25
Breast
Fig. 25.52 (A) Aspirate of tubular carcinoma showing two neoplastic tubules with comma-shaped projections. Note the minimal degree of cellular atypia
(Papanicolaou x HP). (B) Neoplastic tubules in fat (Papanicolaou x LP). (C) Corresponding histology showing infiltrating neoplastic tubules with prominent
desmoplastic fibrosis. Note the open lumina and comma-shaped projections from the neoplastic tubules (H&E x MP).
Secretory Carcinoma
Secretory carcinom a o f the breast is a rare va ria n t first described
b y M c D iv itt and Stew art in 1966.307 The tu m o r is characterized
b y a large a m o u n t o f in tra c e llu la r and extracellular secretions
and cells w ith abundant, granular, e o sin o p h ilic cytoplasm
arranged in papillary, tub ular, o r so lid structures.156,308-314 D if-
fuse intracytoplasm ic, secretory m aterial and signet rin g -lik e
cells are seen. Shinagawa and colleagues believe th a t the grape-
lik e cluster o f vacuolated cells m ay be a h e lp fu l cytologic feature
fo r the diagnosis o f secretory carcinom a.156 de la C ruz M era et al.
dem onstrated round , m uc oid m aterial w ith D iff-Q u ik .309 C yto-
logic find ing s o f breast cystic hypersecretory duct carcinom a
includ e the presence o f m ild ly atypical e p ith elial cells arranged
sing ly and in sm all groups and sheets o f cells set in a back-
g round o f abundant, intensely staining, p in k to purple th y ro id -
lik e c o llo id m aterial th a t has a bubbly, fractured, o r cracking
artifact appearance in the smears.93,187,307,315 There is p o te n tia lly
a resem blance o f secretory carcinom a w ith benign e p ith elial
p rolifera tive lesions, such as lactational changes/lactating ade-
n om a.311,316 O th e r entities to be considered in the d iffe re n tia l
diagnosis include lipid-secreting carcinom a and glycogen-rich
clear cell carcinom a o f the breast.317-319 G lycogen-rich clear cell
carcinom a o f the breast shows perinuclear halos and koilocyte-
lik e cytologic appearance. T he cells are strong ly p ositive fo r the
PAS w ith diastase stain.317
Apocrine Carcinoma
A p ocrine carcinom a is an unusual va ria n t o f breast carcinom a o f
possible sweat duct81 o r ductal o rig in .8 The b iolog ic b e ha vio r is
s im ila r to th a t o f the c om m o n invasive ductal carcinom a. C yto-
logic features include the presence o f num erous cells b o th in d i-
v id u a lly scattered and arranged in syncytial fragm ents having
apocrine features. These features include abund ant basop hilic
to e osin o p hilic g ranular cytoplasm and large nuclei w ith p ro m i-
n en t n uc le oli (Fig. 25.5 6 ).320-322
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