Argyrophilic cells in carcinoma of the female breast

Not only stem cells, but also mature cells, particularly neuroendocrine cells, may develop into tumours: time for a paradigm shift

Stem cells are considered the origin of neoplasms in general, and malignant tumours in particular, and the stage at which the stem cells stop their differentiation determines the degree of malignancy. However, there is increasing evidence supporting an alternative paradigm. Tumours may develop by dedifferentiation from mature cells able to proliferate. Studies of gastric carcinogenesis demonstrate that mature neuroendocrine (NE) cells upon long-term overstimulation may develop through stages of hyperplasia, dysplasia, and rather benign tumours, into highly malignant carcinomas. Dedifferentiation of cells may change the histological appearance and impede the identification of the cellular origin, as seen with gastric carcinomas, which in many cases are dedifferentiated neuroendocrine tumours. Finding the cell of origin is important to identify risk factors for cancer, prevent tumour development, and tailor treatment. In the present review, we focus not only on gastric tumours, but also evaluate the role of neuroendocrine cells in tumourigenesis in two other foregut-derived organs, the lungs and the pancreas, as well as in the midgut-derived small intestine.

Mammary Carcinoma with Argyrophilic Cells: An Immunohistochemical and Ultrastrctural Study

The immunohistochemical and ultrastructural findings of 7 primary argyrophilic tumors of the breast are described. Five cases were selected because of a growth pattern reminiscent of a « carcinoid » tumor and 2 were obtained from 70 consecutive common carcinomas. All patients were females (mean age 68.8) and none had clinical evidence of hormonal secretion. On ultrastructural examination dense-core granules were seen in addition to findings more suggestive of a common carcinoma. Immunoperoxidase stainings for ACTH, calcitonin etc. were negative in all tumors. The authors believe that organoid growth pattern, argyrophilia and dense-core neurosecretory-like granules are not sufficient elements to demonstrate the endocrine nature of a breast neoplasm.

Primary breast carcinomas with neuroendocrine features: Clinicopathological features and analysis of tumor growth patterns in 36 cases

Primary breast carcinoma with neuroendocrine features (NEBC) is an uncommon tumor. In the classification of WHO 2012, these tumors were categorized as: 1- neuroendocrine tumor, well-differentiated; 2- neuroendocrine carcinoma, poorly differentiated/small cell carcinoma; and 3- invasive breast carcinoma with neuroendocrine differentiation. In this study, we reviewed NEBC except poorly differentiated/small cell carcinoma variant in order to define the morphological growth patterns and cytonuclear details of these tumors. All breast surgical excision materials between 2007 and 2016 were re-evaluated in terms of neuroendocrine differentiation. Thirty-six cases showing positive staining for synaptophysin and/or chromogranin A in ≥50% of tumor cells were included in the study. All cases were female with a mean age of 67.4. Mean tumor diameter was 26 mm. Multifocality was noted in 5 cases. Grossly, they were mostly infiltrative mass lesions. T stages, identified in 34 cases, were as follows: 13 cases with pT1; 19 pT2 and 2 pT3. We described schematically 4 types of patterns depending on predominant growth pattern, except one case: 1) Large-sized solid cohesive groups (6 cases), 2) Small- to medium-sized solid cohesive groups with trabeculae/ribbons and glandular structures (6 cases), 3) Mixed growth patterns (20 cases), 4) Invasive tumor with prominent extracellular and/or intracellular mucin (3 cases). The tumor cells were mostly polygonal-oval with eosinophilic/eosinophilic-granular cytoplasm. The nuclei of tumor cells were mostly round to oval with evenly distributed chromatin. Only 5 cases showed high grade nuclear and histological features. Molecular subtypes of the cases were as follows: 33 luminal A, 2 luminal B, and 1 triple negative. NEBC should come to mind when a tumor display one of the morphological patterns described above, composed of monotonous cells with mild to moderate nuclear pleomorphism and abundant eosinophilic/eosinophilic granular or clear cytoplasm, especially in elderly patients.

[Primary neuroendocrine tumors of the breast: a retrospective study of 21 cases and literature review]

PURPOSE

The aim of the present study was to discuss the epidemiology, clinical and pathologic features, treatment, and prognosis of primary neuroendocrine carcinomas of the breast.

PATIENTS AND METHODS

We report 21 cases diagnosed over a period of 12 years (1995-2011) at the university hospital of Sfax. A review of the clinical data with pathology and immunohistochemistry study was carried out for all the cases.

RESULTS

The average age was 62 years (34-86 years). At the time of the diagnosis, tumours were classified T1 and T2 (16 cases), N1 (11 cases) and M1 in two cases. The histological examination has shown 13 cases of solid neuroendocrine carcinoma, six cases of large cell type and two cases of atypical carcinoid. Grade I and II SBR were found in 18 cases. Eighty-one percent of the tumours were reactive for synaptophysin; all tumours were positive for chromogranin. Thirteen (61.9%) tumours were estrogen receptor-positive and 12 (57.5%) progesterone receptor-positive. Nineteen (90.5%) tumours were negative for HER2/neu. Overall five-year survival was 72.7%. All patients had surgical treatment with modified radical mastectomy in 13 cases. Adjuvant treatment was indicated according to histopronostic elements.

CONCLUSION

For primary neuroendocrine carcinoma of the breast, multivariate analysis identified three predictive factors for mortality: disease stage, histological grade and lymph node involvement.

Neuroendocrine differentiation in carcinoma of the breast. Tyramide signal amplification discloses chromogranin A-positive tumour cells in more breast tumours than previously realized

The aim of the study was to determine if, by means of tyramide signal amplification (TSA), the presence of chromogranin A (CgA)-positive tumour cells could be demonstrated in breast cancer cases found to be negative by conventional immunohistochemical staining. Sections from 44 cases of breast cancer (28 infiltrating ductal carcinomas, 2 lobular carcinomas, 4 ductal carcinomas in situ (DCIS), 7 lobular carcinomas in situ (LCIS), and 3 mucinous carcinomas) were stained for CgA by conventional immunohistochemical methods and by immunohistochemistry with TSA. The sections were also histologically graded and their oestrogen receptor (ER), progesterone receptor (PgR) and HER-2 oncogene status was recorded. Five of the tumours showed CgA-positive staining with the polyclonal antibody 430 with conventional methods. Thirty cases showed CgA-immunoreactive tumour cells after immunohistochemical staining with the polyclonal antibody 430 with TSA. However, eight of these also showed faint staining with the negative control antibody X0936 with TSA. One case showed immunopositivity for CgA using a monoclonal antibody without tyramide amplification and only a further two cases were positive when TSA was applied. The presence of CgA appears to be associated with a lower histological grade and may be more often found in oestrogen receptor-positive tumours.

A case of endocrine ductal carcinoma of the breast

A case of endocrine ductal carcinoma of the breast is presented. A 65-year-old woman was admitted with complaints of left breast mass and pain. Physical examination, mammography, ultrasonography, and computed tomography showed a mass 5 cm in diameter in the left breast suggestive of breast cancer, and incisional biopsy confirmed ductal carcinoma. Auchincloss's mastectomy was performed. The tumor, 4.0 x 3.8 cm in size, consisted of a relatively uniform proliferation of tumor cells with round nuclei and abundant eosinophilic cytoplasm. Immunohistochemically, tumors cells were positive for chromogranin A, synaptophysin, and neuron-specific enolase. Endocrine ductal carcinoma with invasion was diagnosed. No lymph node metastasis was observed, and estrogen and progesterone receptors were positive.

Expression of chromogranin/secretogranin mRNA in spontaneous mammary tumors in aging Fischer-344 rats

There is a type of human breast cancer showing a neuroendocrine differentiation. Little is known, however, about the cell origin of this cancer or the process by which it expresses neuroendocrine features. Rat mammary tumors, either spontaneous or induced, have not been subjects for the investigation of aspects regarding the neuroendocrine differentiation of mammary epithelial cells. The aim of the present study was to show the potential of rat mammary tumors for expressing chromogranin (Cg)/secretogranin (Sg) mRNA. We examined CgA, SgI and SgII mRNA expression by reverse transcription-polymerase chain reaction in rat mammary adenocarcinoma and fibroadenoma which had arisen spontaneously in aging Fischer-344 rats. CgA and SgII mRNA were expressed in both mammary tumors, but SgI mRNA was not detected in either. The results of the present study show that rat mammary tumors can express chromogranin genes.

A case of breast cancer with endocrine features

Cancer with endocrine features rarely occurs in the breast. We report a case of breast cancer with endocrine features in an 80-year-old woman. The tumors were treated by wide excision and a postoperative histopathologic diagnosis of carcinoma of the breast with endocrine features was made. Immunostaining was positive for chromogranin A, neuron-specific enolase and synaptophysin, but weakly argyrophilic. Widespread metastases occurred two months postoperatively, and the patient died of breast cancer 6 months after the first treatment

Small cell (oat cell) carcinoma of the breast

A case of small cell (oat cell) carcinoma, which represents both the most distinctive and the least common type of breast carcinoma with neuroendocrine differentiation and usually shows the most aggressive behavior, is described. Radical mastectomy was performed on a 56-year-old female for a 10 cm tumor located in the outer part of the right breast with cutaneous ulceration Microscopically, the tumor predominantly consisted of a diffuse proliferation of small, round to ovoid cells with hyperchromatic nuclei and ill-defined, scant cytoplasm that was reminiscent of oat cell carcinoma of the lung. There were foci of invasive ductal carcinoma and ductal carcinoma in situ. Small cell carcinoma areas constituted approximately 90% of the neoplasm. The patient had axillary lymph node metastasis. The small tumor cells were argyrophilic and positive for CAM5.2, carcinoembryonic antigen, neuron-specific enolase, Leu-7, chromogranin A and synaptophysin. Flow cytometric analysis showed an aneuploid DNA content. The patient was alive and well without disease 4 years after surgery. Small cell carcinomas of the breast may exhibit a spectrum of malignancy that is comparable to similar tumors at better known primary sites.

Sex steroid receptor expression in 'carcinoid' tumours of the breast

Nine 'carcinoids' of the breast (argyrophilic carcinomas) were examined for the presence of estrogen receptor (ER), progesterone receptor (PR), and androgen receptor (AR), using immunohistochemistry. The tumours were selected on the basis of their histo-morphological appearance and positive Grimelius stain. All cases were immunoreactive for neuron-specific enolase (NSE). In one case the tumour cells were intensely chromogranin A positive. All cases were ER positive, while 5 cases expressed AR and 5 cases PR. Immunostaining for ER and simultaneous demonstration of argyrophilia or chromogranin A expression in chromogranin A positive argyrophilic carcinoid tumour of the breast provided further evidence that neuroendocrine cells in breast tumours express sex steroid receptors. The similarity in sex steroid receptor expression pattern in 'carcinoids' of the breast and the more common categories of breast cancer suggests an identical responsiveness to endocrine therapy.

Endocrine ductal carcinoma in situ (E-DCIS) of the breast: a form of low-grade DCIS with distinctive clinicopathologic and biologic characteristics

Endocrine ductal carcinoma in situ (E-DCIS), first characterized by Cross et al. in 1985, is an uncommon entity, and there is little information on its pathobiologic features and natural history in the literature. This report describes the largest series of 34 cases: 14 cases were pure in situ (group A), and 20 were accompanied by an invasive component (group B). All except three patients were over the age of 60 years, with the mean being 69.5 years for group A and 72.6 years for group B. Except for six patients in group A who had nipple discharge, all had a breast mass. On follow-up, one of five group A patients developed local recurrence 5 years after mastectomy, and two of seven group B patients developed another invasive primary in the contralateral breast. Histologically, E-DCIS showed expansile intraductal growths forming solid sheets and festoons traversed by delicate fibrovascular septa. Accumulation of basophilic mucin might be found within the growth and the fibrovascular septa. There were variable degrees of stromal sclerosis. In some cases, the solid intraductal cellular proliferations were focally punctuated by microglandular spaces and rosettes. Comedo necrosis was absent. Intraductal papillomas were found in the immediate vicinity of the tumors in 18 cases and invariably showed pagetoid involvement by E-DCIS. Pagetoid spread into the adjacent ducts and ductules was also a common feature (17 cases). The tumor cells were polygonal, oval, or spindly, often with eccentrically placed, bland-looking, ovoid nuclei and abundant eosinophilic granular cytoplasm. Intracellular mucin was commonly demonstrable. Immunostaining for myoepithelium using muscle-specific actin antibody confirmed the in situ nature of the E-DCIS component. The majority of tumor cells showed strong staining with the neuroendocrine markers chromogranin, synaptophysin, and neuron-specific enolase (monoclonal). Immunostaining also dramatically highlighted the pagetoid spread into the papillomas and ductules by outlining the tumor cells between the negatively stained residual ductal epithelium and myoepithelium. All cases were immunoreactive for estrogen and progesterone receptor, but not p53 and c-erbB2. The Ki-67 index was < 5%. Ultrastructural studies on four cases showed many dense-core neurosecretory granules and larger mucigen granules. In group B cases, the invasive component, which comprised 5-95% of the tumor, included colloid carcinoma, 12; "carcinoid" tumor, 3; mixed "carcinoid"/colloid carcinoma, 4; and small cell neuroendocrine carcinoma, 1. Neuroendocrine markers were also consistently demonstrable in the invasive component. In conclusion, E-DCIS is predominantly a disease of older women that is frequently accompanied by papillomas in the vicinity and may present as nipple discharge (an uncommon presentation in the usual forms of DCIS). It can mimic epitheliosis histologically, but the pagetoid spread is a helpful clue to its neoplastic nature. The bland nuclear morphology, lack of necrosis, and biologic marker profile suggest that E-DCIS is a form of low-grade DCIS despite its solid growth pattern. The invasive carcinomas associated with E-DCIS are also neuroendocrine programmed rather than the usual types of ductal carcinomas, suggesting that E-DCIS represents a biologically distinctive category of DCIS.

Diagnostic criteria of classical carcinoids

The classical (mid-gut) carcinoids of the intestinal tract display a characteristic light microscopic morphology. However, sometimes intestinal tumours are seen resembling carcinoids and differential diagnostic difficulties arise. In the present study silver stains and immunoreactivities to chromogranin A + B, cytokeratins and epithelial membrane antigen (EMA) were evaluated as diagnostic adjuncts in six classical carcinoids and six intestinal carcinomas with carcinoid-like features. All classical carcinoids were argentaffin and argyrophil and contained a majority cell population with chromogranin immunoreactivity while only one carcinoid-like carcinoma was chromogranin-immunoreactive and the stained cells in that case represented a minority of the tumour cell population. The cytokeratins were shown to be non-discriminatory. However, EMA expression occurred in five intestinal carcinomas and in the majority of the tumour cells of four of these cases, while only one classical carcinoid displayed a few EMA positive cells. Thus, silver stains in combination with chromogranin A + B and EMA appears to be of value to discriminate between classical carcinoids and carcinoid-like intestinal carcinomas. Further when intestinal carcinoids and carcinoid-like carcinomas are diagnosed with the aid of various tumour markers both qualitative and quantitative considerations must be made.

Gastrointestinal carcinoid tumours. Histogenetic, histochemical, immunohistochemical, clinical and therapeutic aspects

The increased knowledge of the pathobiology of gastrointestinal carcinoid (neuroendocrine) tumours and the improved therapeutic possibilities have brought a demand for more precise diagnosis. Although the carcinoid tumours can often be tentatively recognized in routinely processed microscopic slides, their more accurate identification requires additional diagnostic procedures. General neuroendocrine markers such as the argyrophil reaction of Grimelius and immunohistochemistry with application of antibodies against chromogranin A and of neuron-specific enolase are discriminatory staining methods which are used to reveal the neuroendocrine origin of almost all highly differentiated carcinoid tumours of the gastrointestinal tract. Mid-gut carcinoids, which predominate among these tumours almost unexceptionally contain serotonin. This biogenic amine can be demonstrated by the argentaffin reaction of Masson, serotonin immunoreactively or by formalin-induced fluorescence. The characteristic staining pattern of mid-gut carcinoids is almost invariably preserved in the metastatic deposits and consequently the staining methods for identifying serotonin can also be used on metastases to reveal a primary mid-gut carcinoid. The enterochromaffin-like (ECL) cell carcinoids of the body and fundic area of the stomach often seen in association with pernicious anaemia are argyrophil with the Sevier-Munger silver stain. Other neuroendocrine tumours, viz. antral, duodenal and rectal carcinoids should be studied by a battery of relevant peptide hormone antisera for adequate diagnosis. During the last decade new peptide hormones have been found in circulation in patients with carcinoid tumours, but serotonin and urinary 5-HIAA are still the most important markers for carcinoids of the mid-gut origin. Other clinically useful tumour markers are chromogranin A + B, pancreatic polypeptide, human chorionic gonadotropin alpha and beta subunits. For localizing procedures, angiography is the most reliable investigative method for primary tumours in the gut, whereas CT-scan and ultrasound investigations are good for detection of liver metastases. During the last five years, the therapy for malignant carcinoid tumours has been considerably improved. Chemotherapy has only revealed objective response rates in about 10-30% of the patients giving median survivals from start of therapy of about 10 months. Recently treatment with alpha interferons and the new somatostatin analogue octreotide have given objective responses in 50-75% of patients with malignant mid-gut carcinoid tumours. These patients have now a median survival from start of therapy of 70 months when treated with alpha interferons. In the future new therapies will come into use such as monoclonal antibodies and perhaps also agents blocking different growth factors.

Argyrophil carcinoma of the breast: a cytologic, histochemical, and ultrastructural study of a case

Aspirate from an argyrophil carcinoma ("carcinoid") of the breast showed malignant dispersed epithelial cells. With Diff-Quik, the cytoplasm was seen to be abundant, with prominent eosinophilic granularity. The nuclei were fairly uniform, round or oval, and eccentric and had a finely stippled chromatin pattern. On histology, the tumor appeared typical for argyrophil carcinoma, and staining with Grimelius for argyrophilic granules was positive. Membrane-bound neurosecretory granules were seen on electron microscopy.

Diagnostic pathology of gastrointestinal and pancreatic neuroendocrine tumours

The increased knowledge of the pathobiology of gastrointestinal and pancreatic neuroendocrine tumours and the improved therapeutic possibilities have brought a demand for more precise diagnosis. Although the neuroendocrine tumours can often be tentatively recognized in routinely processed microscopic slides, their more accurate identification requires additional diagnostic procedures. General neuroendocrine markers, such as the argyrophil reaction of Grimelius and immunohistochemistry with application of antibodies against chromogranin A and of neuron-specific enolase are discriminatory staining methods which are used to reveal the neuroendocrine origin of almost all highly differentiated neuroendocrine tumours of the gastrointestinal tract (carcinoids) and pancreas (insulomas). Midgut carcinoids, which predominate among these tumours almost unexceptionally contain serotonin. This biogenic amine can be demonstrated by the argentaffin reaction of Masson, serotonin immunoreactivity or by formalin-induced fluorescence. The characteristic staining pattern of midgut carcinoids is almost invariably preserved in the metastases and can thus be used to reveal a primary midgut carcinoid. The enterochromaffin-like (ECL) cell carcinoids of the body and fundic area of the stomach are argyrophil with Sevier-Munger silver stain. Other neuroendocrine tumours, viz, antral, duodenal and rectal carcinoids and insulomas, should be studied by a battery of relevant peptide hormone antisera for adequate diagnosis. About 50% of all insulin-producing insulomas are endowed with stromal amyloid deposits, which chemically are composed of a peptide designated islet amyloid polypeptide. This molecule has been observed by electron microscopical immunocytochemistry to occur exclusively in the beta-cells and is co-stored with insulin in the beta-cell granules.

Neuroendocrine differentiation in breast lesions

A review of neuroendocrine features in breast carcinomas is presented and markers for neuroendocrine cells are discussed. Immunostaining for neuron specific enolase is the best screening marker for neuroendocrine cells in breast carcinomas, but immunoreactivity for hormones is not present in all neuron specific enolase (NSE) positive cases. Normal myoepithelial cells are also NSE positive. Thirty per cent of breast carcinomas are NSE positive. Biochemical demonstration of ACTH, PTH and calcitonin, and immunohistochemical demonstration of ACTH, bombesin, serotonin, prolactin, gastrin, VIP, leu-enkephalin, pancreatic polypeptide, beta-endorphin and sub P has been reported in breast carcinomas. Neuroendocrine cells have not been convincingly demonstrated in the normal breast or in benign breast lesions.

The significance of argyrophilia in human breast carcinomas

The significance of demonstrating argyrophilia in human breast carcinomas is a complex issue, although there is general agreement that "true" carcinoid tumours of the breast are rare. A predominantly unselected series of breast carcinomas has been investigated for evidence of argyrophilia using the Churukian Schenk method (Churukian and Schenk 1979), alpha lactalbumin and prealbumin, a marker of neuroendocrine cells. Argyrophilia has been detected in 25% of carcinomas, including all of mucinous types. However, only 4 of 68 tumours had a diffuse cytoplasmic reaction typical of that seen in neuroendocrine cells. The others showed a focal or subluminal/peripheral reaction. Those argyrophilic carcinomas with demonstrable alpha lactalbumin had this latter pattern of reactivity, although the milk protein was always detected in lesser amounts by comparison. Prealbumin was only found to varying degrees in eight tumours and the majority of these had a diffuse or focal cytoplasmic argyrophilic reaction. It would appear that in only a small number of breast carcinomas, approximately six percent, does the presence of argyrophilia probably represent neuroendocrine differentiation, whilst in others it is related to the secretory nature of the tumour cells.

Endocrine variant of ductal carcinoma in situ of breast: ultrastructural and light microscopical study

The ultrastructural and light microscopic presentation of the recently described entity of the in situ endocrine variant of ductal carcinoma of breast are presented.

Nuclear DNA content in breast carcinomas with neuroendocrine differentiation

Sixty-one breast carcinomas (54 infiltrating ductal carcinomas and seven infiltrating lobular carcinomas) were immunostained with anti-NSE and analysed with respect to nuclear DNA content. Nine of the 23 NSE-positive breast carcinomas were diploid, five were triploid, six tetraploid and three pentaploid. Twenty-one of the 38 NSE-negative tumours were diploid, 10 were triploid, seven tetraploid, and none were pentaploid. Three of the eight histologically grade I tumours in the NSE-positive group were aneuploid, whereas all the six grade I tumours in the NSE-negative group were diploid. The results show that a proportion of breast carcinomas with neuroendocrine differentiation are aneuploid and that aneuploid tumours that are grade I histologically are found in the NSE-positive group and not in the NSE-negative group.

A study of different markers for neuroendocrine differentiation in breast carcinomas

Forty-two breast carcinomas were studied with different markers for detecting neuroendocrine differentiation. The Bodian and Grimelius silver stains were applied, as well as immunostaining for neurone specific enolase (NSE), chromogranin, prealbumin and a battery of hormones. All cases were studied by electron microscopy as well. The material included 29 infiltrating ductal carcinomas, 10 infiltrating lobular carcinomas and 3 tubular carcinomas. Immunostaining for hormones was obtained in 11 cases (gastrin and PP (4 cases each), leu-enkephalin (3 cases), substance P (2 cases), beta-endorphin (2 cases), ACTH (1 case) and bombesin (1 case). Three cases revealed immunostaining for more than one hormone. Sixteen cases were positively stained with rabbit anti-NSE (Dako Corporation) and included all the 11 cases with proven immunoreactivity for hormones. 20 cases were positively stained with sheep anti-NSE and only 8 of the 11 cases with immunoreactivity for hormones were included. Immunostaining for prealbumin was observed in only 1 case and chromogranin in only 5 cases. All cases were unstained with the Bodian stain, whereas 3 cases showed a positive argyrophilic reaction with the Grimelius technique. Ultrastructural studies revealed typical small membrane-bound electron dense granules in cytoplasm in 4 cases, all among the 11 cases with immunoreactivity for hormones. We conclude that immunostaining with rabbit anti-NSE is the best screening method for detecting breast carcinomas with neuroendocrine differentiation.

Immunocytochemical evidence for neuroendocrine differentiation in human breast carcinomas

Normal and neoplastic human breast tissues have been stained with antibodies recognizing neuroendrocrine differentiation. Fifteen out of 44 (34 per cent), breast carcinomas stained positively with monoclonal antibody LICRLON-E36, and 11 out of 44 (25 per cent) of these tumours stained with an antibody raised against neuron-specific enolase (NSE). Eight tumours stained positively with both antibodies. No correlation was observed between staining with these antibodies and the tumour histology, nor with the degree of cellular differentiation as indicated by staining with several cell surface directed monoclonal antibodies. Ultrastructural analysis of a series of breast tumours showed the presence of membrane-bound dense-core vesicles in almost all tumours, including E36 and NSE positive and negative tumours. The presence of these structures appears to be of little value in predicting neuroendocrine differentiation.

Breast tumors with a solid and uniform carcinoid pattern. Ultrastructural and immunohistochemical study of two cases

Two cases of breast tumors with a uniform solid carcinoid pattern and argyrophilic dense-core granules were analyzed by immunohistochemistry in order to compare their characteristics with known features of other carcinoid tumors and ordinary breast carcinomas. The tumors were positive for keratin-type intermediate filaments, neuron-specific enolase and alpha-chain of human chorion gonadotropin but negative for vimentin and S-100 protein. Laminin was found only in a rim between tumor cell islands and stroma but not among the cells. It is concluded that these tumors are histologically, ultrastructurally and immunohistochemically similar to other carcinoid tumors. The present results suggest that both breast carcinoids and carcinomas may have a common precursor in the mammary secretory unit.

A morphological and immunocytochemical study of a distinctive variant of ductal carcinoma in-situ of the breast

Because so-called 'carcinoid' tumour of the breast has proven to be a difficult entity to define, we studied in-situ carcinoma as there were reasons to believe that this might help clarify the complex problems involved. We studied a consecutive series of 30 cases of ductal carcinoma in-situ (DCIS) by light microscopy and silver impregnation methods and identified a relatively common endocrine variant of DCIS. This variant was studied by immunocytochemical and ultrastructural methods, using conventional DCIS as a control. Endocrine DCIS is identified by its organoid pattern, stromal 'inclusions', festooned structure and a distinctive type of polypoid invagination. It is argyrophilic and rich in neuron-specific enolase. Ultrastructurally it contains abundant dense core granules which are impregnated selectively by Grimelius' method. This tumour type frequently contains peptide hormones of the ACTH family. Three of seven cases contained cells reactive for ACTH and corticotropin-like intermediate lobe peptide CLIP or their precursor, pro-opiomelanocortin. A fourth tumour contained neurotensin, recently identified in a variety of endocrine tumours. Argyrophil invasive carcinomas are a much more heterogeneous group of tumours than argyrophil DCIS and only a minority have an endocrine structure comparable to that described here.

Breast carcinomas with neuroendocrine differentiation

Twenty-two breast carcinomas with membrane bound granules by electron microscopy were tested for the presence of neuron specific enolase (NSE), neuropeptides and serotonin by immunohistochemistry. By light microscopy the cases studied included infiltrating ductal carcinomas, intraductal carcinomas, apocrine carcinomas, infiltrating lobular carcinomas of both classical and alveolar types, mixed lobular/colloid carcinomas, carcinoid growth pattern and one unclassified carcinoma. Ten cases showed immunoreactivity for 1 or 2 neuropeptides in scattered cells whereas all cases were positively and rather diffusely stained with anti-NSE. Immunohistochemical staining at the ultrastructural level was carried out; the presence of neuropeptides could not be confirmed. Scattered granules were marked with gold particles when antiserum against casein was used. We conclude that neither argyrophilia, nor NSE immunoreactivity nor membrane bound granules seen by electron microscopy constitute at present sufficient evidence to designate a breast carcinoma as neuroendocrine. However, our study indicates that certain breast carcinomas of several types do include cells with neuroendocrine features demonstrable convincingly by light microscopic immunohistochemistry. We have no evidence that these breast carcinomas with neuroendocrine features behave differently from their counterparts lacking such features. The intriguing speculation is that neuropeptides produced by certain breast carcinomas may act as local modulators of tumor growth and differentiation.

Immunocytochemical localization of insulin- and somatostatin-like material in human breast tumors

Four types of human breast lesions and C3H mouse mammary adenocarcinomas (type A) were examined for the immunocytochemical localization of cells containing hormone-like substances. Insulin- or somatostatin-like immunoreactive material was observed in scattered single cells and nests of tumor cells in seven of eight infiltrating duct carcinomas, and in the majority of tumor cells from an anaplastic carcinoma. A few somatostatin-immunoreactive cells were observed in only one of seven fibroadenomas studied. No immunoreactive cells were observed in mouse adenocarcinomas or in human breast dysplasias. These results suggest that cells with hormone-like immunoreactivity may be a common feature in two types of malignant human breast tumors.

Argyrophil cells in normal, hyperplastic, and neoplastic endometrium

Scanty argyrophil cells are present in a substantial proportion of normal endometria, particularly during the secretory stage of the cycle. Argyrophil cells are also present in the various types of hyperplastic endometria and are found in more than half of endometrial adenocarcinomas. In some endometrial neoplasms they are present in abundance, but tumours rich in such cells do not have any features suggestive of a carcinoid tumour and are morphologically identical to adenocarcinomas of similar grade which are devoid of argyrophil cells. Endometrial adenocarcinomas containing argyrophil cells tend to be well differentiated and tend not to invade deeply into the myometrium. It is suggested that Müllerian epithelial stem cells possess a potentiality for differentiation into APUD cells.

Small cell neuroendocrine (oat cell) carcinoma of the male breast. Immunocytochemical and ultrastructural investigations

A case of small cell neuroendocrine (oat cell) carcinoma of the breast in a 52-year old male is presented. Oat cell carcinomas have been reported in various extrapulmonary sites, but this is the second case of a primary oat cell carcinoma of the breast and the first one to have been documented in a male. The tumor was investigated histologically, immunocytochemically and ultrastructurally. The relationship to so-called "carcinoid" mammary tumors is discussed.

Mammary carcinoma with argyrophil cells

In a series of 253 cases of carcinoma of the breast, nonargentaffin, argyrophil cells were seen among the tumor cells in 27 cases (10.7%). An electron microscopic examination in one such case revealed dense cored secretory granules surrounded by a limiting membrane within the cytoplasm of the argyrophil tumor cells. Tumors with argyrophil cells, particularly when these cells were abundant, histologically showed a uniform appearance of relatively small constituent cells with oval or round nuclei of a regular size, forming solid alveolar nests or sheets. In one of these tumors, a delicate vascular stroma separated the sheets of tumor cells to form a ribbonlike pattern, simulating the feature of a carcinoid tumor. This tumor, however, is preferably interpreted at present as a mammary carcinoma with features of a carcinoid tumor, because of an incomplete characterization of argyrophil granules in the tumor cells. Other tumors with argyrophil cells were examples basically of ordinarily featured invasive ductal carcinoma. In a search for the origin of these cells, 99 breasts with various noncancerous lesions were examined; however, these argyrophil cells were never detected in any component of these mammary tissues.

Argyrophil endocrine cells with ACTH and HCG immunoreactivity in a carcinoma of the breast

A middle-aged woman without any symptoms of ectopic hormone production underwent a right-sided mastectomy for infiltrating ductal carcinoma. She later developed axillary lymph node metastases which were somewhat carcinoid-like. This prompted further investigation, when scattered argyrophilic endocrine cells were found in both the primary tumour and its metastases. The endocrine cells reacted immunocytochemically with antisera against ACTH and HCG. Despite the endocrine activity of the tumour, it was still regarded as a ductal carcinoma since the endocrine cells constituted the minority cell population. The present study indicates strongly that ectopic hormone production in association with carcinoma of the breast is a result of hormone synthesis and release by the tumour cells.

Exocrine and endocrine cell differentiation in small intestinal adenocarcinomas

Sixteen adenocarcinomas of the small intestine were examined with respect to the ability of the the tumour cells to differentiate in exocrine and endocrine directions. Both intra- and extracellular mucous material was found in 14 tumors and lysozyme immunoreactivity, a characteristic of normal Paneth cells, was seen in scattered tumor cells in two cases. Three tumors contained a few argyrophil cells, indicating the presence of tumor cell population with endocrine production. In two of these tumors some tumor cells displaying an argentaffin reaction, a staining property characteristic of enterochromaffin cells storing serotonin, were also found. In one tumor examined electron microscopically, tumor cells with cytoplasmic zymogen granules were seen and also two different types of endocrine tumor cells containing neurosecretory hormone granules. The results show that the tumor cells of small-intestinal adenocarcinomas possess the ability to differentiate in both the exocrine and the endocrine direction.

Argyrophilic cells in mammary carcinoma

Breast tumor tissues were treated by the Grimelius procedure and examined for the presence of argyrophilic cells. Carcinomas found to contain argyrophilic cells did not include classic carcinoid tumors; the group was, in fact, heterogeneous, comprising poorly differentiated ductal carcinomas, lobular carcinomas, carcinomas of uncertain origin, and colloid carcinomas. Colloid tumors were the most frequently encountered. The prominence of argyrophilic cells in colloid carcinomas raises the possibility that development into mucin-producing cells is propitious for endocrine differentiation.

'Carcinoid' tumours of the breast: the morphological spectrum of argyrophil carcinomas

Fourteen 'carcinoid' tumours of the breast are described. They are separable into five with and nine without intracellular mucin. All the tumours are argyrophil, but none is argentaffin. Four tumours studied ultrastructurally contain dense-core granules. Argyrophil carcinomas represent the endocrine analogues of ductal carcinoma in situ, of invasive ductal carcinoma and probably of lobular carcinoma also. Current views vary between the one that the so-called carcinoid is a rare and totally distinct entity to the view, at the other extreme, that it is a very common variant of conventional breast cancer. On the basis of our findings, an intermediate view is justified: argyrophil carcinomas constitute about 5% of breast carcinomas and some varieties at least have non-argyrophil analogues. Factors influencing the prognosis in individual cases are discussed. Argyrophil carcinomas of the breast form a tumour spectrum with a wide range of morphological and histochemical appearances and a variable prognosis.