CYTOLOGICAL DIAGNOSIS OF PAGETS-DISEASE OF THE NIPPLE BY SCRAPE SMEARS - A REPORT OF 5 CASES

Five cases of mammary Paget's disease were diagnosed by nipple scrape cytology. The neoplastic material obtained was abundant in two cases, moderate in one, but in two, only a few cell aggregates and single mal ignant cells were obtained. Cell engulfment was a feature in three cas es and this, together with dense tumour cell cytoplasm and the backgro und of keratinous debris, may impart a squamous-like appearance; howev er, three-dimensional cell aggregates, papillary-like groups, acinar-l ike collections, and some cells with vacuolated cytoplasm and eccentri c nuclei allowed glandular differentiation to be inferred in three cas es. In four cases a combination of clinical evaluation, and cytologica l findings of malignant cells compatible with Paget's disease was used so that mastectomy could proceed, and in one case there was frozen se ction confirmation of an underlying invasive carcinoma. In the single case in which it was performed, there was positive immunoperoxidase st aining for c-erb B2 oncoprotein. Demonstration of this protein, CEA, o r mucin, helps distinguish Paget's disease from melanoma or squamous c ell carcinoma in-situ.