Diagnosing invasive cystic hypersecretory duct carcinoma of the breast with fine needle aspiration cytology - A case report

BACKGROUND: Cystic hypersecretory duct carcinoma (CHC) of the breast, first described in 1984, is a rare variant of duct carcinoma. Histologically it is characterized by the formation of dilated ducts ad cyst containing an eosinophilic secretory product resembling thyroid colloid. The lining epithelium of the cysts atypically proliferates to form intraductal carcinoma, Only four case of invasive cystic hypersecretory carcinoma have been reported. CASE: We present a case of invasive CHC with tumor emboli in many lymphatic space and axillary nodal metastases. The lesion was also evaluated by fine needle aspiration. Direct smears with Papanicolaou stain were highly cellular and had abundant, intensely staining, orange-to-gray-green thyroid colloid-like material. Epithelial cells, showing a variety of cellular patterns, were indistinguishable from usual ductal carcinoma cells. These cytologic findings may be characteristic enough to suggest cystic hypersecretory carcinoma CONCLUSIONS: The cytologic features of CHC are distinctive and correlate with histology. This was the first presentation or colloidlike secretory material in cytologic material with Papanicolaou stain in such a case. Invasive CHC tens to have aggressive behavior. Cystic hypersecretory hyperplasia coexisted in this case.