乳腺嗜酸性细胞癌1例及文献复习

目的;探讨乳腺嗜酸性细胞癌的诊断及鉴别诊断。方法：通过ＨＥ、免疫组化染色及电镜观察１例女性乳腺嗜酸性细胞癌,并复习文献,结果：癌细胞呈圆形到多边表,胞浆丰富,胞冻内见弥漫２的强嗜酸性颗粒,细胞核呈轻一中度异型,核仁明显,癌细胞呈巢状排列伴有腺管及乳头形态。电镜下胞浆内充满了无极性分布的线粒体。无分泌颗粒。免疫组化染色显示癌细胞不表达肌动蛋白、Ｓ－１００蛋白及嗜铬素Ａ。ＰＡＳ染色阴性。结论：嗜酸性细     

Oncocytic papillary renal cell carcinoma: a clinicopathological study emphasizing distinct morphology,extended immunohistochemical profile and cytogenetic features

Papillary renal cell carcinoma (PRCC) is traditionally classified into type 1 and type 2. Recently, an oncocytic variant of PRCC has been described. We report a series of 6 oncocytic renal papillary tumors (OPRCC) which tended to occur in older patients (mean, 56.8 years) with a male preference (male-to-female ratio is 5:1). All 6 patients are alive with no evidence of disease after initial resection, showing an indolent clinical behavior. Histologically, tumors exhibited predominant papillary structure with delicate fibrovascular cores. Papillae were lined by single layers of cells with large, deeply eosinophilic and finely granular cytoplasms and round regular nucleus. The phagocytosis of tumor cells was frequently and evidently seen in our cases that hemosiderin-laden tumor cells and foamy tumor cells were noticed in five and four cases respectively. All tumors were immunoreactive for racemase, vimentin, CD10, and MET and negative for CD117. While E-cadherin, EMA, and cytokeratin 7 exhibited variable immunopositivity. FISH analysis was performed in five of six cases and found heterogeneous results. Trisomy of chromosomes 7 was found in three cases and trisomy of chromosomes 17 in two cases. Loss of chromosome Y was noted in one of four tumors in male patients. MET gene status was also investigated by direct sequencing in all 6 cases and found no distinct mutation in any case. These results suggest that OPRCC shows distinct morphology, indolent clinical behavior, and similar immunohistochemical and cytogenetic features with PRCC, seems to be a variant in the PRCC group. Whether the strong expression of MET indicates a potential therapeutic target is still unknown and requires further investigation in clinical trials.     

Encapsulated apocrine papillary carcinoma of the breast: Case report with clinicopathologic and immunohistochemical study

We describe a case of encapsulated papillary carcinoma (EPC), apocrine variant in a 50‐year‐old woman. The patient presented a cystic lesion in her right breast, measuring 8 cm in diameter, containing three solid papillary nodules. A fine‐needle aspiration showed isolated apocrine cells containing round nuclei, irregular nuclear membranes, fine chromatin, and prominent macronucleoli. The lesion was excised and showed a pure papillary apocrine carcinoma, which stained diffusely with GCDFP‐15 and androgen receptors. The lesion was totally devoid of myoepithelial cells (smooth muscle actyn, p63, calponin, and collagen IV stains were negative). With MIB1 the proliferative activity was 10%. To the best of our knowledge, this is the first report of EPC apocrine variant with cytologic and immunohistochemical study. This lesion must be included in the list of apocrine lesions of the breast. Diagn. Cytopathol. 2010. © 2010 Wiley‐Liss, Inc.     

乳腺实性乳头状癌伴浸润性癌临床病理分析

目的探讨乳腺实性乳头状癌(solid papillary carcinoma,SPC)伴浸润性癌的临床病理特点、组织学特征和免疫表型。方法收集乳腺SPC伴浸润性癌8例,总结该组病变的临床资料,采用HE及免疫组化En Vision两步法染色检测组织病理学特征。结果乳腺SPC伴浸润性癌好发于老年女性,平均发病年龄55.5岁,其发生率约占SPC总病例的30%。肿瘤最常见的临床特征为乳腺肿块和乳头溢液,伴浸润癌常见的类型为乳腺非特殊类型癌和黏液癌,亦常伴神经内分泌分化。SPC伴浸润性癌时,浸润癌周边及其癌巢内肌上皮染色均为阴性。SPC与伴随的浸润癌区域ER、PR均阳性且阳性率较高(≥70%),HER-2均阴性,Ki-67增殖指数均≤10%。神经内分泌免疫组化标记Cg A及Syn均双阳性或单个阳性。结论 SPC可能是低级别乳头状导管原位癌的变异型,其具有进展为其他类型乳腺浸润性癌的潜能。SPC可能为伴神经内分泌分化乳腺黏液癌及非特殊类型癌原位癌阶段的病变。     

Oncocytic papillary renal cell carcinoma with inverted nuclear pattern: Distinct subtype with an indolent clinical course

Reported herein are seven cases of a histologically distinct oncocytic papillary renal cell carcinoma (OPRCC) with an inverted nuclear pattern. To define its prognostic significance, the clinicopathological features of OPRCC were compared to those of types 1 and 2 PRCC. The median age of the seven patients was 67 years. Grossly, tumors were well-circumscribed and small (1.2 cm ± 0.4 cm). Microscopically, the OPRCC were composed of well-developed thin papillae, lined with a single layer of cuboidal-to-columnar oncocytic cells. The tumor cells had round-to-oval nuclei and eosinophilic granular cytoplasm, which was strongly positive for anti-mitochondrial immunostaining. The nuclei were characteristically polarized toward the surface of the papillae and contained mostly small nucleoli. The tumors had high expression of α-methylacyl-coenzyme A racemase, CD15, CD117, cytokeratin (CK) 7, E-cadherin, epithelial membrane antigen, MOC 31, mucin-1, vascular endothelial growth factor and vimentin, low expression of CD10 and Ki-67, and no expression of CK20. Genetically, gain of chromosomes 3p, 11q, and 17q, and loss of chromosome 4q was observed. All seven patients were alive with no recurrence or metastasis at a mean follow-up time of 37.1 ± 23.7 months. In conclusion, OPRCC show unique pathological features with indolent clinical behavior and are more similar clinicopathologically to type 1 than to type 2 PRCC.     

Synchronous papillary thyroid carcinoma and follicular thyroid carcinoma: case report and review of literature

Collision tumor is a term denoting two histologically distinct tumor types occuring at the same anatomic site, which is a rare clinical entity. In the thyroid gland, collision tumors are rare. Here we report a case of the synchronous occurrence of follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC). The current case report describes a 40-year-old woman with synchronous FTC and PTC. Pathologists and surgeons should be aware of collision tumors to avoid possible misdiagnosis.     

Papillary carcinoma of the breast in a male patient with a treated prostatic carcinoma diagnosed by fine-needle aspiration biopsy: a case report and review of the literature

Papillary carcinoma of the male breast is very rare. In this case report, we describe the cytologic, histologic, immunohistochemical, and radiological findings of a papillary carcinoma of male breast. A 67-yr-old man, who had a previous history of prostatic adenocarcinoma, presented with a retroareolar painless mass. There was no known history of breast cancer in his family. A fine-needle aspiration biopsy (FNAB) was performed. Cytological examination revealed a cellular aspirate with three-dimensional papillary clusters. A diagnosis of papillary lesion favoring papillary carcinoma was rendered. Immunohistochemical staining of the cell-block of the FNAB revealed the presence of mammaglobin, and the absence of prostatic specific antigen. The patient underwent lumpectomy, which showed a moderately differentiated infiltrating papillary carcinoma with adjacent areas of ductal carcinoma in situ. FNAB is a useful technique in identifying male breast carcinoma. In conjunction with ancillary studies, this procedure can effectively differentiate between a primary versus metastatic lesion.     

Invasive lobular carcinoma of the breast: incidence and variants

The criteria for the separation of invasive lobular and ductal carcinomas are analysed. Lobular tumours account for 14% of invasive cancers in our material. The widely differing figures given in the literature are mainly attributable to intrinsic difficulties of classification. In addition to the classical dissociated-cell patterns with single filing, a tragetoid appearance and related features, variants with trabecular, loose alveolar and tubular features are recognized; a 'solid' variant requires further investigation. The variants either represent better differentiated forms, or in some cases, an 'earlier' phase in the production of the more traditional Indian file formations and dartboard patterns. Focal signet-ring cell differentiation is another newly-recognized feature. The theoretical and practical implications of these variants are considered. The division into invasive lobular and ductal carcinomas is not as easy as most of the literature implies. Five per cent of cases could not be so classified and, in some of these unclassified cases, both ductal and lobular differentiation may be present. In the diagnosis of problem cases, no single parameter proved reliable but a combination of several parameters enables one to make an objective diagnosis in about 95% of cases.     

Oncocytic variant of medullary thyroid carcinoma; a rare tumor with numerous diagnostic mimics by fine needle aspiration

Oncocytic variant of medullary thyroid carcinoma is rare form of thyroid carcinoma that is easily misdiagnosed on fine needle aspiration specimens due to it is low incidence and cytomorphologic overlap with other more common Hurtle cell lesions. A correct initial diagnosis by fine needle aspiration is imperative as the clinical treatment for medullary carcinoma differs significantly from the mimickers. We present a case of this rare variant tumor that on initial fine needle aspiration was described as a Hurthle cell lesion and was subsequently correctly classified on the resection specimen. In this brief review, we describe the cytomorphologic features of medullary carcinoma, oncocytic variant of medullary carcinoma and it is most common mimickers, and we discuss the ancillary studies required to confirm the diagnosis. This case highlights the importance of a complete clinical history and radiologic correlation, which in conjunction with a careful attention to the cytologic features of the fine needle aspiration sample, should in most cases ensure a correct initial diagnosis.     

Metastatic papillary oncocytic carcinoma of the pancreas to the liver diagnosed by fine-needle aspiration

A 37-year-old white male with a large pancreatic mass was referred to our institution with a hypodense liver lesion detected on CT scan. A fine-needle aspiration (FNA) was performed on the liver lesion. Diff-Quik smears demonstrated scattered papillary structures and single neoplastic cells with abundant well-defined dense granular cytoplasm. Eccentrically located nuclei were noted with single prominent nucleoli. Cell block preparations showed papillary structures lined by cells with abundant pink granular cytoplasm, hyperchromatic nuclei, and prominent single nucleoli. Electron microscopic examination displayed numerous but poorly preserved mitochondria. The diagnosis of papillary carcinoma with oncocytic features was made. Only two previous cases of pancreatic oncocytic tumors diagnosed by FNA have been reported in the literature. We present an additional case, notable in that the diagnosis was made in a metastatic liver nodule. Diagn. Cytopathol. 1998;18:291–296. © 1998 Wiley-Liss, Inc.     

Sebaceous carcinoma of the breast

We report on a rare distinctive variant of infiltrating ductal carcinoma characterized by sebaceous differentiation of tumor cells. The neoplasm was identified in a lumpectomy specimen from a 45-year-old woman with extensive metastatic disease. In addition to conventional in situ and invasive ductal components, approximately half of the tumor cells exhibited a phenotype resembling tumors of the sebaceous skin appendage with coarsely vacuolated cytoplasm and peripherally displaced nuclei. The sebaceous moiety was also present in the distant metastatic deposits. There was no evidence of mucin production by tumor cells. Ultrastructurally, empty-appearing non-membrane bound vacuoles attested to the sebaceous cells' lipid content. The immunoprofile of the lesion included positivity for cytokeratin and epithelial membrane antigen. Vimentin, S100 protein and carcinoembryonic antigen were not expressed. Most tumor cell nuclei reacted with antibodies to oestrogen and progesterone receptors but failed to show overexpression of the HER2/neu protein. The MIB-1 labeling index averaged 16%. At variance with sebaceous breast carcinomas on record, the present case is notable for its prolonged clinical course.     

Warthin-like tumor variant of papillary thyroid carcinoma: Case report and literature review

A tumor approximately 4.0 x 3.0 cm in size with a cystic change was observed in the left lobe of the thyroid gland of a 52-year-old woman. The removed tumor had lymph follicle formation with a germinal center. This lymphatic tissue showed papillary and island-like growth; the growths were surrounded by atypical epithelium showing nuclear features of papillary carcinoma. The atypical epithelium had ground-glass nuclei with nuclear grooves, clearly indicating intranuclear cytoplasmic inclusion bodies. No chronic thyroiditis was observed in the background of the patient. Parts of the metastatic lymph nodes had cells with an eosinophilic cytoplasm, clearly showing an intratumor lymph follicle formation, as in the primary lesion. This is a rare case of thyroid papillary carcinoma similar to Warthin's tumor of the salivary gland. Here we present this case, with a review of previously published reports.     

Invasive micropapillary carcinoma of the breast: clinicopathological and immunohistochemical study

Invasive micropapillary carcinoma (IMPCa) of the breast refers to a unique variant of invasive ductal carcinoma, but its biological behavior has not been elucidated well. We analyzed 16 IMPCa cases (10 pure type, six mixed type). The incidence of IMPCa was 1.0% of all primary breast carcinoma. High nuclear grade (75.0%), as well as poorly differentiated histological grade (81.3%), was frequently seen. Lymph node metastases were evident in 92.9% of the examined cases, and about half of them showed more than 10 positive nodes. Comparison between serially experienced invasive ductal carcinoma, not otherwise specified (IDC-NOS), revealed that both high nuclear grade and poor histological grade were significantly more frequent ( P  < 0001), there was a lower frequency of positive estrogen receptor/progesterone receptor ( P  < 0.05, P  < 0.01), a higher frequency of HER-2 overexpression ( P  < 0.025), and more frequent lymph node metastases ( P  < 0.05) in IMPCa. The comparison between lymph node positive IDC-NOS did not show any statistically significant differences in frequency for positive p53, matrix metalloproteinase protein-2 (MMP-2), vascular endothelial growth factor (VEGF) or E-cadherin. However, IMPCa showed a significantly increased number of blood vessels counted by CD34 immunostains ( P  < 0.05). These results suggest that IMPCa is, at least, the same or more aggressive than lymph node positive cases of IDC-NOS. Hence, not only the high incidence of lymph node metastases but also distant, blood-borne metastases may be important.     

Composite encapsulated papillary carcinoma and solid papillary carcinoma

Encapsulated papillary carcinoma (EPC) and solid papillary carcinoma (SPC) are distinctive variants of intraductal papillary carcinomas, each accounting for <1% of breast carcinomas. Here we report a composite carcinoma consisting of EPC and SPC. A 73‐year‐old woman was found to have a high density mass in the left breast on mammogram. A biopsy showed intermediate to high grade ductal carcinoma in situ (DCIS). Gross examination of the lumpectomy specimen revealed a solid, multinodular mass. Microscopic examination demonstrated two morphologically distinct intraductal carcinomas intermingled with each other. One had delicate papillae in multi‐cystic spaces surrounded by thick fibrous capsule, consistent with EPC. The other had solid tumor nests with delicate fibrovascular cores. The cells were monotonous with round nuclei and salt and pepper‐like chromatin, characteristic of SPC. The lack of myoepithelial cells within the papillae and at the periphery of the lesion was confirmed by immunostaining for p63 and CK5/6. Neuroendocrine differentiation of SPC was demonstrated by neuron specific enolase staining. To our knowledge, this is the first reported case of composite EPC and SPC. It raises an interesting question as to a possible common pathway of carcinogenesis of these two rare variants.     

Solid-papillary carcinoma of the breast: clinicopathological study of 20 cases

The purpose of the present paper was to evaluate the clinicopathological and biological features of 20 Japanese patients with solid-papillary carcinoma of the breast (SPC) or SPC associated with invasive breast cancer. All the patients were Japanese women, including two sisters. The mean age was 66.0 years. The incidence of SPC among all the breast cancers treated at two institutions was 1.1% and 1.7%, respectively. The mean disease-free interval was 4 years 11 months. Axillary lymph node metastasis or tumor recurrence did not occur in any of the cases. Fifteen cases of SPC contained invasive cancers that ranged from <5% to 60% of the entire tumor area. Histological types of invasive cancers were mucinous carcinoma in five cases and neuroendocrine cell carcinoma in 10 cases. These results indicate that SPC is a potential precursor lesion for neuroendocrine carcinoma as well as mucinous carcinoma. When all the cases were classified and analyzed according to both the 2002 tumor node metastasis (TNM) classification system and the Nottingham histological grade, SPC patients, even those with invasive cancers, seemed to have longer disease-free survival compared to patients with the other invasive breast cancers of matching grade and stage. Clinicopathologically, SPC could be regarded as a separate type of ductal carcinoma in situ.     

Loss of myoepithelium is variable in solid papillary carcinoma of the breast

AIMS: Reports on the frequency of myoepithelial loss in solid papillary carcinoma (SPC) of the breast, an unusual variant of papillary carcinoma with a solid pattern of expansile growth, have been strikingly contradictory. The aim was to clarify the frequency of myoepithelial loss in cases of SPC diagnosed at our institution. METHODS AND RESULTS: Eleven cases of SPC with available blocks or unstained slides were retrieved from the M. D. Anderson archives or obtained from outside contributors. Immunohistochemistry for smooth muscle actin (SMA) and p63 was evaluated on the circumscribed nests that appeared to be non-invasive by haematoxylin and eosin morphology. Three of the 11 cases (27%) were positive for both SMA and p63 at the periphery of all such foci, whereas eight cases (73%) lacked staining for both myoepithelial markers in at least one focus. Of these eight cases, one was diagnosed with only microinvasion, yet metastatic tumour resembling the circumscribed primary SPC was identified in two ipsilateral axillary lymph nodes. CONCLUSIONS: SPC of the breast frequently lacks myoepithelial markers at the tumour-stromal interface in spite of a circumscribed non-invasive appearance. Metastases from such tumours are infrequent, but can occur in cases that lack myoepithelial marker expression by immunohistochemistry.     

乳腺实性乳头状癌73例临床病理诊断

目的对乳腺实性乳头状癌(solid papillary carcinoma,SPC)的临床病理特征和免疫表型特点、预后和鉴别诊断进行探讨。方法收集伴或不伴有浸润癌的SPC共73例,总结其临床资料、大体和组织病理特征,并行透射电镜观察及免疫组织化学EnVision法染色。选用抗体包括CK、肌上皮标记、神经内分泌标记、增殖标记Ki-67和ER、PR、c-erbB-2等。结果本病好发于老年女性,发病平均年龄64.7岁。肿瘤最常见的临床症状为乳腺肿块和乳头溢液。行腋窝淋巴结清扫术43例中有31例检出癌转移。镜检所有标本均见到实性乳头状病变,25例伴有黏液分泌。周边常可伴有导管内乳头状瘤。肿瘤细胞呈多边形、卵圆形或梭形,呈印戒样。胞质丰富,呈嗜酸性或细颗粒状。细胞核轻度或中度异型,51例核分裂象5个/10HPF。43例伴发浸润癌。肿瘤基底型CK表达呈阴性。平滑肌肌动蛋白SMA、p63在乳头轴心肌上皮的阳性率分别为91.8%、67.1%,在导管周围肌上皮的阳性率分别为91.8%,73.9%。CgA和Syn以及NSE阳性率分别为89.0%,86.3%,95.9%。Ki-67平均阳性指数为10.2%。73例行ER、PR染色的肿瘤大部分呈阳性,Her-2大部分呈阴性。电镜下可见到细胞内的神经内分泌颗粒。结论乳腺SPC是一种低度恶性的乳腺导管内癌,好发于老年女性,有其独特的组织形态、免疫组织化学特征,部分SPC与乳腺黏液癌和神经内分泌癌相关。随访资料显示SPC具有良好的预后。