Neuroendocrine Ductal Carcinoma In Situ (NE-DCIS) of the Breast: Cytological Features of 32 Cases
T Kawasaki, G Sakamoto, T Kondo, Y Ishii, T Yuminamochi, T Nakazawa, T Yamane, K Mochizuki, D Niu, D Ma, M Inoue, S Inoue, H Tsunoda-shimizu, S Nakamura, R Katoh. University of Yamanashi, Yamanashi, Japan
Background: Neuroendocrine ductal carcinoma in situ (NE-DCIS) of the breast has characteristic clinical and histological features and has been regarded as a distinct variant of DCIS. However, only a few case reports have described cytological findings of NE-DCIS in fine needle aspiration (FNA) smears. This study aimed to clarify the cytopathological profiles of NE-DCIS in a large series of FNA and nipple discharge smears.
Design: We cytologically analyzed 22 FNA smears and 17 nipple discharge smears obtained from 32 patients with NE-DCIS. All patients were Japanese (31 women and 1 man) with a mean age of 50.8 years. NE-DCIS was diagnosed using surgical specimens according to the histological criterion of >50% of cancer cells immunohistochemically expressing neuroendocrine markers (chromogranin A and/or synaptophysin).
Results: Backgrounds in FNA smears were clear (59%), mucoid (23%), hemorrhagic (14%) or necrotic (5%). Most FNA smears (95%) showed high cellularity. Characteristically, the NE-DCIS cells were loosely arranged in three-dimensional, solid clusters or singly dispersed. Well-developed vascular cores with or without cancer cells were occasionally recognized. Cancer cells were polygonal or spindle-shaped with a fine-granular, abundant cytoplasm. Nuclei with fine-granular chromatin were round or oval and often eccentrically located (plasmacytoid appearance) (Figure). Nuclear grade was estimated to be low in 86% (19/22) of the samples.
Most of the nipple discharge smears had fairly-low cellularity with poorly-preserved cell clusters in markedly hemorrhagic backgrounds, although two (12%) were extremely cellular with cytological characteristics similar to those of the FNA smears. Immunohistochemistry for neuroendocrine markers (chromogranin A and synaptophysin) confirmed the neuroendocrine nature of this tumor in adequate cytological specimens as well as histological specimens.
Conclusions: NE-DCIS of the breast has distinctive cytological features and can, therefore, be diagnosed as a neuroendocrine malignancy by most FNA and some nipple discharge smears.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 68, Wednesday Afternoon