Cell cannibalism and nucleus-fragmented cells in voided urine: useful parameters for cytologic diagnosis of low-grade urothelial carcinoma

OBJECTIVE: To clarify whether the 3 parameters of cell clusters, cell cannibalism and nucleus-fragmented cells could improve diagnostic accuracy for grade 1 urothelial carcinoma (G1UC). STUDY DESIGN: A total of 52 voided urine samples from 31 patients histologically diagnosed as having G1UC were reviewed. In addition, 10 voided urine samples from cases with grade 3 demonstration urothelial carcinoma (G3UC) and 30 voided urine samples from 25 patients with a histologic diagnosis of chronic inflammation of the bladder were evaluated for comparison. Areas of tumor cells with cannibalism were measured. RESULTS: Cell cannibalism was evident in 12 of 31 G1UC cases (38.7%), significantly less often than with G3UC, but never identified in the control group. Mean areas of tumor cells featuring cannibalism were significantly smaller in G1 UC than in G3UC cases. Nucleus-fragmented cells were also less frequent in G1UC than in G3UC, but more common than in the control group. CONCLUSION: Cell cannibalism and nucleus-fragmented cells in voided urine with special attention to areas of tumor cell with cannibalism could be applied as a parameter to improve diagnostic accuracy for G1UC.     

Can cytological features differentiate reactive renal tubular cells from low‐grade urothelial carcinoma cells?

H. Ohsaki, E. Hirakawa, Y. Kushida, S. Yokoshita, M. Nakamura, H. Kiyomoto and R. Haba Can cytological features differentiate reactive renal tubular cells from low‐grade urothelial carcinoma cells? Objective: To compare the cytomorphological and immunocytochemical features of reactive renal tubular cells and low‐grade urothelial carcinoma cells (LG‐UCs). Methods: We examined 15 cytological parameters in 38 cases with reactive renal tubular cells in renal disease and 20 cases of LG‐UCs from bladder cancer that had been diagnosed by histological examination. Voided urine cytological parameters evaluated were as follows: (i) maximum cell numbers of clusters, (ii) cannibalism, (iii) rosette‐like arrangement, (iv) hobnail‐shaped cells, (v) vacuolated cytoplasm, (vi) intracytoplasmic haemosiderin, (vii) irregular nuclear contours, (viii) chromatin pattern, (ix) prominent nucleoli, (x) cast encasement, (xi) casts, (xii) dysmorphic erythrocytes, (xiii) isomorphic erythrocytes, (xiv) necrosis, and (xv) vimentin reactivity. The above parameters were determined using Mann–Whitney U‐test and chi‐square test, with differences considered significant at P < 0.05. Results: In reactive renal tubular cells, low to moderate cell numbers of clusters (fewer than 50 cells), rosette‐like arrangement, hobnail‐shaped cells, vacuolated cytoplasm, intracytoplasmic haemosiderin, euchromatin pattern, prominent nucleoli, dysmorphic erythrocytes and vimentin reactivity were present in significantly higher proportions compared with those in LG‐UCs. In LG‐UCs, high cell numbers of clusters (50 cells or more), cannibalism, heterochromatin pattern, isomorphic erythrocytes and necrosis were seen in significantly higher proportions. No significant differences were observed in irregular nuclear contours, cast encasement or casts. Conclusions: Based on results of the present study, maximum cell numbers of clusters, cannibalism, rosette‐like arrangement, hobnail‐shaped cells, vacuolated cytoplasm, intracytoplasmic haemosiderin, chromatin pattern, prominent nucleoli, dysmorphic erythrocytes, isomorphic erythrocytes, necrosis, and vimentin reactivity were capable of distinguishing reactive renal tubular cells from LG‐UCs.     

Expression of vimentin and high‐molecular‐weight cytokeratin (clone 34ßE12) in differentiating reactive renal tubular cells from low‐grade urothelial carcinoma cells in voided urine

H. Ohsaki, E. Hirakawa, M. Nakamura, Y. Norimatsu, H. Kiyomoto and R. Haba Expression of vimentin and high‐molecular‐weight cytokeratin (clone 34ßE12) in differentiating reactive renal tubular cells from low‐grade urothelial carcinoma cells in voided urine Objective: Reactive renal tubular cells show features of an atypical repair reaction. Differentiation between reactive renal tubular cells and low‐grade urothelial carcinoma (LG‐UC) cells can therefore be a diagnostic challenge based on morphology alone. In this study, we evaluated the diagnostic utility of vimentin and a high‐molecular‐weight cytokeratin antibody (clone 34ßE12) in differentiating reactive renal tubular cells from LG‐UC. Methods: We evaluated voided urine cytology and surgical specimens from 40 patients with renal disease, and 17 patients with LG‐UC. All slides were stained with vimentin and 34ßE12. Results: In the reactive renal tubular cells in voided urine cytology, vimentin showed strong cytoplasmic staining in 39/40 (97.5%) cases, but all were negative for 34ßE12. LG‐UC cells showed positive staining for 34ßE12 in 3/17 (17.6%) cases, whereas none were positivity for vimentin. The reactive renal tubular cells of histological specimens in the renal disease group demonstrated positive for vimentin in all 40 cases and all were negative for 34ßE12. The LG‐UC group showed abnormal staining for 34ßE12 in 4/17 (23.5%) cases, whereas none were positive for vimentin. Conclusions: Vimentin expression in urine cytology can help to distinguish reactive renal tubular cells from LG‐UC. However, 34ßE12 does not appear to be a useful adjunct to distinguish these two groups in voided urine cytology.     

Genetic polymorphisms of glutathione S-transferases are associated with ulcerative colitis in central China

The present study aimed to investigate the association between genetic polymorphisms of glutathione S-transferases (GSTs) and susceptibility to ulcerative colitis (UC) in central China. The prevalence of GSTM1, GSTT1, and GSTP1 gene polymorphisms were examined using polymerase chain reaction methods in 270 consecutive UC patients and 623 age- and sex-matched healthy controls. The frequencies of the GSTM1(null) and GSTT1(null) as well as GSTP1 (Val/Val) genotypes were significantly higher in UC patients than in the controls (70.74% vs. 41.74%, P = 0.0001; 64.82% vs. 47.19%, P = 0.0001; and 48.89% vs. 34.35%, P = 0.0004, respectively). When the UC patients were stratified according to clinical features, we found that the frequencies of the GSTT1(null) and GSTP1 (Val/Val) genotypes but not the GSTM1(null) genotype were significantly higher in patients with distal colitis than in extensive colitis (P = 0.0007, P = 0.001, and P = 0.271, respectively). However, these variant GST genotypes were not significantly linked to severity of the disease (P > 0.05). GST variant genotypes are strongly correlated with prevalence and extent but not with severity of UC in the Hubei Han population in central China.     

Value of computer‐assisted quantitative nuclear morphometry for differentiation of reactive renal tubular cells from low‐grade urothelial carcinoma

H. Ohsaki, E. Hirakawa, K. Kagawa, M. Nakamura, H. Kiyomoto and R. Haba Value of computer‐assisted quantitative nuclear morphometry for differentiation of reactive renal tubular cells from low‐grade urothelial carcinoma Objective: To assess whether computer‐assisted quantitative morphological parameters can be an effective tool for objectively distinguishing reactive renal tubular cells from low‐grade urothelial carcinoma cells (LG‐UCs) in voided urine. Methods: Nuclear morphometry was performed by a computer‐assisted image analyser system on Papanicolaou‐stained cytological specimens. The circumference of reactive renal tubular cells (n = 40) or LG‐UC (n = 20) nuclei were manually traced, and the following nuclear morphometric parameters were analysed: (i) area, (ii) perimeter, (iii) roundness factor, (iv) maximum length, and (v) linear factor. For each nuclear measurement, we calculated the maximum, minimum, mean and standard deviation. Results: The mean nuclear area and nuclear perimeter were higher in reactive renal tubular cells compared to the LG‐UCs. The mean of roundness and linear factors (reflecting a tendency for the nuclear outline to be regular and oval, respectively) were higher in LG‐UCs compared with reactive renal tubular cells. Among nuclear areas, the nuclear perimeter, roundness factors and maximum length did not show any significant differences between reactive renal tubular cells and LG‐UCs. On the other hand, the linear factor showed a mean higher value among LG‐UCs than reactive renal tubular cells (P = 0.023). Conclusions: Of five quantitative nuclear morphological parameters, only linear factor was statistically significant in differentiating reactive renal tubular cells in renal disease from LG‐UCs.     

Kidney concentrating ability of a subterranean xeric rodent,the naked mole-rat (Heterocephalus glaber)

The naked mole-rat (Heterocephalus glaber) is a strictly subterranean mammal inhabiting the arid zones of north-east Africa. These animals have no access to free water and water balance thus might be facilitated by regulating renal water loss. The urinary concentrating ability of the naked mole-rat was determined using five dietary manipulations in which both water and salt content were altered. Control animals (n=7) received a high quality protein cereal mixed to a thin paste with water (1 g cereal: 85 g water). Water stress was induced by reducing the water content of the diet by either 50% (n=7) or 65% (n=7). Salt loading was facilitated by replacing the water with the same volume of either 0.9% salt (n=7) or 3.0% salt (n=4) solutions. Changes in body mass, food consumption and urine volume were measured daily. The effect of diet on osmolality and electrolyte concentrations of urine and plasma were determined on termination of the diet trials. Although energy intake was not reduced, naked mole-rats lost body weight with both water stress treatments. Urine volume voided per day decreased significantly with both water stress treatments (P<0.05), such that the most extreme water stress led to an 80% reduction in urine volume. Mildly salt-loaded animals gained weight, yet underwent a sodium diuresis, as indicated by a 1.3-fold increase in the daily volume of urine voided (P<0.05). Maximum urine concentration (1521±250 mmol·kg^-1) was achieved with mild water stress and was 4.6±0.9 times that of plasma. Neither further water stress nor salt loading further increased urine osmolality (P>0.05). The naked mole-rat exhibits a moderate kidney concentrating ability and cannot maintain plasma osmolality or body mass with either extreme water stress or salt loading. Although this species succesfully inhabits arid zones, survival in these areas is not facilitated by renal water conservation, but rather by their underground existence in a microhabitat where humidities are high and radiant heat loads low. In this milieu a moderate kidney concentrating ability is adequate.Abbreviations Bm body mass - ESL extreme salt load - EWS extreme water stress - MSL mild salt load - MWS mild water stress     

Life history responses depend on timing of cannibalism in a damselfly

1. Cannibalism has often been suggested as an important mechanism to reach the necessary developmental stage and size before a critical time horizon is reached, but this role has been largely unexplored. We studied effects of cannibalism on the life history of the damselfly Lestes viridis under combinations of a time constraint (by manipulating the perceived time available in the growth season) and a biotic constraint (density). 2. Larvae had a faster development and growth rate when reared at high time stress (late photoperiod). They also had a higher growth rate and mass at emergence when cannibalism occurred (density 2 and 4). Cannibalism occurred earlier at higher density. Accelerated life history responses (faster development and growth rate) and a higher mass at emergence were dependent upon the timing of cannibalism. Responses were more pronounced or only present if cannibalism occurred early in the larval period. 3. Our data suggest that cannibalism may not only act as a lifeboat mechanism by enabling cannibals to survive detrimental ecological conditions, but may also act as a compensatory mechanism to keep life history variables near‐optimal at life history transitions, even under sub‐optimal conditions.     

The strange occurrence of male cannibalism on adult females in snakes

Cannibalism is widespread in the animal kingdom. The most common, well-known cases are found in some arthropod systems where the larger females occasionally consume the smaller males before, during, or after mating (i.e., sexual cannibalism). The killing and consumption of females by males are, on the other hand, seemingly much rarer and theoretically more difficult to explain, at least among adults, because the consumption of females would result in the loss of potential mates for males. Here, we use observations submitted to a community science reporting system to describe three instances of adult males feeding on adult females in the Montpellier snake, Malpolon monspessulanus, in the south of France. We discuss our observations in the theoretical framework of cannibalism to provide potential explanations for these observations and briefly review empirical findings of cannibalism in vertebrates, which confirms that this sex-reversed form of sexual cannibalism is rare in nature.     

Nymphal cannibalism in relation to oviposition behavior of adults in the assassin bug,Agriosphodrus dohrni signoret

Summary Nymphal cannibalism was studied over a five year period in a natural population of the assassin bug,Agriosphodrus dohrni Signoret. Cannibalism among instar I nymphs was potentially an effective agent to cause rapid decline of the newborn population in contrast to the rarity of cannibalism in other instars. The high incidence of cannibalism among newborn was associated with concentrated oviposition on the same site by two or more females. The rate of the duplicate oviposition was high at hollows on tree trunk where early mortality of nymphs in the absence of cannibalism was significantly low in comparison with other types of sites. However, analyses of oviposition showed that more than half of the overlapping ovipositions took place on the same day and that insuch a situation 95% of the lately deposited egg masses escaped cannibalism suggesting existence of avoiding mechanism of cannibalism in adult females under circumtances of ovipositional site limitation.     

Cannibalistic behaviour of the vulnerable and endemic Baetica ustulata (Rambur 1838) (Orthoptera: Tettigoniidae: Ephippigerinae): first report

Little is known about the biology of the vulnerable and endemic Orthoptera Baetica ustulata. Here, we describe for the first time a case of cannibalism in this species. Cannibalism across Orthoptera is well documented and is mainly associated with swarming behaviour, which is absent in B. ustulata. Given that Ephippigerinae produce the largest spermatophylax across tettigonids, cannibalism in this katydid may represent a major resource of specific nutrients for producing an optimal nuptial gift in its difficult and hostile habitat.     

Über den Kannibalismus bei Larven der Baumwollblatteule

On cannibalism of the larvae of the cotton leafworm Spodoptera littoralis (Boisd.) . Some ecological studies on the larvae of the cotton leafworm Spodoptera littoralis (Boisd.) were carried out in the laboratory to prove the appearance of cannibalism under different conditions of temperature, relative humidity, population density as well as abstraction of food, and furthermore the effect of food and food quantity. Results obtained showed, that when food was sufficiently provided the different instars did not show any cannibalistic habit. Cannibalism only appeared in case of insufficient quantity of food and reached its maximum at total withdrawal of food. The cannibalism rate was different for the various instars, the fourth stage showed the highest rate. During moulting time the rate was very low. The cannibalism rate was higher at 35° C than at lower temperatures and at lower relative humidity (30–40%) higher than at higher relative humidity (70–80%). In a limited space under withdrawal of food the rate was higher with greater initial numbers of larvae than with lower initial numbers. This rate was also higher for the cultures of mixed larvae instars than for the cultures of unmixed larvae instars. Records after 72 hours showed that only the eldest instars of larvae survived. The cannibalism rate increased with the length of the fasting period.     

Sibling Cannibalism of Young Red Drum, Sciaenops ocellatus, in Relation to Size Disparity and Metabolic Rates

Cannibalism is a leading cause of young mortality in the red drum, Sciaenops ocellatus, culture, and size disparity is its primary causative factor. Cannibalism did not occur in young fish, graded by a difference of 0.5cm from 2.0 to 4.5cm in total length. There was a shift in the size distribution from unimodal (normal) when there was no cannibalism, to bimodal or trimodal when cannibalism occurred. The results suggested that the wider was the size disparity, the greater was the sibling cannibalism. Size disparity increased with growth and in turn with sibling cannibalism, which became insignificant when the young grew to a size of about 6cm. We present threshold levels of size disparity among siblings to prevent mutual cannibalism. We hypothesize that through sibling cannibalism a hierarchy may evolve in a red drum cohort, at which a stable population will form.     

Modulation of gut mucosal microbiota as a mechanism of probiotics-based adjunctive therapy for ulcerative colitis

This was a pilot study aiming to evaluate the effects of probiotics as adjunctive treatment for ulcerative colitis (UC). Twenty-five active patients with UC were assigned to the probiotic (n = 12) and placebo (n = 13) groups. The probiotic group received mesalazine (60 mg kg⁻¹ day⁻¹) and oral probiotics (containing Lactobacillus casei Zhang, Lactobacillus plantarum P-8 and Bifidobacterium animalis subsp. lactis V9) twice daily for 12 weeks, while the placebo group received the same amounts of mesalazine and placebo. The clinical outcomes were assessed. The gut mucosal microbiota was profiled by PacBio single-molecule, real-time (SMRT) sequencing of the full-length 16S rRNA of biopsy samples obtained by colonoscopy. A significantly greater magnitude of reduction was observed in the UC disease activity index (UCDAI) in the probiotic group compared with the placebo group (P = 0.043), accompanying by a higher remission rate (91.67% for probiotic-receivers versus 69.23% for placebo-receivers, P = 0.034). The probiotics could protect from diminishing of the microbiota diversity and richness. Moreover, the gut mucosal microbiota of the probiotic-receivers had significantly more beneficial bacteria like Eubacterium ramulus (P < 0.05), Pediococcus pentosaceus (P < 0.05), Bacteroides fragilis (P = 0.02) and Weissella cibaria (P = 0.04). Additionally, the relative abundances of the beneficial bacteria correlated significantly but negatively with the UCDAI score, suggesting that the probiotics might alleviate UC symptoms by modulating the gut mucosal microbiota. Our research has provided new insights into the mechanism of symptom alleviation in UC by applying probiotic-based adjunctive treatment.     

THE GENETICS AND EVOLUTION OF CANNIBALISM IN FLOUR BEETLES (GENUS TRIBOLIUM)

Cannibalism plays a major role in population regulation in Tribolium confusum, accounting for up to tenfold differences in population size between different genetic strains. I characterized the within- and between-strain genetic variation for cannibalism using standard quantitative-genetic methods. The four laboratory strains studied have similar birth and death rates but differ in their strain-specific cannibalistic tendencies. The cannibalism rates of the strains were stable for more than 60 generations of laboratory husbandry. I found considerable genetic variation for cannibalism within each strain. A genetic analysis of the between-strain differences in each of three types of cannibalism (larvae eating eggs, adults eating eggs, and adults eating pupae) showed that all three cannibalism pathways are autosomally inherited and exhibit minor degrees of dominance. Adult cannibalism of eggs and larval cannibalism of eggs appear to be genetically correlated. The differences between the “high” and “low” cannibalism strains appear to be polygenic for two kinds of cannibalism, larvae eating eggs and adults eating pupae. However, strain differences in adult cannibalism of eggs may be due to only two loci. The stability of the between-strain differences for more than 60 generations, the additive nature of inheritance, and the demonstration of considerable within-strain genetic variation suggest that cannibalism may be selectively neutral or under stabilizing selection with many adaptive peaks.     

Time courses of changes of para-, meta-, and ortho-tyrosine in septic patients: A pilot study

Objectives: Sepsis is associated with oxidative stress. Due to oxidative stress, three tyrosine isoforms, para-, meta-, and ortho-tyrosine (p-, m-, and o-Tyr), can be formed non-enzymatically in smaller amounts. p-Tyr is mainly formed physiologically in the kidneys through the activity of the phenylalanine hydroxylase enzyme. The three tyrosine isoforms may undergo different renal handling.

Methods: Twenty septic patients were involved in the study and 25 healthy individuals served as controls. Blood and urine levels of p-, m-, and o-Tyr were measured on admission and four consecutive days.

Results: Serum m-Tyr levels were higher in septic patients than in controls on days 2 (P = 0.031) and 3 (P = 0.035). Serum p-Tyr levels were lower in the cases than in controls on days 1 (P = 0.005) and 2 (P = 0.040), and subsequently normalized due to a day-by-day elevation (P = 0.002). The tendency of urinary m-Tyr concentration was decreasing (P = 0.041), while that of urinary p-Tyr concentration was increasing (P = 0.001). Fractional excretion of m-Tyr (FE_m-Tyr) showed a decreasing tendency (P = 0.009), and was, on all days, higher than FE_p-Tyr, which remained near-normal, less than 4%. Procalcitonin showed significant correlation with FE_m-Tyr (r = 0.454; P < 0.001).

Discussion: Our data suggest that the oxidative stress marker m-Tyr and physiologic p-Tyr may be handled differently in septic patients. The excretion of m-Tyr correlates with inflammation. m-Tyr may be actively secreted or produced in the kidney in some patients, whereas the decreased serum level of p-Tyr is a consequence of diminished renal production and not of renal loss.     

Cannibalism of parasitoid‐attacked conspecifics in a non‐carnivorous caterpillar

Cannibalism, the killing and consumption of conspecifics, can even occur in insect species typically considered to be non‐carnivorous. Of particular interest is the cannibalism of parasitoid‐attacked conspecifics, which could reduce parasitism levels in subsequent generations for that conspecific population. This study reports on the occurrence and some of the consequences of cannibalism in parasitoid‐attacked obliquebanded leafroller, Choristoneura rosaceana (Harris) (Lepidoptera: Tortricidae). We show that larvae of C. rosaceana, which is considered to be an herbivorous caterpillar species, did not prey upon live conspecifics, but readily consumed conspecifics attacked by Habrobracon gelechiae Ashmead (Hymenoptera: Braconidae). Further examination found that C. rosaceana larvae feeding on parasitoid‐attacked conspecifics, since their fourth instar, suffered a higher mortality and reduction in body size than those fed on plant material only. The cannibalism of attacked conspecifics did not appear to offer any nutrient benefits for the cannibal. To our best knowledge, this is the first empirical example of the occurrence and some of the consequences of cannibalism by a non‐carnivorous insect on its parasitoid‐attacked conspecifics. We discuss the adaptive significance of such cannibalism on parasitoid‐attacked conspecifics with respect to a trans‐generational fitness gain for the population through the killing of the parasitoids, thereby reducing parasitism in subsequent generations.     

Sibling and non-sibling cannibalism by larvae of a lady beetleHarmonia axyridis Pallas (Coleoptera: Coccinellidae) in the field

Sibling (cannibalism among siblings) and non-sibling cannibalism (cannibalism among non-siblings) were studied in a natural population of a lady beetle, Harmonia axyridisPallas . Of all the eggs laid (n=2269), 24.76% (n=562) were killed by sibling cannibalism and 36.10% (n=819) were killed by non-sibling cannibalism. Sibling cannibalism occurred constantly and intensively in most egg batches throughout the entire oviposition period. On the other hand, non-sibling cannibalism was more intense in the middle and late oviposition periods, and when the egg batches were close to an aphid colony. This may be due to the high density of H. axyridis larvae relative to aphid density in the middle and late oviposition periods and also the larvae searching intensively near an aphid colony.     

Filial cannibalism in the Chestnut-backed Sparrow-lark Eremopterix leucotis

Cannibalism is a rare event in passerines, especially filial cannibalism. Here I report on two instances of filial cannibalism observed in the Chestnut-backed Sparrow-lark Eremopterix leucotis in the Limpopo province, South Africa. In both instances it was only the females that engaged in filial cannibalism. It is suggested that a dead nestling is viewed as a waste product that must be moved from the nest as part of nest sanitation, either by carrying it from the nest or by consuming it. These events represent not only the first record of cannibalism in the Alaudidae, but also only the second record of a lark eating another vertebrate.     

Territoriality mediates atypical size‐symmetric cannibalism in the Amblypygi Phrynus longipes

Cannibalism can have important demographic and ecological effects on populations. Typically, cannibalism is size‐structured, where larger individuals eat smaller conspecifics. Initial cursory observations of the whip spider, Phrynus longipes, however, suggested that cannibalism might not be size‐structured in this species, perhaps because cannibalism is often a by‐product of territory contests. We staged paired interactions and recorded latency to escalate to physical aggression or cannibalize to understand the dynamics of cannibalism and resource contests. We employed a multimodel comparative approach to tease apart the contest characteristics that best predicted cannibalism during behavioral trials between P. longipes opponents. We found that, while armament size symmetry predicted escalation of contests, cannibalism was best predicted by body mass asymmetry. Further, cannibalism was most likely to occur among individuals similar in armament, but dissimilar in body mass. This suggests a discrepancy between phenotypes that may have evolved to communicate resource holding potential (e.g., armaments which benefit individuals if dishonest), and body mass as a cue of resource holding potential.     

Cytological diagnostic clues in poorly differentiated squamous cell carcinomas of the breast: Streaming arrangement,necrotic background,nucleolar enlargement and cannibalism of cancer cells

Objective

Squamous cell carcinoma (SCC) is a rare histological type of breast cancer. The cytological diagnosis of non‐keratinising, poorly differentiated SCC is often difficult, and distinguishing it from invasive ductal carcinoma or apocrine carcinoma (AC) is especially challenging. We aimed to define the diagnostic cytological features of poorly differentiated SCC of the breast.

Methods

We studied the cytological findings of poorly differentiated SCC (n=10) and compared them to those of IDC (n=15) and AC (n=14). The following six cytological features were evaluated: streaming arrangement, nucleolar enlargement, dense nuclei, cannibalism, atypical keratinocytes and necrotic background.

Results

SCC exhibited significantly higher frequencies of streaming arrangement (70% vs 6.7%, P=.002), nucleolar enlargement (80% vs 27%, P=.02), and necrotic background (80% vs 36%, P=.002) than invasive ductal carcinoma. The detection of two or three of these features yielded a higher sensitivity (80%) and specificity (93%) for the diagnosis of SCC. Streaming arrangement (70% vs 0%, P<.001), cannibalism (60% vs 0%, P=.002), and a necrotic background (80% vs 36%, P=.047) were all significantly more frequent in SCC than in AC. When distinguishing SCC from AC, the presence of two or three of these features yielded a high sensitivity (80%) and specificity (100%).

Conclusions

Cytological features such as a streaming arrangement, a necrotic background, nucleolar enlargement and cannibalism are useful indicators for the diagnosis of SCC of the breast. As such, greater attention should be paid to these morphological features in daily clinical practice.