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Fine needle aspiration cytology findings of cystic hypersecretory ductal carcinoma of the breast: a reappraisal.

Cystic hypersecretory ductal carcinoma is a rare subtype of ductal carcinoma in situ (DCIS) of the breast first described by Rosen et al in 1984.1 It has a peculiar gross and microscopic appearance. Histologically, there are multiple dilated, ductal lumina rimmed by carcinoma cells and containing a colloidlike secretion. The ductal carcinoma cells often demonstrate high secretory activity, with cytoplasmic vacuolation and hobnailing. Sometimes cystic hypersecretory DCIS is associated with an invasive component. Owing to the prominent cystic dilatation and paucity of tumor cells, cystic hypersecretory DCIS may be mistaken for benign breast diseases on cytologic or even histologic grounds. The fine needle aspiration cytology of this entity has rarely been described.2-7 According to some authors, one important diagnostic cytologic feature is the presence of colloidlike substance in the smears. The morphology in cytospin preparations, however, has not been described before. We report the cytologic features of cystic hypersecretory DCIS in Cytospin (Shandon, Cheshire, U.K.) preparations with radiologic and histologic correlation. The appearance seen in Cytospin preparations, however, is slightly different from the direct smear findings described in the literature. The recognition of this discrepancy is important, especially for centers that base the fine needle aspiration cytologic assessment solely on Cytospin preparations. The patient was a 55-year-old, Chinese female who presented with a 3-cm-diameter mass in the upper outer quadrant of the left breast. The lesion was clinically malignant and appeared suspicious on radiologic examination. Ultrasound showed a multilobulated, complex, cystic lesion with foci of echogenicity and acoustic shadowing. No associated dilated duct was seen. Ultrasound-guided fine needle aspiration biopsy was performed by a radiologist using a 21-gauge needle, yielding bloodstained material. Direct smears were not made. Instead, the needle and syringe were rinsed into an equal volume of 50% ethanol and normal saline, which was later centrifuged at a rate of 1,500 rpm for 20 minutes. The sediment obtained was processed as for a routine paraffin cell block. Cytospin preparations were also produced from the supernatant and stained with hematoxylin and eosin or Papanicolaou stain. Wide local excision of the breast mass was subsequently performed after Acta Cytologica