人肺癌冷冻蚀刻法透射电镜观察

用冷冻蚀刻透射电镜法,观察18例人类肺癌(6例鳞癌,6例腺癌,3例小细胞癌,3例大细胞癌)。结果表明,各型肺癌细胞间显示不同的连接特征:未分化癌细胞膜常平直并行。鳞癌细胞多为指状镶嵌,桥粒较多。腺癌细胞可见紧密连接。高分化癌细胞核膜孔数目较少,而低分化和未分化癌细胞核膜孔数目明显增多。作者认为,肺癌细胞随分化程度降低核膜孔数量增多,可能与其生长速度、代谢功能有关。观察细胞生物膜和细胞间连接结构,冷冻蚀刻技术优于超薄切片技术。     

乳腺放射状硬化性病变的病理形态学观察

目的 探讨乳腺放射状硬化性病变的组织病理特点和鉴别诊断.方法 收集44例乳腺放射状硬化性病变,进行组织形态学和免疫组织化学SP法或EnVision二步法染色观察.结果 44例均发生在女性,年龄17～54岁(平均40.3岁).31例会诊者中13例误诊为癌.镜下病变呈放射状,中央为纤维瘢痕区,其内常有受压变形的腺管,周围有放射状分布的扩张腺管及不同程度增生的导管和小叶,可伴大汗腺、柱状细胞化生增生,其中14例见坏死,8例伴不典型导管增生.免疫组织化学染色显示纤维瘢痕组织内假浸润的变形腺管周围有肌上皮,旺炽性增生的上皮呈CK5/6阳性.结论 乳腺放射状硬化性病变有特殊的形态特点,易误诊为癌,需与导管内癌、小叶性肿瘤、小管癌、浸润性导管癌鉴别.     

乳腺小管癌29例病理形态学观察

目的探讨乳腺小管癌的临床与病理形态学特点、诊断及鉴别诊断。方法应用光镜观察、免疫组织化学染色等方法对29例乳腺小管癌进行分析,并复习文献。结果肿瘤由开放性小管组成,浸润性分布于增生的纤维间质中,小管由单层上皮围绕构成,细胞形态温和,异型性不明显,核分裂罕见。肿瘤常与小叶性肿瘤、柱状细胞病变、导管不典型增生/原位癌等伴发。免疫组化染色显示小管周围肌上皮缺失或不完整。结论乳腺小管癌是一种形态独特、预后良好的乳腺癌亚型,常与微腺性腺病、放射状硬化性病变、浸润性导管癌等混淆;免疫组化有助于鉴别。     

乳腺原发性印戒细胞癌

目的：观察乳腺原发性印戒细胞癌的形态特征。方法：通过HE及AB/PAS染色,对4例乳腺原发性印戒细胞癌进行观察。结果：4例癌细胞内印戒细胞均超过205。HE染色呈典型印戒样细胞,AB/PAS染色胞质内阳性。导管内型及小叶型各1例,浸润性导管型及小叶型各1例。结论：乳腺原发性印戒细胞癌是一种特殊型癌,诊断时应排除转移性印戒细胞癌。     

乳腺皮脂腺样癌临床病理诊断

目的探讨乳腺皮脂腺样癌的临床病理学特征及其诊断和鉴别诊断要点。方法对1例乳腺皮脂腺样癌进行光镜观察和免疫组化标记。结果癌组织由两型细胞构成：一型为未分化细胞,较基底细胞胞质丰富;另一型为较分化细胞,胞界清楚,胞体宽大,胞质丰富,有小空泡,两型细胞均可见1～3个小红核仁。癌细胞排列成不规则小叶,各小叶中两型细胞的数目和分布不一,部分似皮脂腺小叶结构。可见癌组织与残存小叶内导管上皮移行结构,部分区域伴鳞化。结论皮脂腺样癌为罕见的特殊类型乳腺癌,可能源自小叶内导管上皮皮脂腺化生。确诊须符合下列标准：①肿物位于乳腺实质内;②具备皮脂腺分化特点及恶性特征;③可见癌组织与乳腺导管上皮移行结构。     

人体乳腺单纯癌癌细胞线粒体及溶酶体形态结构的定量研究

对三例晚期女性乳腺单纯癌癌细胞线粒体、溶酶体１６个形态参数进行体现学统计分析，结果发现癌细胞与正常细胞比较，线粒体、溶酶体的有关体积、表面积、膜面积、面数密度、数密度等１０个形态参数有高度显著和显著差异。并讨论了它们的功能和形态结构变异的定量依据。     

乳腺肌上皮细胞免疫标记物的研究进展

在病理诊断工作中，乳腺某些良恶性病变的鉴别往往给病理医师带来很大的困难，如某些腺病与癌的鉴别、导管／小叶普通型增生和不典型增生与原位癌的鉴别、原位癌与浸润癌的鉴别、导管内乳头状瘤与高分化囊内乳头状癌的鉴别、微腺性腺病与小管癌的鉴别等。一般来说，几乎所有的乳腺良性增生性病变(除微腺性腺病外)都存有肌上皮细胞     

乳腺良、恶性上皮性病变诊断及鉴别诊断的某些问题

上皮增生/增殖性病变是乳腺最常见的疾病，其良恶性病变的鉴别常遇到困难，而且容易误诊。主要有以下几个方面的问题：①良性非肿瘤增生性病变（如导管、小叶增生，腺病等）和原位/润癌的鉴别。②肿瘤性增生性病变（如导管、小叶不典型增生）与原位癌或浸润癌的鉴别。③假浸润性病变（如放射状瘢痕、硬化性腺病、乳头状病变）与癌性浸     

乳腺良恶性病变中CD10表达及意义

目的 探讨CD10免疫标记乳腺肌上皮细胞的可行性。方法 收集50例乳腺良恶性病变的石蜡包埋标本(腺瘤、纤维腺瘤、叶状肿瘤、纤维囊性病、导管内乳头状瘤、乳头腺瘤、导管内癌、小叶内癌、浸润性导管癌、浸润性小叶癌)，采用免疫组化(S-P法)检测CD10在上述病变中的表达。结果 在乳腺良性病变中，CD10阳性的肌上皮细胞连续地环绕在普通型增生的小导管的周围。但在囊性扩张或不典型上皮增生的导管周围，CD10阳性细胞不连续，甚至不见阳性细胞。导管原位癌的癌细胞巢外周的阳性细胞由完整到不完整，甚至完全缺失。在浸润性癌中癌巢周围不见阳性细胞，在早期浸润性癌中可见残存的阳性细胞。除少许癌细胞和肌纤维母细胞表达CD10外，其余癌细胞、肌纤维母细胞、血管平滑肌细胞和上皮细胞均不表达CD10。结论 CD10标记肌上皮细胞具有较高的敏感性和特异性，可以作为肌上皮细胞的有效标记物。     

乳腺癌癌旁腺病的病理形态观察

从病理形态学角度研究了本院142例乳腺癌并存癌旁腺病的改变,并重点观察乳腺癌癌旁腺病性上皮增生、不典型增生与癌的关系。发现:全组95%以上腺病性导管上皮出现不典型增生;40.1%显示增生、不典型增生与癌的移行形态;11.3%发现腺病性小叶内上皮多中心癌变灶。由此提出腺病(尤其当出现导管上皮重度增生、不典型增生时)与乳腺癌发生有直接关系,应引起临床重视和慎重处理。     

Cytodiagnosis of secretory carcinoma of the breast: a report on two cases

Secretory carcinoma of the breast is a rare (<1%) low grade breast carcinoma which shows distinct features at histology. Diagnosis of this carcinoma at fine needle aspiration cytology (FNAC) is difficult. Two cases of secretory carcinoma of the breast presenting as a breast mass, one in a 24-year-old female and the other in a 40-year-old female are reported, highlighting their appearance at FNAC. In both the cases the aspirates were cellular and consisted of clusters and single cells with uniform round nuclei showing minimal nuclear atypia. Most of the cells had moderate to abundant cytoplasm with prominent intracytoplasmic vacuoles. Many cells showed a plasmacytoid appearance and others were binucleate. A typical amphophilic bubbly cytoplasm of the tumor cells was observed. Both cases were confirmed as secretory carcinoma on histology. The differences in cell morphology at FNAC of secretory carcinoma of the breast from other breast carcinomas, and its utility of making a preoperative diagnosis are discussed.     

Metaplastic breast carcinoma on fine-needle cytology samples: a report of three cases

Metaplastic breast carcinoma (MBC) may have a varied presentation on fine-needle cytology samples. We herewith describe three cases of MBC found in our series. One of these cases showed a peculiar mixture of malignant ductal, apocrine type, and squamous epithelial cells with fascicles of spindle cells with variable degree of atypia and was diagnosed as metaplastic carcinoma of the carcino-sarcomatous type. The other two lesions were characterized by an abundant chondroid extracellular matrix to which were variably admixed carcinomatous and chondroid-type cells, with variable degree of atypia. Both these latter cases were defined as matrix-producing metaplastic carcinomas. Because of the various presentation of MBC on fine-needle cytology samples and the possible influence of needle "sampling" on the cytological specimen, the spectrum of differential diagnoses to be considered may encompass a number of benign and malignant entities, like keratinous subareolar cysts, malignant fibroepithelial lesions with myxo-chondroid stroma, and true sarcomas of the breast, with cartilaginous metaplasia. It is the Authors' feeling that, with optimal samples, the cytomorphological findings of this rare variant of breast carcinoma permit its accurate pre-operative diagnosis.     

Oncocytic carcinoma of the breast: frequency, morphology and follow-up

Oncocytic breast carcinomas are tumors composed of no fewer than 70% of oncocytic cells (World Health Organization). The purpose of this study was to determine the frequency, morphologic, immunohistochemical, and clinical features of invasive oncocytic carcinoma in a large series. Twenty-eight cases of putative oncocytic breast carcinoma (selected cases group) and 76 consecutive cases of invasive breast carcinoma (consecutive cases group) were analyzed. Immunohistochemistry for mitochondria, gross cystic disease fluid protein 15, chromogranin, estrogen receptor, progesterone receptor, androgen receptor, HER2/Neu, cytokeratin 7, cytokeratin 14, epithelial membrane antigen, and differentiation cluster 68 was performed. Score for mitochondria was based on intensity and percentage of immunopositive cells. Classes were as follows: (1) oncocytic carcinoma: at least 70%, 3+; (2) mitochondrion-rich carcinoma: 50% to 70%, 3+, or more than 50%, 2+; and (3) all the other cases were referred to as invasive breast carcinoma. Ultrastructural examination was available for 6 cases of oncocytic carcinoma. Morphologic and immunohistochemical features of the 3 groups were compared using Fisher exact test (P < .05). For overall survival analysis, Kaplan-Maier curves were compared using log-rank and Wilcoxon tests (P < .05). Our results suggest that oncocytic breast carcinoma is a morphologic entity with distinctive histologic and ultrastructural features. Mitochondrion-rich carcinomas are histologically similar to oncocytic carcinomas and constitute 19.7% of all invasive carcinomas, indicating that cytoplasmic eosinophilia in breast cancer cells is often due to accumulation of mitochondria. Oncocytic carcinomas and mitochondrion-rich carcinomas are more often grade III tumors and show human epidermal growth factor receptor 2 overexpression. Clinical features and overall survival of oncocytic carcinomas are not distinctive because they are similar to those of the other cases when matched for grade and stage.     

A role of VLA-6 laminin receptor in invasion of breast carcinoma

The integrin VLA-6 as a laminin receptor and laminin as a ligand for laminin receptor were detected immunohisto-chemically in normal, benign tumor and carcinoma tissues of the breast. Epithelial cells of both normal breast and benign tumor were in almost all cases strongly immuno-reactive for VLA-6 in the plasma membrane. Carcinoma cells in 34 of 70 cases (49%) with an invasive component were not immunoreactive for VLA-6, and no carcinoma ceils showed strong positivity. Although carcinoma cells in only four of 51 cases (8%) with intraductal components were negative for VLA-6, 37 cases (72%) showed weak expression of VLA-6 and 10 cases (20%) showed strong expression of VLA-6. A concordant expression of VLA-6 on carcinoma cells and laminin around carcinoma cell nests with an invasive component was observed, and VLA-6 expression in carcinoma cells was correlated to tubular formation in carcinoma cell nests as an indicator of differentiation. These findings suggest that loss of VLA-6 plays a role in the invasion of breast carcinoma, and that VLA-6 laminin receptor and laminin may contribute to tubular differentiation of breast carcinoma cells.     

Electron microscopic and immunohistochemical studies of spindle cell carcinoma of the breast

A spindle cell carcinoma of the breast was investigated by electron microscopy and immunohistochemistry. Histologically, the tumor was composed of an admixture of carcinomatous parts and sarcomatoid element composed of atypical spindle cells. Ultrastructurally, carcinomatous cells had numerous tonofilaments and desmosomes, and occasional intracytoplasmic lumina. In contrast, spindle cells possessed numerous intermediate filaments and a few weak junctions. Immunohistochemically, carcinomatous cells showed positive reactions for epithelial markers, but spindle cells for vimentin, only. Thus, the carcinomatous cells had characteristics of epithelial cells, but the spindle cells had characteristics of mesenchymal cells. These features were distinguishable by both electron microscopy and immunohistochemistry. This study was presented at the 24th Annual Meeting of the Clinical Electron Microscopy Socienty of Japan, Okayama, September 17, 1992.     

Morphological behavior of carcinoma of the pancreas. 2. Argyrophil cells and Langerhans' islets in the carcinomatous tissues

The incidence and the behavior of endocrine cells in carcinomatous tissues were studied in 84 autopsy cases and 10 surgical or autopsy cases of pancreatic carcinoma, by light and electron microscope, respectively. It was found that the islets persistently survived in the carcinomatous tissues. In large duct type carcinomas, the islets showed unique familiarity with the carcinomatous ducts, which may be interpreted as suggesting interactions between ductal cells and islet cells in pancreatic carcinogenesis. Aside from these survivor islet cells, carcinomas exhibited different degree and kind of differentiation to endocrine cells, depending upon their histological types. Namely, neoplastic argyrophil cells were found at the incidence of 82% (large duct type carcinoma), 39% (small duct), 43% (adenosquamous), and 18% (undifferentiated one). Moreover, argyrophil cells with their apexes stretching far to the neoplastic lumen were found only in large duct type carcinoma and cystadenocarcinoma. In three cases of carcinoid or oat cell type carcinoma, argyrophil cells were diffusely scattered and irregular in shape. These findings further justify the classification, reported in the previous article. The differentiation to endocrine cells was confirmed also by electron microscope.     

Fine-needle aspiration cytology of sarcomatoid carcinoma of the breast: A cytologically overlooked neoplasm

Sarcomatoid carcinoma of the breast is a very uncommon neoplasm. Fine-needle aspiration findings have been rarely reported. We report a case of sarcomatoid carcinoma of the breast that was diagnosed as a typical ductal carcinoma cytologically. The patient was a 45-year-old female who had a right breast mass for a short duration. Fine-needle aspiration (FNA) showed smears predominantly composed of single cells exhibiting plasmacytoid features with moderate degree of pleomorphism. A granular bluish background was noted on the Papanicolaou-stained smears. This background was thought to represent tumor diathesis, and the diagnosis of grade II ductal carcinoma of the breast was rendered. The patient underwent a subsequent lumpectomy with axillary node dissection. Histological examination of the lumpectomy revealed a neoplasm predominantly composed of a grade II chondrosarcoma with increased cellularity. A small (10%) component showed grade II invasive ductal carcinoma of the breast. No in situ component was seen. The sarcomatoid component was positive for S-100 protein and vimentin and negative for keratin, whereas the carcinomatous component was positive for vimentin, epithelial membrane antigen, and low molecular weight keratin. Ultrastructurally, the tumor showed features of a poorly differentiated epithelial neoplasm without evidence of chondrosarcoma. Metastases were seen in seven of ten axillary lymph nodes with exclusive epithelial component. Retrospective evaluation of the FNA smears revealed an extensive metachromatic stroma on the DIFF QUIK™-stained smears. Our findings and review of the literature suggest that sarcomatoid carcinoma of the breast will be very frequently overlooked or misdiagnosed either because of the subtlety of the stroma or the predominance of the mesenchymal component. Our findings also provide supportive evidence that the use of the DIFF QUIK™ stain can be very helpful in the identification of the stroma in this neoplasm. The predominance of epithelium in the metastases in our case is further proof that tumors with dual differentiation such as sarcomatoid carcinomas and mixed muellerian tumors are truly carcinomas with metaplastic features. Diagn. Cytopathol. 16:242–246, 1997. © 1997 Wiley-Liss, Inc.     

Pseudoangiosarcomatous carcinoma: a clinicopathological study of seven cases

Seven cases of carcinoma mimicking angiosarcoma occurring in skin (3 cases), breast (3) and lung (1) are described. The cutaneous, pulmonary and one of the breast carcinomas were poorly differentiated and squamous in type; the other two breast tumours were poorly differentiated ductal carcinomas with focal squamous differentiation. Histologically, the pseudoangiosarcomatous pattern was due to complex anastomosing channels and spaces lined by neoplastic cells. The spaces contained hyaluronic acid. The neoplastic cells exhibited cytokeratin positivity but yielded negative results with the endothelial cell markers, factor VIII-related antigen and CD 34 (QB-END/10). Two breast tumours showed binding of UEA-1. Ultrastructurally, unequivocal epithelial differentiation was demonstrated in six of the cases. Pathogenetically, these tumours appeared to be variants of acantholytic squamous cell carcinoma. Recognition of this unusual form of carcinoma is important, as an incorrect diagnosis of angiosarcoma may lead to inappropriate treatment and prognostication.     

Stromal changes in early invasive and non-invasive breast carcinoma: an ultrastructural study

Six examples of histologically diagnosed, non-invasive breast carcinomas were studied by electron microscopy to elucidate the ultrastructural features for an accurate diagnosis of in situ carcinoma. The results obtained revealed two patterns of basal lamina/stromal cells relationship. One pattern showed intact basal lamina with associated periductal stromal cells consisting entirely of fibroblasts, the other pattern showed disruption of basal lamina by gaps and malignant cell protrusions with associated stromal cells consisting of both fibroblasts and myofibroblasts. As myofibroblasts are not a component of normal breast stroma but are known to be a prominent feature in the stroma of infiltrating breast carcinoma, the present observations suggest that myofibroblastic proliferation around in situ carcinoma represents an early sign of carcinomatous infiltration. Hence the definitive diagnosis of non-invasive carcinoma of the breast requires an intact basal lamina and a complete absence of a myofibroblastic reaction.     

Metaplastic carcinoma with extensive chondroid differentiation in the breast (chondroid carcinoma)

Metaplastic breast carcinoma is very rare, and metaplastic carcinoma with chondroid differentiation is even rarer. Here, we report a case of metaplastic carcinoma with extensive chondroid differentiation mimicking chondrosarcoma that was challenging to diagnose. The tumor was characterized by an abundant chondromyxoid matrix. The definitive area of classic invasive ductal carcinoma was minimal. The peripheral portion of the tumor showed increased cellularity with pleomorphism and definitive invasive growth. Tumor cells in the chondrosarcomatous areas were diffusely immunoreactive for S-100 protein, patchy positive for cytokeratin, but negative for epithelial membrane antigen (EMA). Tumor cells in carcinomatous areas were diffusely positive for cytokeratin, S-100 protein, and patchy positive for EMA. In both areas, tumor cells were negative for smooth muscle actin (SMA) and CD34, while oncoprotein p53 was overexpressed. When pathologists encounter breast tumors with chondroid differentiation, careful sampling and immunohistochemistry for cytokeratin and SMA are most helpful to differentiate metaplastic carcinoma from malignant phyllodes tumor and malignant adenomyoepithelioma.