Journal of Cytology
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Year : 2020  |  Volume : 37  |  Issue : 1  |  Page : 63-65
Secretory carcinoma breast – the characteristic cytological features in diagnosis of this rare carcinoma


1 Department of Laboratory Medicine, Sahara Hospital, Lucknow, Uttar Pradesh, India
2 Department of General Surgery, Sahara Hospital, Lucknow, Uttar Pradesh, India

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Date of Submission18-May-2019
Date of Decision02-Oct-2019
Date of Acceptance17-Oct-2019
Date of Web Publication23-Dec-2019
 

How to cite this article:
Gupta S, Gupta P. Secretory carcinoma breast – the characteristic cytological features in diagnosis of this rare carcinoma. J Cytol 2020;37:63-5

How to cite this URL:
Gupta S, Gupta P. Secretory carcinoma breast – the characteristic cytological features in diagnosis of this rare carcinoma. J Cytol [serial online] 2020 [cited 2020 Apr 10];37:63-5. Available from: http://www.jcytol.org/text.asp?2020/37/1/63/273802




Sir,

Secretory carcinoma, also called as juvenile carcinoma, is a rare breast carcinoma with a frequency of 0.15% of all breast malignancy.[1],[2] The patients clinically present with an indolent, well-defined mobile breast lump leading to common clinical diagnosis of fibroadenoma. Because of the rarity of tumor, the diagnosis is often missed on FNAC. This case highlights the characteristic findings in cytology to clinch the diagnosis confidently on FNAC.

The patient was a 66-year-old female who presented with a breast lump, which was slowly increasing in size for the last 2 years. On examination, there was a well-defined firm, nontender mobile subareolar lump, 3.0 × 3.0 cm in size in left breast. The nipple and overlying skin were unremarkable. USG showed a 2.8 × 2.8 × 2.5 cm well-defined capsulated lobulated mass lesion with smooth borders and no axillary lymphadenopathy.

Fine needle aspiration revealed highly cellular smears, which consisted of numerous papillaroid fragments, loosely cohesive clusters, and singly lying atypical epithelial cells. These cells had abundant clear grape like vacuolated cytoplasm, eccentrically placed nuclei with mild pleomorphism, and inconspicuous nucleoli [Figure 1]. There was presence of intra- and extracellular PAS - positive secretory material [Figure 2]. There was no evidence of mitotic activity in the tumor cells. A possibility of secretory carcinoma of the breast was suggested.
Figure 1: Highly cellular smears with numerous papillaroid fragments of epithelial cells with abundant clear grape like vacuolated cytoplasm (×400 Giemsa)

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Figure 2: Smear showing intra- and extracellular PAS – positive secretory material (×400 PAS)

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The patient underwent simple mastectomy with axillary clearance. On gross examination, a well-circumscribed tumor with pushing margins was detected just beneath the areola. The tumor was 2.5 cm in diameter. On microscopic examination, an infiltrating carcinoma was seen. The tumor composed of solid, microcystic, tubular, and papillary areas [Figure 3]. The cells were polygonal and there was presence of intra- and extracellular PAS – positive secretory material. Mitotic activity was minimal. None of the lymph node had metatstatic deposits. On immunohistochemistry, the tumor was negative for hormone receptors (triple negative for ER, PR, and Her-2neu) and was positive for Pan CK, EMA, and S-100. To confirm, ETV6-NTRK3 gene fusion (balanced translocation t (12; 15) resulting in an ETS variant 6-neurotrophic tyrosine kinase receptor3 fusion gene encoding a chimeric tyrosine kinase) was also done.[3] It was also positive. Hence, a final diagnosis of Secretory Carcinoma Breast was rendered. The patient was not given any chemotherapy. One year follow-up until now does not show any recurrence or metastasis.
Figure 3: The tumor showing papillary cores with cells having large intracellular vacuoles (×400 H and E)

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Secretory carcinoma breast is a rare low-grade invasive carcinoma, which is composed of cells that produce intra- and extracellular secretory material.[3],[4] These tumors have an indolent clinical course and appear to have an excellent prognosis in patients under the age of 20 year.[2] However, in older patients, a more aggressive course is manifested with late recurrences.

Fine needle aspiration appears to be an excellent tool in diagnosing this rare carcinoma with confidence.[5] Typical features on cytology include highly cellular material, mild nuclear pleomorphism, and the presence of prominent intracytoplasmic vacuolation, which is the cytological hallmark of Secretory Carcinoma.[6] The presence of clear grape like clusters in the cytoplasm of the cells has been considered a distinctive feature for distinguishing Secretory Carcinoma from other benign and malignant breast lesions.[6]

In the above described case, there was a striking similarity between the cytological and histopathological findings, the highly cellular papillary cores, and cells having abundant clear grape like vacuolated cytoplasm were characteristically seen in both. Our case was triple negative and showed no regional or distant metastasis. It also showed ETV6-NTRK3 gene fusion.

It is important to diagnose this tumor on FNAC so that patient can undergo simple mastectomy and sentinel node biopsy rather than going for a more debilitating modified radical mastectomy and axillary clearance. Thus, Secretory Carcinoma Breast can be diagnosed with confidence by FNAC and this helps in appropriate surgical management.

Acknowledgement

Authors are thankful to technical staff of Department of Laboratory Medicine, Sahara hospital for their contribution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Tavassoli FA, Norris HJ. Secretory carcinoma of the breast. Cancer 1980;45:2404-13.  Back to cited text no. 1
    
2.
Rosen PP, Cranor ML. Secretory carcinoma of the breast. Arch Pathol Lab Med 1991;115:141-4.  Back to cited text no. 2
    
3.
Arce C, Cortes-Padilla D, Huntsman DG, Miller MA, Dueñnas-Gonzalez A, Alvarado A, et al. Secretory carcinoma of the breast containing the ETV6-NTRK3 fusion gene in a male: Case report and review of the literature. World J Surg Oncol 2005;3:35.  Back to cited text no. 3
    
4.
Madhusmita J, Shameem S. Cytodiagnosis of secretory carcinoma of the breast: A report on two cases. Diagn Cytopathol 2010;38:921-4.  Back to cited text no. 4
    
5.
Shanthi V, Rama Krishna BA, Rao NM, Sujatha C. Cytodiagnosis of secretory carcinoma of the breast. J Cytol 2012;29:63-5.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Horowitz DP, Sharma CS, Connolly E, Addeo DG, Deutsch I. Secretory carcinoma of the breast: Results from the survival, epidemiology and end results database. Breast 2012;21:350-3.  Back to cited text no. 6
    

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Correspondence Address:
Dr. Surbhi Gupta
Department of Laboratory Medicine, Sahara Hospital, Lucknow, Uttar Pradesh - 226010
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOC.JOC_72_19

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