title: Extracellular hyaline material in association with other cytologic features in aspirates from collagenous spherulosis and adenoid cystic carcinoma of the breast.
abstract: OBJECTIVE
  To reevaluate breast aspirates showing extracellular hyaline material (EHM) and globules to assess if clinicoradiologic and cytologic features could help in differentiating between benign and malignant lesions, especially collagenous spherulosis (CS) and adenoid cystic carcinoma (ACC).
  
  
  METHODS
  Fine needle aspiration was performed on 884 patients with breast lumps. The cytomorphologic features of 6 cases showing EHM, including classic hyaline globules (HGs), were analyzed in detail. Three cases also had hemorrhagic nipple discharge. Tissue diagnosis (4) and mammography (6) were available.
  
  
  RESULTS
  Aspirate smears revealed high cellularity composed of monolayers: clusters of uniform, small cells; EHM; and HGs surrounded by similar cells. Benign naked nuclei and stromal fragments (4), nuclear pleomorphism (3), apocrine cells (2), foam cells (2), naked HGs (2) and spindle cells in proximity to HGs were also seen (4). Nipple discharge smears showed foam cells, erythrocytes (3) and epithelial cell clusters with hyaline material (1). The cytologic diagnosis was CS (4) and ACC (2). Histopathology confirmed the diagnosis of CS (2) and ACC (1).
  
  
  CONCLUSIONS
  There may be a morphologic overlap between the cytomorphologic features of CS and ACC, leading to diagnostic errors. The presence of EHM and HGs in association with bland cellular features should be interpreted with caution to avoid erroneous diagnoses. Histopathology is mandatory in these cases because of their different prognostic implications.
authors.affiliation: Department of Pathology, Maulana Azad Medical College. jainshyama@rediffmail.com
authors.forename: Shyama
authors.initials: S
authors.lastname: Jain
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Neeta
authors.initials: N
authors.lastname: Kumar
authors.forename: Pushpa
authors.initials: P
authors.lastname: Sodhani
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D001940:Breast / Q000378:metabolism* / Q000473:pathology; D001941:Breast Diseases / Q000378:metabolism / Q000473:pathology; D001943:Breast Neoplasms / Q000378:metabolism* / Q000473:pathology; D003528:Carcinoma, Adenoid Cystic / Q000378:metabolism* / Q000473:pathology; D003094:Collagen / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006818:Hyalin / Q000378:metabolism*; D008875:Middle Aged
chemical_list: D003094:Collagen