expectedly , therefore , secretions are observed in some lesions of the breast , including carcinomas , which may show intracellular or extracellular secretions . mucinous and secretory carcinomas of the breast are uncommon compared to the idc and lobular variants , but need to be recognized because of their better prognosis and low rate of lymph - node metastasis . the objective of this study was to a ) identify the range of lesions that yielded intracellular and extracellular secretions and b ) attempt to distinguish lesions with secretions by evaluating quantity and location of secretions in relation to morphology of the malignant cells on fine - needle aspiration cytology ( fnac ) . in this retrospective study , cytology smears from 160 patients with diagnoses of carcinoma of the breast over a 2-year period were reviewed . both may - grnwald - giemsa ( mgg ) and papanicolaou stained smears were available . cases with intracellular and/or extracellular secretion were subclassified into idc , mucinous carcinoma , and secretory carcinoma by the existing criteria.[13 ] cellularity , location and extent of secretion , and nuclear grade ( nuclear size , nucleoli , chromatin pattern and nuclear membrane)were documented . the amount of intracellular and/or extracellular secretion was quantified as minimal ( less than 10% ) , moderate ( up to 50% ) , or extensive ( more than 50% ) of the material present on each slide . presence and absence of necrosis was also noted . all 160 patients were females , with age ranging from 25 to 61 years ( median 49 years ) . secretions were seen in 16 tumors of three tumor types : idc ( 11 ) , mucinous carcinoma ( 3 ) , and secretory carcinoma ( 2 ) . predominantly dispersed cells of nuclear grade 2 and 3 were also present in this group . secretions were minimal and intracellular in the majority ( 10/11 ) [ figure 1 ] . two patients had extracellular secretions : in one patient , these were minimal and associated with intracellular secretions and in the other , only extracellular secretions in moderate quantity were present [ table 1 ] . both these cases were identified as idc because of their nuclear grade and presence of cell clusters that had irregular margins [ figure 2 ] . idc : minimal intracellular secretions ( mgg , 400 ) comparative cytomorphology of invasive ductal , mucinous and secretory carcinomas of the breast idc : extracellular secretions and cell clusters with irregular margins ( mgg , 200 ) mucinous carcinomas had abundant , mucoid aspirates . small cell clusters with rounded contours [ figure 3 ] , single cells , signet cells , and thin - walled  chicken - wire mucinous carcinoma : extracellular secretion with floating , rounded contoured cell fragments ( mgg , 100 ) secretory carcinoma had abundant , cellular aspirates of nuclear grade 1 . signet cells and minimal extracellular mucoid material associated with grape - like mucous globular structures were also present . secretory carcinoma : single and small clusters strung on a capillary ( mgg , 100 ) mucinous and secretory carcinomas of the breast are uncommon and indolent tumors.[710 ] a conservative surgical approach for treatment is advocated because of their better prognosis . , we quantified the secretions in aspirates from breast carcinomas on a 3-point scale as minimal , moderate and extensive . as noted by others , while these were extracellular in mucinous carcinomas , secretory carcinomas were characterized by predominantly intracellular secretions . thus , quantifying the secretions and characterizing their location appears to be useful in separating these two lesions . mucinous carcinoma is characterized by poorly cellular , abundant mucoid aspirate , extensive extracellular secretion , thin - walled vessels and few single and small clusters of cells floating in the secretions.[121114 ] we observed that the cell clusters comprised uniform cells with rounded contours reminiscent of those seen in tissue sections . conversely , idc with extracellular secretions , often mistaken for mucinous carcinoma , showed at least some cell clusters with irregular margins as in conventional idc . besides , the secretions in idc were minimal to moderate compared to extensive in mucinous carcinoma . high nuclear grade in idc with extracellular mucin has been used to differentiate mixed idc and mucinous carcinoma . we propose that a careful search for the characteristic irregular margins of cell clusters is necessary and should be used as an additional distinguishing feature of idc . mucocoele - like tumors need to be distinguished from mucinous carcinoma ; however , being benign lesions , these are outside the scope of this study . in the literature , they are described as being characterized by an abundance of mucin and poor cellularity ; the cells are present as monolayered sheets of epithelial cells . intracellular secretions have been described in secretory carcinoma,[31517 ] lobular carcinoma and some idc . though the morphological features on histopathology suggest that the secretions in secretory carcinoma are extensive in both extracellular and intracellular locations , in cytopathology smears there are predominantly intracellular secretions with minimal mucoid material in proximity to epithelial cells , and mucous globular structures . as visualized by transmission electron microscopy , the secretions are intracellular , within intracytoplasmic lumens , or present in extracellular lumens which are several times larger than the intracellular lumens . the latter are probably the mucous globular structures seen in cytology smears . in both our patients with secretory carcinoma , we observed small cellular clusters and single cells appearing to be strung on capillaries , probably caused by disintegration of papillary structures while smearing . poor cellular yield , small hyperchromatic nuclei and nuclear molding have been described to characterize lobular carcinoma . in contrast , idc are cellular , with high nuclear grade ( nuclear enlargement and pleomorphism ) , and distinct cytoplasm . however , necrosis was encountered in four cases of high - grade ductal carcinomas with secretions . these observations are not unexpected as mucinous and secretory carcinomas are low - grade tumors . to conclude , secretions are seen in a range of breast cancer that includes invasive ductal carcinoma , mucinous carcinoma and secretory carcinoma . evaluation of the quantity and location of secretions and the contours of the cell clusters complement cell morphology , and could improve diagnostic cytopathological criteria . small cellular clusters and single cells appearing to be strung on capillaries should be considered additional distinguishing features of secretory carcinoma .
background : secretions are seen in a range of breast cancer that includes invasive ductal carcinoma , mucinous carcinoma and secretory carcinoma . 
 evaluation of the quantity and location of secretions and the contours of the cell clusters complement cell morphology could improve diagnostic cytopathological criteria.aim:to identify the range of breast carcinomas with secretions on fine - needle aspiration.materials and methods : a retrospective study of 160 patients with breast carcinoma was carried out . 
 the tumors were typed by evaluating the quantity and location of secretions , cellularity and nuclear grade.results:secretions were seen in 16 of 160 breast carcinomas . 
 eleven were invasive ductal carcinoma ( idc ) , three were mucinous and two were secretory carcinomas . in idc , minimal intracytoplasmic secretions were seen in 10 , nuclear grades of 2 and 3 in 9 , cell clusters with irregular margins in 6 , and necrosis in 4 . 
 all mucinous and secretory carcinomas were nuclear grade 1 . 
 extensive extracellular secretions and cell clusters with rounded contours were seen in mucinous carcinomas . in secretory carcinomas , 
 the secretions were predominantly intracellular ; stringy vasculature was a unique feature.conclusion:secretions in breast cancer are seen in a range of lesions that include idc , mucinous , and secretory carcinomas . the quantity and location of secretions in breast cancer offer clues to differentiating these .