The ultrastructure of tubular carcinoma of the breast

Breast tubular carcinoma at parasternal and retro-nipple area: Two case reports

INTRODUCTION

Breast tubular carcinoma (TC) is a well-differentiated infiltrating ductal carcinoma, common in postmenopausal women.

PATIENT CONCERNS

Two patients concerned their abnormality of their breasts, one at deep parasternal higher chest wall in a 74-year-old female and the other behind the nipple in a 39- year-old female.

DIAGNOSIS

These masses were detected by mammography, ultrasound and magnetic resonance imaging (MRI) examinations. The parasternal mass identified by mammography showed long spicules along the edges of the mass. Ultrasound examination revealed that these masses had solid irregular hypoechoic nodules. The color Doppler ultrasound of the retro-nipple mass presented with increased blood flow resistance index. The dynamic contrast-enhanced MRI examination of the retro-nipple nodule demonstrated an intensely enhancing mass with a plateau-type time-signal intensity curve.

INTERVENTIONS

Two cases were surgically removed by local resection of foci under ultrasound guidance.

OUTCOMES

These imaging examinations strongly suggest possible breast tubular carcinoma, which was confirmed by the pathological evaluation of frozen sections from surgically removed masses.

CONCLUSION

Although uncommon, breast tubular carcinoma may be considered in the differential diagnosis of small solid masses with long spicules at parasternal breast or behind the nipples in adult women.

Immunohistochemical detection of maspin is a useful adjunct in distinguishing radial sclerosing lesion from tubular carcinoma of the breast

Maspin is a recently described member of the serpin family of protease inhibitors that is consistently expressed at high levels in mammary myoepithelial cells. This feature was used in the immunohistochemical evaluation of tubular carcinoma (TC) and radial sclerosing lesion (RSL) of the breast, and compared with other markers of myoepithelial cells. Ten cases of TC and 11 cases of RSL were studied for the expression of maspin, alpha-smooth muscle actin (alpha-SMA), metallothionein (MT), and S-100 protein by immunohistochemistry. Myoepithelial cells stained strongly and diffusely for maspin creating a pattern of an outer continuous ring surrounding the epithelium of tubules of all RSLs. This pattern was absent in all TCs; however, the single-layered epithelium comprising the tubules of two TCs was positive for maspin with a moderate to strong intensity. Myoepithelial cells were not positive for MT in a consistent manner. Benign nonproliferative epithelium stained focally and weakly for maspin in four of 11 cases of RSL and was negative for MT in all 11 cases. Foci of mild to moderate epithelial hyperplasia noted in five of 11 cases of RSL stained diffusely with a weak to moderate intensity for maspin and focally with a strong intensity for MT. alpha-SMA was consistently expressed in myoepithelial cells but also in stromal myofibroblasts and blood vessels, creating a pattern that was less satisfactory than maspin in distinguishing RSL from TC. Immunohistochemical staining for S-100 protein was of no differential diagnostic value. In conclusion, immunohistochemical staining for maspin is diagnostically useful and superior to MT, S-100, and alpha-SMA, in distinguishing RSL from TC. The epithelial immunoreactivity for maspin in two of 10 TCs merits further investigation from a prognostic viewpoint.

Solid Tubular Carcinoma of the Breast: MR Imaging and Pathologic Correlation

PURPOSE: Solid tubular carcinoma of the breast is a recognizable histologic type of invasive ductal carcinoma, characterized by rare axillary lymph nodal metastases and a good prognosis. The purpose of this study is to describe the magnetic resonance (MR) characteristics of solid tubular carcinoma and to emphasize the spotty appearance on the MR subtraction images. MATERIALS AND METHODS: We reviewed the MR findings of seven patients with biopsy-proven solid tubular carcinoma. Two of the 7 cases were of the pure type (more than 85% solid tubular component) and the remaining 5 were of the mixed type (50% to 85% solid tubular component). The mean age of the patients was 56 years. RESULTS: The mean size of the lesions was 28 mm. On T1-weighted images four of the lesions were visible and three were not identified. After Gd-DTPA all the lesions were enhanced. On the subtraction images, g" popcorn" appearence areas were noted in the stained mass. CONCLUSION: Our preliminary results suggest that solid tubular carcinomas have a characteristic apperarence on the subtraction MR images.

Intracytoplasmic lumina in ependymomas: an ultrastructural study

Intracytoplasmic lumina (ICL) are rarely described in tumors of the central nervous system. The morphogenesis of ICL remains incompletely characterized. Ultrastructural features of ICL in six ependymomas (one from lateral ventricle, three from fourth ventricle, and two from spinal cord) and three myxopapillary ependymomas of the filum terminale were analyzed. Two types of ICL were identified: ICL with both microvilli and cilia, and ICL with only microvilli. Some ICL also contained granulofibrillary or condensed material. Ciliated ICL were common in ependymomas of the ventricles, whereas nonciliated ICL were frequently seen in the myxopapillary variant. Various stages of formation and development were observed in ciliated ICL. They seemed to originate from distended periciliary cisterns, to enlarge by fusion with cytoplasmic vesicles or other ICL, and subsequently to open into the intercellular space. The last process may be the mechanism by which the intercellular microrosettes are formed. Ciliated ICL have not been described in other neoplasms. They may represent a characteristic ultrastructural feature of ependymomas. The morphogenesis of nonciliated ICL remains unknown. They may represent a degenerative form of ciliated ICL or pseudolumina resulting from invagination of the extracellular space within the cytoplasm.

Immunohistochemistry with keratin, vimentin, desmin, and alpha-smooth muscle actin monoclonal antibodies in canine mammary gland: malignant mammary tumours

Ten malignant canine mammary gland tumours and five metastases from three of these tumours were studied immunohistochemically with monoclonal antibodies (MoAbs) directed against different human keratin types (K), alpha-smooth muscle actin, vimentin, and desmin. In all tumours the neoplastic epithelium was rather homogeneously labelled with the keratin MoAbs RCK 102 (K 5 and 8) and CAM 5.2 (K 8). The adenocarcinomas (n = 5), the solid carcinomas (n = 2), and the carcinosarcoma (n = 1) showed heterogeneous labelling with the MoAbs specific for luminal cell antigens in the normal canine mammary gland, i.e., K 18, K 7 and K 19 MoAbs. These cells were also immunoreactive with K 4 and K 10 MoAbs. The spindle cell carcinomas (n = 2), however, did not react with these MoAbs. All tumours except one adenocarcinoma were characterized by the absence of immunoreactive labelling with the alpha-smooth muscle actin MoAb. In the solid carcinomas this was associated with the absence of labelling with one or both basal cell specific keratin MoAbs, i.e., 8.7 (K 14 and 17) and RCK 107 (K 14), respectively. In contrast, the other malignant tumours showed marked labelling of neoplastic epithelium with these MoAbs. Another remarkable finding was the labelling of a limited to moderate number of neoplastic epithelial cells with the vimentin MoAb. The presence of such labelling patterns in canine mammary gland tumours may be indicative of malignancy. Metastatic tumour tissues had a labelling pattern largely similar to that of the primary tumour, although also loss of reactivity for some keratin MoAbs was seen.

Stromal changes in invasive breast carcinoma: an ultrastructural study

The stroma in infiltrating breast carcinomas, with particular reference to stromal spindle cells, has been studied by electron microscopy. A mixture of cells including resting fibroblasts, active fibroblasts, early myofibroblasts, and mature myofibroblasts has been identified. In loose stroma, myofibroblasts possessed prominent organelles and showed secretory products along the cell surface, whereas in dense stroma, there was relative prominence of cytoplasmic filaments as well as other features consistent with a contractile state of myofibroblasts. The degree of myofibroblastic proliferation was related to the growth pattern of the tumour. It is suggested that the infiltrating process of cancer cells is analogous to wound production and healing with continuous granulation tissue and scar formation resulting in the characteristic desmoplastic reaction seen in certain breast carcinomas.

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.

Radial scars of benign and malignant breasts: comparative features and significance

From a study of tissue from 34 cancerous breasts and 34 benign breasts the nature and occurrence of radial scars has been assessed. The frequency of detection was influenced more by the amount of tissue assessed and by the diligence of search than by any association with cancer. Bilaterality and multifocality were features in cancerous and benign breasts and a similar range of scar histological appearance was apparent in both types. The histological features of 103 radial scars were tabulated to compare the association of characteristics within individual scars, and the information used to formulate modes of development and progression. The 'early' stage appeared to correlate with central chronic inflammatory response, many spindle cells and minor fibroelastotic distortion of parenchyma; the 'late' stage showed few spindle cells and dominant fibroelastosis with considerable distortion and separation of parenchymal elements. No support was found for the concept that the lesion is premalignant. Rather it belongs to the spectrum of sclerosing alterations affecting the breast parenchyma which ranges from physiological through to clearly pathological changes. Position in the spectrum depends upon the extent and degree of change.

Basement membrane and apocrine epithelial antigens in differential diagnosis between tubular carcinoma and sclerosing adenosis of the breast

The distributions of defined basement membrane proteins in nine pure tubular carcinomas, 10 cases of sclerosing adenosis, and 15 ductal adenocarcinomas were compared. Sections of formalin fixed, paraffin embedded specimens were pretreated with pepsin and then immunostained for laminin, type IV collagen, and basement membrane proteoglycan, components specific for basement membranes. In sclerosing adenosis the tubules were surrounded by a continuous intact basement membrane composed of laminin, type IV collagen, and basement membrane proteoglycan, while the epithelium in the tubular carcinomas was negative for these proteins. The tumours were also analysed for the distribution of the apocrine epithelial antigen (AEA). In contrast to the benign lesions the tubular carcinomas expressed the AEA in a distinct non-polar fashion throughout the cell surface. In normal ducts and in adenosis the AEA was confined exclusively to the luminal surface. These studies suggest that there is a disturbance of cell polarity in tubular carcinomas. It is concluded that a combined analysis of basement membrane proteins and luminal surface antigens is a reliable and convenient way to differentiate between tubular carcinoma and sclerosing adenosis of the breast.

Intraluminal calcium hydroxyapatite crystals in breast carcinoma: an ultrastructural study

Sixty-three breast carcinomas were examined by electron microscopy to determine the frequency of calcium hydroxyapatite (apatite) within tumor lumina. Twenty-one adenocarcinomas contained apatite in intracytoplasmic and/or intercellular lumina. Well-differentiated tumors exhibited a higher incidence of apatite (44%), while only 20% of the poorly differentiated tumors contained apatite (gamma = +.22). There was no apparent correlation between the presence of apatite and a positive estrogen receptor assay. Ninety-eight adenocarcinomas of other than breast origin (previously processed for electron microscopy) were examined, revealing 2 cases containing apatite in the appropriate locations. The tissue of origin in one case was determined to be ovarian, while the origin of the second case remains undetermined. The ultrastructural finding of apatite in lumina of adenocarcinoma appears to be unusual in that it has only been observed in breast carcinomas and certain ovarian tumors. The presence of apatite within the lumen in addition to other characteristics of an adenocarcinoma may suggest the breast as the primary site.

Ultrastructure of gastric myxofibroma with intracytoplasmic collagen

Electron microscopy of a small mass removed from the stomach of a 65-year-old women demonstrated a myxofibroma composed of a pure population of fibroblasts, many of which contained intracytoplasmic, membrane-bound collagen fibers similar to those found in a few other human tumors and in certain experimental conditions. This ultrastructural documentation supports the hypothesis that pure fibrous neoplasms of the stomach do occur. Electron microscopy of gastric mesenchymal tumors almost always allows for confident differentiation among fibrous, neural, and smooth muscle neoplasms.

Aggressive fibromatosis involving the paramandibular soft tissues. A study with the aid of electron microscopy

The distinction at the level of light microscopy between aggressive fibromatosis and low-grade malignancies with fibroblastic features may be difficult. An electron microscopic study of four cases of aggressive fibromatosis of the mandibular soft tissue was undertaken to determine whether any ultrastructural characteristics could be identified that would aid in a more uniform distinction between these lesions. The pertinent findings include the identification of cells of fibroblastic derivation showing a range of organelle-poor to organelle-rich features, cytoplasmic microfibrils, and dilated rough endoplasmic reticulum profiles. These features are discussed in the light of previously published findings of other forms of aggressive fibromatosis and closely related lesions. The study reaffirms that although electron microscopy may be useful in confirming the cell of origin in these lesions, the accurate diagnosis of fibrous tumors still rests with the proper correlation of clinical and light microscopic features. Clinical follow-up of the cases supports both the diagnosis of aggressive fibromatosis and the recommended treatment of adequate local excision.

Tubular carcinoma of the breast. Clinical pathologic correlations based on 100 cases

One hundred tubular carcinomas were reviewed, analyzed and compared with previously reported studies in the literature. Our cases were subdivided into five groups, according to the proportion of the carcinoma which was tubular. In the case of pure or almost pure tubular carcinomas (76% or more), tumor size was small, no metastases were found, no recurrences developed, and there were no deaths attributable to the carcinoma. As the proportion of the carcinoma which was tubular decreased, the size and biologic aggressiveness of the tumor increased; this it is likely that tubular carcinoma may represent an early form of carcinoma. A right-sided preponderance was found of the "pure tubular" carcinomas; and lesions of the central sector of the breast were rare in all five groups. The incidence of bilateral cancer was greater than that expected for breast cancer in general and included three patients with bilateral tubular carcinomas. On the basis of our findings, we suggest that lesions which are composed 90% or more of tubular carcinoma may be treated by simple mastectomy, and that axillary dissection is not necessary. For all carcinomas with a lower proportion of tubular elements, at least total mastectomy and axillary dissection are indicated, although the safest treatment probably is radical mastectomy.

Tubular carcinoma: a variant of secretory breast carcinoma

Fifteen cases of tubular carcinoma of the breast have been studied using histochemical methods for mucosubstances, immunocytochemical methods for casein and actin and conventional electron microscopy. Mucosubstances and casein were demonstrated lying freely in the lumina of the tubules. Occasionally, mucosubstances and casein assumed the form of target-like intracytoplasmic 'inclusions' like those characteristically seen in lobular carcinoma. The neoplastic cells did not react with antisera specific against actin. Even at ultrastructural level no myoepithelial cells were observed, whilst villi were revealed along the tubular luminal surface. It appears that, in addition to distinctive biological, histological and ultrastructural features, tubular carcinoma has an almost constant histochemical pattern. This suggests a differentiation towards epithelial secretory cells engaged in intensive milk protein production which has also been shown to be a feature of lobular carcinoma. It is concluded that though lobular carcinoma and tubular carcinoma of the breast have been traditionally regarded as two distinct entities, they have certain similar functional characteristics and it is postulated that these two tumours could represent the extreme variants fo the same entity: the infiltrative lobular carcinoma being the most undifferentiated and tubular carcinoma the most highly differentiated.

ATPase activity in the breast: a comparison between three methods

Adenosine triphosphatase enzymatic activity was investigated in human approximatively normal, dysplastic and neoplastic mammary tissue, by three different methods. Staining intensity varied within wide limits; myoepithelial cells and blood vessels showed similar enzymatic activity. Epithelial cells reacted only faintly, or not at all; carcinoma cells were never labelled. Stromal response was highly variable. The calcium-cobalt method of Padykula and Herman gave more intense reactions than the lead-nitrate procedure of Wachstein and Meisel, either in the original form or according to the modifications recommended by Russo and Wells. With the latter method the sharpness of stain deposits on the different structures was markedly enhanced. The functional significance of ATPase activity is discussed.

Myxoma of the mandible--a fibroblastic tumor

A case of myxoma of the mandible is described. The tumor was examined by both light and electron microscopy. Histochemistry showed an abundant acid mucopolysaccharide stroma, embedded in which were stellate cells with branching processes. Ultrastructurally, these cells were seen to be fibroblasts. Occasional myofibroblasts were seen in the tumor. No odontogenic epithelium was identified, and this component was not thought to be important in the histogenesis of the tumor.

Mucin-producing carcinomas of the breast: ultrastructural observations

The ultrastructural characteristics of mucin production in mammary mucoid carcinoma, signet ring cell carcinoma (Harris, Wells & Vasudev 1978), papillary carcinoma and lobular carcinoma are compared. The mucin in lobular carcinoma is confined to intracytoplasmic lumina whereas it is present as membrane bound granules in the other three types, although intracytoplasmic lumina also occur in the latter. A possible origin of intracytoplasmic lumina from distended Golgi cisternae is proposed. Possibly, extracellular mucin acts as a mechanical barrier between tumour cells and lymphatics, thus explaining the good prognosis of typical mucoid carcinomas.