Difficulty in the Cytodiagnosis of Mammary Analogue Secretory Carcinoma: Survey of 109 Cytologists with a Case Originating from a Minor Salivary Gland

Abstract

Background: Mammary analogue secretory carcinoma (MASC) of the salivary gland shows morphologic similarities and shares an immunophenotype and characteristic ETV6-NTRK3 translocation with secretory carcinoma of the breast. We present a buccal case of MASC along with a survey-based debate about its cytologic diagnosis by fine-needle aspiration (FNA). Case: FNA of the buccal nodule of a 58-year-old Japanese man was initially performed by 3 cytologists who gave different assessments of the Papanicolaou classification (i.e., class II, III, and V). To investigate the potential for discrepant diagnosis of MASC on a larger scale, we distributed a survey with questions about the cytological diagnosis of the present case to cytologists at other institutions. A total of 109 cytologists completed the survey, providing varying assessments of the Papanicolaou classification: class I/II (14%), class III (53%), and class IV/V (33%). Most of the respondents (72%) could not identify a particular tumor or disease. Even the respondents who identified a particular tumor suggested widely differing diagnoses, from a benign lesion to various malignant tumors. Only 2 respondents correctly identified MASC. Conclusion: Our experience and the results of the survey suggest difficulty in the cytodiagnosis of MASC.

Mammary Analogue Secretory Carcinoma of the Thyroid Mimicking Locally Advanced Papillary Thyroid Carcinoma: A Rare Case Report

“…11 MASC is difficult to diagnose on cytology because of the overlapping features and has previously been reported to mimic PTC, similar to our case, resulting in a misdiagnosis. [11][12][13][14][15] The intracytoplasmic and intraluminal eosinophilic secretions may be a helpful sign in addition to the enlarged vesicular nuclei with prominent nucleoli, which are typically seen in MASC and are not a feature of PTC. An additional finding of abundant granular to vacuolated cytoplasm is also a diagnostic clue of MASC in cytology specimens.…”

Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland

“…They occasionally form cysts filled with white fluid. The cytological diagnosis of secretory carcinoma is difficult [69][70][71][72]. FNA may show cohesive epithelial clusters, sheets, papillary groups and/or dispersed cells with background colloid-like cystic debris.…”

“…15) [76][77][78][79][80]. AcCC-PCV may undergo metaplastic oncocytic or squamoid changes [72]. Some macrocysts may even contain scant mucin [2].…”

Secretory Carcinoma: A Silent Mass Increasing in the Parotid Gland

“…Although fine-needle aspiration may be performed during ultrasound evaluation, the cytology diagnosis for SC is poor. According to Kai et al, only 2 of 109 cytologists identified SC [11]. Immunohistochemistry and FISH studies using pathologic specimen can yield a definite diagnosis.…”