the characteristic features are pronounced intracellular and intramicrocystic periodic acid schiff ( pas ) positive secretions .
as this carcinoma usually occurs in children and young adults , it was originally referred to as a type of juvenile carcinoma .
slow growth and delayed recurrence are characteristic of many of these tumors . prolonged follow - up is needed to assess accurately the biological behavior of this tumor .
a female aged 62 years presented with painful swelling in the right breast since two years , which was gradually increasing in size since six months . clinical examination revealed a hard mobile lump measuring about 5  4 cm in the upper outer quadrant of the right breast .
fine needle aspiration smears revealed loose clusters and isolated population of tumor cells showing abundant finely granular and vacuolated cytoplasm [ figure 1 ] .
the tumor cells had eccentrically placed nuclei with mild pleomorphism and inconspicuous nucleoli [ figure 1 ] . there was no colloid material in the background and no evidence of mitotic activity in the tumor cells . a possibility of secretory carcinoma of the breast was suggested .
tumor cells showing vacuolated and abundant granular eosinophilic cytoplasm ( h and e ) . left upper : tumor cells showing eccentrically placed nuclei ( h and e ) the patient underwent modified radical mastectomy and the specimen was sent to pathology department for histopathological examination . cut section of the specimen revealed circumscribed firm grey - white lesion with tiny cystic areas measuring 5  3  2.5 cm in size [ figure 2 ] .
gray white tumor with pushing borders and with tiny cystic spaces filled with gray brown material on microscopic examination , the sections revealed tumor cells arranged in solid sheets , ducts , tubular and microcystic pattern [ figure 3 ] .
the tumor cells showed carcinoembryonic antigen ( cea ) positivity on immunohistochemistry [ figure 3 ] .
secretory carcinoma is a rare form of breast carcinoma seen primarily in children , but it can also occur in adults .
these lesions appear to have an excellent prognosis in women under the age of 20 years .
fine needle aspiration smears tend to be poorly cellular , but show abundant material in the background resembling thyroid colloid .
this material does not show streaming around embedded epithelial cells as does mucin in a colloid carcinoma .
fine needle aspiration cytology ( fnac ) smears stained with may - grnwald - giemsa ( mgg ) were highly cellular with a monotonous population of dissociated and clustered tumor cells that show a bland cytological appearance with cytoplasmic vacuolation .
the cytological features of secretory carcinoma of the breast resembles that of benign epithelial proliferating lesions , particularly lactational changes or lactating adenoma , which may lead to the misdiagnosis of the lesion on fnac .
important diagnostic clues suggesting malignancy are high cellularity of the fna cytologic material and absence of bipolar naked nuclei , which are present in the lactating adenoma . grossly , it is usually well circumscribed , less than 6 cm in diameter .
the margins are  pushing type  and prominent hyalinization is often present in the central portion .
tubuloalveolar and focally papillary formations lined by cells with a vacuolated cytoplasm are seen forming lumina filled by eosinophilic pas positive secretions .
immunohistochemically , there is strong positivity for   lactalbumin , s-100 , cea , lysozyme salivary type amylase and variable positivity for gcdfp 15 .
the differential diagnosis of secretory carcinoma of the breast are histiocytoid carcinoma , mucinous carcinoma , signet ring cell carcinoma , lipid - rich carcinoma , apocrine carcinoma , glycogen - rich , clear cell carcinoma . in histiocytoid carcinoma ,
mucinous carcinoma is characterized by pools of extracellular mucin with tumor cells floating in mucin .
the secretory carcinoma can be distinguished from mucinous carcinoma because of the granular background metachromasia that differs markedly from the  sea of mucin appearance seen in mucinous carcinoma .
the background mucus will be less in secretory carcinoma than in mucinous carcinoma , attributing this to the fact that secretory carcinoma retains some intracellular mucins where as the mucinous carcinoma shows predominantly extracellular mucin .
signet ring cell carcinoma is often associated with classic lobular carcinoma pattern and has no predilection for young patients .
smears in signet ring cell carcinoma are cellular containing poorly cohesive large malignant cells with marked anisonucleosis and hyperchromatism .
the tumor cells in lipid - rich carcinoma show scant pas positivity and stain positive for fat stains . however , secretory carcinoma is negative for fat stains .
the tumor cells in apocrine carcinoma have large vesicular nuclei with prominent nucleoli and show granular cytoplasmic staining for pas . in glycogen - rich
secretory carcinomas are distinguished from infiltrating ductal carcinomas not otherwise specified ( idc nos ) of the breast by the characteristic cytomorphology of the tumor cells which show more pleomorphism , hyperchromatic nuclei and a high nucleocytoplasmic ( n : c ) ratio .
the presence of etv6-ntrk3 fusion gene seems to make these particular neoplasms behave more indolent than their aggressive ductal carcinoma counterparts , which do not harbor the etv6-ntrk3 gene fusion .
tavassoli and norris suggested three features of secretory carcinoma that indicate a favorable prognosis , namely , tumor size less than 2 cm , age of less than 20 years at diagnosis and tumor with circumscribed margin .
case reports of local recurrence following local excision suggest that local excision alone may not be adequate and have advocated mastectomy .
lymph nodal metastasis develops late in the course of disease and is observed in approximately 20 - 30 % of the cases .
it is very important to differentiate this lesion cytologically from other benign lesions particularly lactating adenoma .
 secretory carcinoma is a rare form of breast carcinoma which has a predilection for juveniles and young adults ( usually less than 30 years of age ) , becoming progressively less common with advancing age . 
 it is a low grade breast carcinoma which shows distinct features at histology . 
 diagnosis of this carcinoma on fine needle aspiration cytology ( fnac ) is difficult . 
 we report a case of a 62-year - old woman diagnosed to have secretory carcinoma of breast on fnac . 
 histopathological examination confirmed the diagnosis . 
 the recognition of secretory carcinoma is important because the cytological findings can be confused with those of lactating breast . 
 preoperative diagnosis is essential for appropriate surgical therapy . 
 secretory carcinoma is reported to have good prognosis , but surgical therapy with an axillary node dissection is recommended , since axillary metastases have been found in approximately 30% of the recorded cases . 
Introduction
Case Report
Discussion
Conclusion