significant. However, these additional parameters were found helpful in assigning the correct grade, in cases with borderline scores. The concordance rate with histology was 100% for grade 1, 98% for grade 2, and 93% for grade 3.