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Sanders ME, Allison KH, Chen YY, Lester SC, Johnson NB, Factor RE, Tse GMK, Shin SJ, Eberhard DA, Tan PH, Perou CM, Collins LC, Jensen KC, Korski K, Waldman FM, Reis-Filho J, Knoblauch NW, Beck AH. Abstract P4-05-10: PIK3CA mutations are enriched in invasive lobular carcinomas and invasive mammary carcinomas with lobular features: Results from a TCGA sub-analysis. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-05-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Aberrant signaling via the PI3K pathway is a common alteration in breast cancer (BC), with frequent activating mutations in the PIK3CA gene helical (exon 9) and catalytic (exon 20) domains. These mutations occur across all BC subtypes with an overall incidence of 36%, with the highest frequency (∼45%) in luminal A/ER+ tumors. Lobular phenotype is common among luminal A tumors. We examined associations between lobular histology and molecular features among BC samples submitted for comprehensive molecular analyses for The Cancer Genome Atlas (TCGA).
Design: Experts in breast pathology reviewed digital slides of breast cancer samples submitted for comprehensive molecular profiling to the TCGA. Tumors were graded, subtyped and scored for additional histopathologic features. We tested pairwise associations between lobular features and components of grade, PAM50-derived molecular subtype and mutational status for BRAC1/2, PIK3CA, TP53 and CDH1 by performing Chi-Square analysis for comparisons with a categorical variable and the Mann-Whitney test for comparisons with an ordinal variable
Results: A total of 1132 images were scored from 589 unique cases in TCGA. For cases with multiple scorers (43% of cases), we summarized scores by taking the median (for ordinal variables) or the consensus diagnosis (for categorical variables). A total of 567 cases had a consensus diagnosis for lobular features, all of which had pathological information on components of histologic grade and 540 of which had data for TP53, CDH1, and PIK3CA mutations. 110/567 (19%) of cases were classified as invasive lobular or invasive mammary carcinoma with lobular features. The lobular cases had significantly less nuclear pleomorphism (p = 3.3 e -12), lower mitotic index (p = 3.4e-16), less tubule formation (p = 3.9e-8), increased association with lobular carcinoma in situ (p < 2.2 e-16), decreased stromal inflammation (p = 1.5e-7), and decreased necrosis (p = 4.4e-11) compared with cases without lobular features. Cases with lobular features were highly enriched for CDH1 mutations with 19% of cases with lobular features having CDH1 mutations, compared with only 1% of cases without lobular features (p = 2.4 e-14). The lobular features cases were more likely to have PIK3CA mutations (p = 0.01), with 33% of the lobular features cases having PIK3CA mutations, compared with 21% of the non-lobular cases. The lobular features cases were less likely to have TP53 mutations (p = 0.02), with 13% of lobular features cases having TP53 mutations as compared with 24% of the non-lobular feature cases. Lobular status was associated with PAM50 molecular subtype (Chi-square p = 0.002) with the lobular cases significantly less likely to be basal molecular subtype and more likely to be Luminal-A.
Conclusions: PIK3CA mutations are enriched in invasive lobular carcinomas and invasive mammary carcinomas with lobular features. These associations point to the possibility that PIK3CA mutations as well as CDH1 alterations are important drivers of invasive lobular carcinomas.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-05-10.
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Affiliation(s)
- ME Sanders
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - KH Allison
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - Y-Y Chen
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - SC Lester
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - NB Johnson
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - RE Factor
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - GMK Tse
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - SJ Shin
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - DA Eberhard
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - PH Tan
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - CM Perou
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - LC Collins
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - KC Jensen
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - K Korski
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - FM Waldman
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - J Reis-Filho
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - NW Knoblauch
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - AH Beck
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
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Chen YY, Allison KH, Lester SC, Collins LC, Eberhard DA, Factor RE, Jensen KC, Johnson NB, Korski K, Reis-Filho JS, Sanders ME, Shin SJ, Tan PH, Tse GMK, Waldman FM, Knoblauch NW, Perou CM, Beck AH. Abstract P4-05-15: Breast cancers with BRCA1 and BRCA2 mutations are associated with specific pathologic features and molecular profiles: Results from a TCGA sub-analysis. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-05-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Previous studies have found that particular pathologic features are more common in breast cancers arising in BRCA mutation carriers. However, the biologic and molecular bases for the morphologic associations are not clear. This study is conducted to analyze pathologic and molecular features in tumors stratified by BRCA1 or BRCA2 mutation status using the breast cancer samples that have comprehensive molecular portraits characterized by the Cancer Genome Atlas (TCGA).
Methods: The digital slides of breast cancer samples submitted for comprehensive molecular profiling to the TCGA were reviewed by expert breast pathologists, who were unaware of the BRCA status or other molecular signatures. Each tumor was evaluated and scored for histologic type, nuclear pleomorphism, tubule formation, mitosis, stromal inflammation, and necrosis. 562 cases had both pathology and tumor exome sequencing data available and constituted the current study population. We determined the association of somatic BRCA1 and BRCA2 mutation status with pathologic features and molecular characteristics (mutation of PIK3CA and TP53, and molecular subtypes defined by PAM50 mRNA data) using the Fisher exact test for categorical variables and the Wilcoxon test for ordinal variables.
Results: Of the 562 tumors, 514 had no BRCA1 or BRCA2 mutation, while 48 (8.5%) of tumors were found to harbor a BRCA1 mutation (n = 16, 3%), BRCA2 mutation (n = 30, 5%), or mutation in both (n = 2, 0.3%). BRCA1 and BRCA2 mutational status showed no significant association with lobular features, tubule formation, nuclear pleomorphism, or stromal inflammation (all p > 0.05), although there was a trend for increased nuclear pleomorphism in BRCA2 mutant cases (p = 0.07). The lack of significant association of BRCA1/2 mutational status with these features may be due to our study's relatively small number of BRCA1/2 mutant cases. Both BRCA1 and BRCA2 mutations were associated with a higher mitotic count (p = 0.03 and 0.04, respectively). BRCA2 mutation showed no association with necrosis (p = 1), while BRCA1 mutation status was associated with increased necrosis (OR = 2.7, p = 0.04). BRCA2 mutation status showed no significant association with PAM50 subtype (p = 0.37), while BRCA1 mutation status was significantly associated with PAM50 molecular subtype (p = 0.005), with the greatest enrichment among Basal-like (7/70 Basal-like with BRCA1 mutation, 10%) and depletion among Luminal-B (0/79 Luminal-B with BRCA1 mutation, 0%). Neither BRCA1 nor BRCA2 mutations were significantly association with PIK3CA mutations (p = 0.39, 0.08, respectively). BRCA2 mutation status was not associated with TP53 mutations (p = 0.65), while BRCA1 mutation status was associated with increased TP53 mutations (OR = 4.0, p = 0.005).
Conclusion: Tumors with BRCA1 and BRCA2 alterations are associated with specific pathologic and molecular features. However, there is molecular and morphologic heterogeneity within these cancers. These factors need to be considered when designing algorithms for BRCA testing and targeted therapy in BRCA-related cancers.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-05-15.
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Affiliation(s)
- Y-Y Chen
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - KH Allison
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - SC Lester
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - LC Collins
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - DA Eberhard
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - RE Factor
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - KC Jensen
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - NB Johnson
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - K Korski
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - JS Reis-Filho
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - ME Sanders
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - SJ Shin
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - PH Tan
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - GMK Tse
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - FM Waldman
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - NW Knoblauch
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - CM Perou
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
| | - AH Beck
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology, Bethesda, MD
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Allison KH, Chen YY, Jensen KC, Sanders ME, Reis-Filho J, Lester SC, Johnson NB, Factor RE, Tse GMK, Shin SJ, Eberhard DA, Tan PH, Collins LC, Korski K, Waldman FM, Perou CM, Beck AH. Abstract P4-05-06: Host inflammation and breast cancer molecular subtypes: Updated results from a TCGA sub-analysis. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-05-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: There is increasing evidence that the presence of a host inflammatory response to breast cancer may influence outcomes. Utilizing inflammation scores on the histology of breast cancer samples submitted for comprehensive molecular analyses for The Cancer Genome Atlas (TCGA), we provide an updated look at associations between the presence of host inflammation and breast cancer molecular and pathologic features.
Design: Experts in breast pathology reviewed the digital slides of breast cancer samples submitted for comprehensive molecular profiling to the TCGA and scored each case for the level of inflammation present (high/moderate vs mild/minimal). We tested pairwise associations between host inflammation and molecular subtypes (DNA copy-number, RNA expression, RPPA defined subtypes, miRNA subtypes, methylation subtypes) and pathological features by performing Chi-Square analyses. Multiple hypothesis testing correction was performed using the Bonferroni method.
Results: 598 breast cancer cases with TCGA molecular profiling data were scored by the expert breast pathologists for morphological features (including inflammation). 195 (33%) of these were scored as high/moderate inflammation. Cases with inflammation had a significantly higher rate of TP53 mutations (p = 9.0e-8) with 64 of 118 (54.2%) p53 mutant cases with inflammation. Inflammation was also significantly associated with PAM50 molecular subtypes (p = 2.2e-11), with the greatest enrichment among basal-like (64.5% of 70 basal-like cases had inflammation) and the greatest depletion among Luminal A (18.1% of 166 Luminal A cases had inflammation). Cases with inflammation were significantly less likely to be lobular (p = 1.5e-7), had less tubule formation (p = 0.0006), increased mitoses (p <2.2 e-16), increased nuclear pleomorphism (p = 2.9e-15), and increased necrosis (p = 2.9e-14).
Conclusions: There are strong associations between breast cancer molecular and pathological features and the host inflammatory response.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-05-06.
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Affiliation(s)
- KH Allison
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - Y-Y Chen
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - KC Jensen
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - ME Sanders
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - J Reis-Filho
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - SC Lester
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - NB Johnson
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - RE Factor
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - GMK Tse
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - SJ Shin
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - DA Eberhard
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - PH Tan
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - LC Collins
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - K Korski
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - FM Waldman
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - CM Perou
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
| | - AH Beck
- Cancer Genome Atlas (TCGA) Breast Cancer Expert Pathology Committee, Bethesda, MD
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King AD, Keung CK, Yu KH, Mo FKF, Bhatia KS, Yeung DKW, Tse GMK, Vlantis AC, Ahuja AT. T2-weighted MR imaging early after chemoradiotherapy to evaluate treatment response in head and neck squamous cell carcinoma. AJNR Am J Neuroradiol 2013; 34:1237-41. [PMID: 23306012 DOI: 10.3174/ajnr.a3378] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE T2-weighted MRI shows potential in early posttreatment assessment of the primary tumor. Residual masses composed entirely of low T2-signal scar tissue suggest local control and those ≥1 cm of similar signal to untreated tumor suggest local failure. The purpose of this study was to investigate the diagnostic accuracy of T2-weighted MR imaging early after chemoradiotherapy for identifying primary tumor treatment failure in squamous cell carcinoma of the head and neck. MATERIALS AND METHODS At 6 weeks after treatment, T2-weighted MR images of 37 primary tumors in 37 patients were assessed. Residual masses were divided into 3 patterns: pattern 1 = scar tissue only (flat-edged/retracted mass of low T2 signal intensity); pattern 2 = mass without features described in pattern 1 or 3; and pattern 3 = any pattern that included an expansile mass ≥1 cm of intermediate T2 signal intensity (similar grade of signal intensity to the untreated tumor). T2 patterns were analyzed for local outcome (Fisher exact test) and time to local failure (univariate and multivariate analysis of T2 pattern, age, T stage, and tumor size by use of the Cox regression model). RESULTS Residual masses after treatment were present in 34 (92%) of 37 patients. Local failures occurred in residual masses with pattern 1 in 0 (0%) of 14 patients; pattern 2 in 6 (55%) of 11 patients; and pattern 3 in 9 (100%) of 9 patients. Significant associations were found between local control and pattern 1 (P = <.0001; sensitivity, 74%; specificity, 100%; PPV, 100%; NPV, 75%; accuracy, 85%), and between local failure and pattern 3 (P = <.0001; sensitivity, 60%; specificity, 100%; PPV, 100%; NPV, 76%; accuracy, 82%). Pattern 2 showed no significant associations with local outcome. Univariate analysis of time to local failure showed that the T2 pattern was significant (P < .0001) and remained significant on multivariate analysis. CONCLUSIONS T2-weighted MR imaging is a potential tool for early posttreatment assessment of primary HNSCC treatment response. Awareness of correlation of the T2 pattern of any residual mass with treatment outcome at the primary site may contribute to patient treatment.
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Affiliation(s)
- A D King
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
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Tse GMK, Ma TKF, Lui PCW, Ng DCH, Yu AMC, Vong JSL, Niu Y, Chaiwun B, Lam WWM, Tan PH. Fine needle aspiration cytology of papillary lesions of the breast: how accurate is the diagnosis? J Clin Pathol 2008; 61:945-9. [DOI: 10.1136/jcp.2008.057489] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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King AD, Ahuja AT, Leung SF, Abrigo J, Wong JKT, Poon WS, Woo KS, Chan HS, Tse GMK. MR imaging of nonmalignant polyps and masses of the nasopharynx and sphenoid sinus after radiotherapy for nasopharyngeal carcinoma. AJNR Am J Neuroradiol 2008; 29:1209-14. [PMID: 18467517 DOI: 10.3174/ajnr.a1043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The development of a new polyp or mass in the radiation field of a previously treated carcinoma is usually an ominous sign of a recurrent cancer, but rarely may it be caused instead by a nonmalignant process. The purpose of this study was to document the MR appearance of unusual nonmalignant polyps or masses (NMPMs) in the nasopharynx and sphenoid sinus arising after radiation treatment of nasopharyngeal carcinoma. MATERIALS AND METHODS The MR imaging reports of patients undergoing imaging after radiation therapy for nasopharyngeal carcinoma were reviewed retrospectively to identify patients with unusual polyps and masses in the nasopharynx. The MR images of those patients with no evidence of malignancy on biopsy or follow-up were reviewed. RESULTS The MR imaging reports of 1282 patients were reviewed, and 11 patients (1%) with NMPMs in the nasopharynx or sphenoid sinus were identified. Two patterns were identified: contrast enhancing nasopharyngeal polyps ranging in size from 1 to 5 cm (n = 5) and sphenoid sinus masses consisting of a nonenhancing mass filling a nonexpanded sinus (n = 4) and a heterogeneous enhancing mass expanding the sinus (n = 2). Osteoradionecrosis produced a large defect in the roof of the nasopharynx causing direct communication with the sphenoid sinus (n = 6). Histology revealed granulation tissue in all of the patients with variable amounts of fibrin and inflammatory cells. A direct infective etiology was not proved in any patient. CONCLUSION NMPMs in the nasopharynx and sphenoid sinus are rare complications after radiation therapy to the skull base, but the radiologist needs to be aware of their appearance so that they can be considered in the differential diagnosis of suspected tumor recurrence.
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Affiliation(s)
- A D King
- Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
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Abstract
Breast lesions with mucin represent a broad spectrum of entities, ranging from benign fibrocystic changes with luminal mucin to mucocele-like lesions (MLL), which can be associated with banal epithelial alterations, atypical ductal hyperplasia or ductal carcinoma in situ. Occasionally invasive mucinous carcinoma can be identified in contiguity with MLL. Diagnostic challenges are enumerated, histological differentials are discussed, and a practical approach towards resolving some of these issues is provided. In addition to these lesions with abundant extracellular mucin, there are also conditions that feature stromal mucinous or myxoid material, as well as rare entities that demonstrate both epithelial extracellular and stromal mucin.
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Affiliation(s)
- P H Tan
- Department of Pathology, Singapore General Hospital, Singapore.
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Wong KT, Tsang RKY, Tse GMK, Yuen EHY, Ahuja AT. Biopsy of deep-seated head and neck lesions under intraoral ultrasound guidance. AJNR Am J Neuroradiol 2006; 27:1654-7. [PMID: 16971607 PMCID: PMC8139773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Although transcutaneous ultrasound combined with fine-needle aspiration is often used as initial modality for evaluating superficial neck masses, its role in management of deep-seated neck masses is limited. Intraoral ultrasound and guided biopsy helps in obtaining tissue from deep-seated neck masses for an accurate histologic diagnosis, providing useful information in treatment planning. This article discusses the role of intraoral ultrasound and presents 3 cases in which biopsy of deep-seated neck masses under intraoral ultrasound guidance helped in diagnosis and management.
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Affiliation(s)
- K T Wong
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Hong Kong, China
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Tse GMK, Tan PH, Lui PCW, Gilks CB, Poon CSP, Ma TKF, Law BKB, Lam WWM. The role of immunohistochemistry for smooth-muscle actin, p63, CD10 and cytokeratin 14 in the differential diagnosis of papillary lesions of the breast. J Clin Pathol 2006; 60:315-20. [PMID: 16698948 PMCID: PMC1860581 DOI: 10.1136/jcp.2006.036830] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Histological differentiation of mammary papillary lesions can be difficult. The evaluation of myoepithelial cells can be helpful, with benign papilloma showing a continuous myoepithelial cell layer, which becomes attenuated or absent in malignant papillary lesions. METHODS A large series of 100 papillomas (28 papillomas with florid epithelial hyperplasia) and 68 papillary carcinomas (9 invasive, 44 in situ, and 15 ductal carcinomas in situ (DCIS) involving papillomas) of the breast were stained for myoepithelial cells by immunohistochemistry using antibodies to smooth-muscle actin (SMA), p63, CD10 and cytokeratin (CK) 14. RESULTS In the papillomas, using these four antibodies, myoepithelial cells were positive in 88%, 99%, 91% and 95% of cases, respectively, with SMA showing marked stromal component cell staining and CD10 showing epithelial and stromal staining. CK14 also showed epithelial staining in 71% of papillomas and 96% of papillomas with florid epithelial hyperplasia. In the papillary carcinomas, 36 (53%) cases showed staining of myoepithelial cells that were scattered, discontinuous and diminished in number and the remaining 32 (47%) cases did not show myoepithelial cells. Invasive papillary carcinoma has the lowest proportion (33%) with myoepithelial cells, and DCIS involving papillomas had the highest proportion (87%). CONCLUSIONS p63 had the highest sensitivity and did not cross-react with stromal cells and only rarely with epithelial cells. CK14 has the added ability to distinguish between florid epithelial hyperplasia involving papilloma and DCIS involving papillomas. CK14 and p63 may be used as an adjunct in assessing difficult papillary lesions of the breast.
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MESH Headings
- Actins/metabolism
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Papillary/metabolism
- Carcinoma, Papillary/pathology
- DNA-Binding Proteins/metabolism
- Diagnosis, Differential
- Female
- Humans
- Keratin-14/metabolism
- Middle Aged
- Neoplasm Proteins/metabolism
- Neprilysin/metabolism
- Papilloma/metabolism
- Papilloma/pathology
- Papilloma, Intraductal/metabolism
- Papilloma, Intraductal/pathology
- Trans-Activators/metabolism
- Transcription Factors
- Tumor Suppressor Proteins/metabolism
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Affiliation(s)
- G M K Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China.
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10
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Tse GMK, Tan PH, Ma TKF, Gilks CB, Poon CSP, Law BKB. CD44s is useful in the differentiation of benign and malignant papillary lesions of the breast. J Clin Pathol 2006; 58:1185-8. [PMID: 16254109 PMCID: PMC1770758 DOI: 10.1136/jcp.2005.026906] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS CD44s, the standard form of CD44, has been shown to be downregulated during malignant transformation of breast cancers. It has also been reported recently to be a useful marker in differentiating between benign and malignant papillary lesions of the breast, with high expression in the former. CD44s expression in benign and malignant papillary lesions was evaluated. METHODS CD44s expression was assessed by immunohistochemistry in 101 benign papillomas and 59 papillary carcinomas (seven invasive papillary carcinomas, 41 papillary ductal carcinomas in situ, and 11 ductal carcinomas involving papillomas). RESULTS Patients' age and tumour size were significantly different between the papilloma and papillary carcinoma groups (p < 0.0001). CD44s showed positive staining in 45 papillomas (45%) and five papillary carcinomas (8%), and the difference was significant (p < 0.0001). The myoepithelial cells, when present, were also positive for CD44s in both groups, with no observable differences. Using CD44s positive staining to differentiate between benign and malignant papillary lesions gives a sensitivity, specificity, and accuracy of 45%, 92%, and 62%, respectively. CONCLUSIONS CD44s may be useful as an adjunct in the evaluation of morphologically problematic cases of papillary lesion of the breast.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, Neoplasm/metabolism
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Diagnosis, Differential
- Female
- Humans
- Hyaluronan Receptors/metabolism
- Middle Aged
- Papilloma, Intraductal/diagnosis
- Papilloma, Intraductal/pathology
- Sensitivity and Specificity
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Affiliation(s)
- G M K Tse
- Department of Anatomical Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Ngan Shing Street, Shatin, NT Hong Kong, SAR.
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11
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Lee ML, Chen GG, Vlantis AC, Tse GMK, Leung BCH, van Hasselt CA. Induction of thyroid papillary carcinoma cell proliferation by estrogen is associated with an altered expression of Bcl-xL. Cancer J 2005; 11:113-21. [PMID: 15969986 DOI: 10.1097/00130404-200503000-00006] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE One of the features of thyroid carcinoma is its predilection for women of reproductive age relative to men. An increased risk has also been documented in women who have used estrogens for gynecologic reasons. The aim of this study was to explore the mechanism by which sex hormones contribute to the development of thyroid carcinoma, which is not well understood at present. MATERIALS AND METHODS In this study, we investigated the effects of estradiol and testosterone on cell proliferation in a human thyroid papillary carcinoma cell line (KAT5) by MTT assay. We also studied the expression of estrogen receptors and the levels of anti-apoptotic Bcl-xL protein, pro-apoptotic Bax protein, and messenger RNA in the cells by Western blot and reverse transcriptase polymerase chain reaction analysis. RESULTS The results showed that estradiol promotes cell proliferation when compared with cells treated with testosterone and untreated cells, and that the growth-promoting effect of estradiol was attenuated by tamoxifen. The expression of Bcl-xL was markedly increased in a dose-dependent manner, resulting in an elevated ratio of Bcl-xL to Bax. DISCUSSION We conclude that estradiol promotes KAT5 cell proliferation and that the underlying mechanism may be associated with up-regulation of Bcl-xL expression. The data provide insight into the molecular mechanism underlying the epidemiologic data that shows a two- to threefold increased prevalence of thyroid carcinoma in women relative to men. From the therapeutic point of view, the finding that estradiol enhances anti-apoptotic signaling pathways may be significant in the search for novel prevention and treatment strategies of thyroid carcinomas.
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Affiliation(s)
- M L Lee
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China
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12
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Tse GMK, Wong FC, Tsang AKH, Lee CS, Lui PCW, Lo AWI, Law BKB, Scolyer RA, Karim RZ, Putti TC. Stromal nitric oxide synthase (NOS) expression correlates with the grade of mammary phyllodes tumour. J Clin Pathol 2005; 58:600-4. [PMID: 15917410 PMCID: PMC1770683 DOI: 10.1136/jcp.2004.023028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nitric oxide synthase (NOS), particularly endothelial and inducible forms (e/i-NOS), are expressed in various cancers, including breast cancer. In mammary fibroepithelial lesions, NOS expression in stromal cells has been reported to be lower in fibroadenomas than in phyllodes tumours. AIMS To investigate NOS expression in phyllodes tumours of varying degrees of malignancy. METHODS One hundred and sixty seven mammary phyllodes tumours (97 benign, 47 borderline malignant, and 23 frankly malignant) were evaluated for e-NOS and i-NOS expression by immunohistochemistry. Correlations with previously reported expression of stromal vascular growth factor (VEGF) and microvessel density were also performed. RESULTS Stromal expression of e-NOS was absent, weak, moderate, and strong in 43%, 31%, 13%, and 13% of benign tumours; 17%, 26%, 13%, and 44% of borderline malignant tumours; and 17%, 35%, 13%, and 35% of frankly malignant tumours, respectively. Stromal expression of i-NOS was 77%, 18%, 4%, and 1% in benign tumours; 42%, 28%, 19%, and 11% in borderline malignant tumours; and 43%, 13%, 26%, and 18% in frankly malignant tumours, respectively. Stromal expression of both i-NOS and e-NOS was significantly different between the benign and malignant (borderline and frank) groups of phyllodes tumours (p < 0.0001). Furthermore, the expression of i-NOS correlated with stromal VEGF expression and microvessel density. The expression of NOS in the epithelial cells was strong, and showed no differences between the different groups of tumours. CONCLUSIONS Higher stromal expression of NOS in phyllodes tumours is associated with malignancy, suggesting a possible role in malignant progression, particularly metastasising potential.
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Affiliation(s)
- G M K Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Ngan Shing Street, Shatin, NT, Hong Kong, China.
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13
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King AD, Yeung DK, Ahuja AT, Yuen EHY, Ho SFM, Tse GMK, van Hasselt AC. Human cervical lymphadenopathy: evaluation with in vivo 1H-MRS at 1.5T. Clin Radiol 2005; 60:592-8. [PMID: 15851048 DOI: 10.1016/j.crad.2004.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Revised: 10/21/2004] [Accepted: 11/10/2004] [Indexed: 11/24/2022]
Abstract
AIM To evaluate the feasibility of performing in vivo proton magnetic resonance spectroscopy ((1)H-MRS) of cervical lymph nodes, and the clinical usefulness of the technique in the characterization of cervical lymphadenopathy. MATERIALS AND METHODS Cervical lymphadenopathy was examined in 20 individuals with malignant disease, i.e. 10 with squamous cell carcinoma (SCC), 6 with undifferentiated carcinoma (UDC) and 4 with non-Hodgkin's lymphoma (NHL). Cervical lymphadenopathy was also examined in 4 individuals with benign disease, i.e. 3 with tuberculosis (TB) and 1 with Castleman's disease. A point-resolved spectroscopic sequence with echo times (TE) of 136 and 272 ms and a time-domain spectral fitting procedure were used to estimate peak amplitude of choline (Cho), creatine (Cr) and unsuppressed water. Cho/Cr and Cho/water ratios were measured for each lesion. The mean ratio for each lesion group was obtained and results were compared statistically. RESULTS At TE of 136 ms, spectra were interpretable in all 24 cases and a Cr peak was identified with post-processing in 15 cases. The Cho/Cr and Cho/water ratios for NHL were 9.1 +/- 5.2 and 1.7 +/- 0.2 x 10(-3), for UDC were 4.4 +/- 0.9 and 1.2 +/- 0.4 x 10(-3), and for SCC were 2.1 +/- 0.6 and 0.5 +/- 0.3 x 10(-3), respectively. Both Cho/Cr and Cho/water ratios for UDC were significantly higher than SCC (p = 0.002 and 0.026, respectively). At TE of 272 ms, spectra were interpretable in 22 of 24 cases and a Cr peak was identified with post-processing in 11 cases. Cho/Cr and Cho/water ratios for NHL were 5.4 and 4.6 +/- 1.4 x 10(-3), for UDC were 4.2 +/- 1.5 and 2.6 +/- 1.0 x 10(-3) and for SCC were 2.5 +/- 1.1 and 1.3 +/- 0.6 x 10(-3), respectively. The Cho/water ratio for UDC was significantly higher than for SCC (p = 0.04). The Cho/Cr ratio for UDC was also higher than for SCC, but this difference was not statistically significant (p = 0.07). Neither Cho nor Cr was detected in the 3 cases of TB. CONCLUSION In vivo (1)H-MRS is a feasible technique for the evaluation of cervical lymph nodes and it offers potential as a clinical tool in the investigation of cervical lymphadenopathy. However, further studies with larger patient cohorts are needed to validate the findings of this initial report.
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Affiliation(s)
- A D King
- Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, The Chinese University of Hong Kong, Shatin.
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14
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Chen GG, Liu ZM, Vlantis AC, Tse GMK, Leung BCH, van Hasselt CA. Heme oxygenase-1 protects against apoptosis induced by tumor necrosis factor-alpha and cycloheximide in papillary thyroid carcinoma cells. J Cell Biochem 2005; 92:1246-56. [PMID: 15258907 DOI: 10.1002/jcb.20157] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Heme oxygenase-1 (HO-1) plays a role in the resistance to apoptosis of several types of cells, but its role in the development of thyroid cancer is unknown. In this study, we investigated the regulation of HO-1 in human papillary thyroid carcinoma cells (KAT5). The results show that HO-1 is significantly induced by hemin and cadmium. In addition to inducing HO-1, hemin and cadmium also cause a rise in the levels of p21, a cyclin-dependent kinase inhibitor. Cells with increased levels of HO-1 and p21 were more resistant to apoptotic stimuli than cells with normal levels. The cells resistant to apoptosis also displayed an increased arrest at the G(0)/G(1) phase of the cell-cycle. The induced levels of HO-1 and p21 were significantly reduced by p38 mitogen-activated protein kinase (p38 MAPK) and extracellular-regulated kinase (ERK) inhibitors. More importantly, KAT5 cells regained their sensitivity to apoptotic stimuli after they were treated with these kinase inhibitors, indicating that p38 MAPK and ERK are required for the resistance to apoptosis conferred by HO-1. Furthermore, we demonstrated that increased levels of HO-1 and p21 expression are associated with an increase in the activity of NF-kappaB and that inhibiting NF-kappaB leads to a block in the induction of HO-1 and p21. In summary, this study reveals that an increase in the level of HO-1 markedly reduces the sensitivity of papillary thyroid carcinoma cells to apoptotic stimuli. The HO-1 pathway of apoptosis resistance is associated with an increase in the levels of p21, involves a p38 MAPK and ERK-mediated mechanism and can be suppressed by inhibiting NF-kappaB.
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Affiliation(s)
- George G Chen
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China.
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15
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Tse GMK, Tsang AKH, Putti TC, Scolyer RA, Lui PCW, Law BKB, Karim RZ, Lee CS. Stromal CD10 expression in mammary fibroadenomas and phyllodes tumours. J Clin Pathol 2005; 58:185-9. [PMID: 15677540 PMCID: PMC1770579 DOI: 10.1136/jcp.2004.020917] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2004] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS CD10 (CALLA) has recently been reported to be expressed in spindle cell neoplasia, and has been used to differentiate endometrial stromal sarcoma from leiomyoma and leiomyosarcoma. In the breast, myoepithelial cells express CD10, but there are few studies of the expression of CD10 in mammary fibroepithelial lesions. METHODS Stromal CD10 expression was studied in 181 mammary phyllodes tumours (102 benign, 51 borderline malignant, and 28 frankly malignant) and 33 fibroadenomas using immunohistochemistry, to evaluate whether differences in expression correlated with the degree of malignancy. RESULTS There was a progressive increase in the patients' age and tumour size, from fibroadenoma to phyllodes tumours with an increasing degree of malignancy (p < 0.001). Stromal CD10 expression was positive in one of 33 fibroadenomas, six of 102 benign phyllodes tumours, 16 of 51 borderline malignant phyllodes tumours, and 14 of 28 frankly malignant phyllodes tumours. The difference was significant (p < 0.001) and an increasing trend was established. Strong staining was seen in subepithelial areas with higher stromal cellularity and activity. Stromal CD10 expression had a high specificity (95%) for differentiating between benign lesions (fibroadenomas and benign phyllodes tumours) and malignant (borderline and frankly malignant) phyllodes tumours. CONCLUSIONS CD10 may be a useful adjunct in assessing malignancy in mammary fibroepithelial lesions.
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Affiliation(s)
- G M K Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Ngan Shing Street, Shatin, NT, HKSAR, China.
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Chu WCW, Lam WWM, Pang ALM, So NMC, Tang APY, Tse GMK, Ahuja AT. Computer-assisted detection as a second reader in symptomatic Asian women with palpable breast cancer. Acta Radiol 2004; 45:148-53. [PMID: 15191097 DOI: 10.1080/02841850410003950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the potential role of a computer-assisted detection (CAD) algorithm as a second reader for experienced and inexperienced radiologists in mammography reading in Asian women. MATERIAL AND METHODS Two-view mammograms performed in 124 consecutive patients who presented with palpable breast cancer masses were retrospectively evaluated by two experienced breast radiologists (7 and 10 years' experience). The original reports of the session radiologists with variable experience of reading mammograms (2 to more than 10 years) were also evaluated. The number of suspicious masses and microcalcification clusters detected in each patient by both groups of radiologists were recorded. The radiologists then re-evaluated the films with the CAD system as a second reader. Any improvement in the detectability of breast pathology by either the experienced radiologists and/or by the session radiologists was then assessed. A total of 127 breasts had biopsy-proven carcinoma; 74 breasts had mastectomy performed. All the imaging results were correlated with tru-cut biopsy or mastectomy histology. RESULTS With CAD-aided interpretation, there were altogether 95 visible masses and 77 suspicious microcalcification clusters in 109 mammographically detectable cancers correlated with histology results. There was a 7.4% (7/95) and 10.4% (8/77) increase in the number of masses and microcalcification clusters detected, respectively, by the experienced radiologists after application of CAD, whereas the increase was 13.7% (13/95) and 27.3% (21/77) for detection of masses and microcalcifications by the session radiologists, respectively. In 9 patients, a secondary focus detected by CAD was confirmed by histology. Three patients had contralateral breast tumors, 1 had a satellite invasive tumor while 5 had ductal carcinoma in situ on the same breast. Based on the biopsies and 74 mastectomies, the true-positive and false-positive detection rate of CAD was 92.6% and 31.8% for detection of carcinomas. The true-positive and false-positive detection rates were 100% and 58.8% for microcalcification clusters. CONCLUSION The current generation CAD algorithm helped to improve the detection rate of carcinomas, calcifications and multifocality in Asian breasts.
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Affiliation(s)
- W C W Chu
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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18
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Affiliation(s)
- P C W Lui
- Department of Pathology, United Christian Hospital, Hong Kong
| | - L-M Pang
- Departments of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - T-T Hlaing
- Department of Pathology, Kwong Wah Hospital, Kowloon, Hong Kong
| | - G M K Tse
- Departments of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong;
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Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) is a newly described form of atypical pneumonia linked to a novel coronavirus. AIMS To review the sputum cytology of 15 patients who fulfilled the World Health Organisation clinical criteria for SARS in an attempt to evaluate whether early diagnosis is feasible with routine sputum examination. METHODS All sputum samples from patients with SARS from the four major hospitals in Hong Kong were reviewed; abnormalities were sought in the cellular component, including abnormal numbers and morphology of the component cells compared with those from age matched controls taken over the same period one year ago. RESULTS Fifteen sputum samples from patients were compared with 25 control samples. In the patients with SARS, loose aggregates of macrophages were seen more frequently in the sputum. These macrophages frequently showed morphological changes, such as cytoplasmic foaminess, vacuole formation, and nuclear changes (including multinucleation and a ground glass appearance) when compared with the control samples. CONCLUSIONS The cytological features of SARS are non-specific, but the observation of any of the described features should prompt further investigations, especially in patients with suspicious clinical features.
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Affiliation(s)
- G M K Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Ngan Shing Street, NT, Hong Kong ROC.
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20
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Abstract
A 56 year old man with previously unsuspected recurrence of squamous cell carcinoma of the oesophagus presented with dyspnoea. Bronchoscopy and computed tomography suggested bronchopneumonic changes with an infectious cause. He suffered a rapidly deteriorating course and died despite active treatment, including antibiotics and mechanical ventilation. Necropsy revealed a florid pulmonary tumour microembolism mimicking alveolitis. No bronchopneumonia was seen. The emboli arose from loosely attached tumour vegetations in the tricuspid valve. In a patient with known malignancy, tumour microembolism should be considered as an uncommon cause of rapid respiratory failure, refractory to antibiotic treatment.
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Affiliation(s)
- A W I Lo
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China
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21
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Abstract
AIMS Granulomatous mastitis (GM) is an uncommon breast lesion that mimics carcinoma. The fine needle aspiration cytological (FNAC) features of GM have rarely been discussed in the literature. These features are reported in eight histologically confirmed cases of GM. METHODS A retrospective study was undertaken in which a diagnosis of GM had been made on histopathology, and the FNAC slides were reviewed and assessed for the presence of granulomas, necrosis, multinucleated giant cells, and inflammatory background cells. Polymerase chain reaction (PCR) for Mycobacterium tuberculosis was performed on the histological material to exclude tuberculosis. RESULTS All cases were confirmed histologically and PCR for mycobacterial DNA was negative. In the FNACs, varying numbers of granulomas composed of epithelioid histiocytes were present in four cases. The same four cases showed giant cells of either foreign body or Langhan's type. No necrosis was noted. Six cases showed many histiocytes, some plump and others epithelioid, in the background. The number of epithelioid histiocytes corresponded to the presence of granulomas. Neutrophils were the predominant background inflammatory cells in most cases (six). CONCLUSIONS The cytological diagnosis of GM is difficult because the features overlap with other aetiologies, including tuberculosis. Specific features are absent. The absence of necrosis and a predominantly neutrophilic infiltrate in the background favour a diagnosis of GM. This diagnosis should also be considered when abundant epithelioid histiocytes are seen in smears, even in the absence of granulomas. However, the definitive diagnosis of GM depends on histology from fine needle biopsies and negative microbiological investigations.
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Affiliation(s)
- G M K Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT, Hong Kong, China.
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Abstract
Intravascular lymphomatosis (IVL) is a rare angiotrophic large cell lymphoma producing vascular occlusion of arterioles, capillaries, and venules. Antigenic phenotyping shows that these lymphomas are mostly of B cell type, and less commonly T cell or Ki-1 lymphomas. The central nervous system and skin are the two most commonly affected organs; patients usually present with progressive encephalopathy with mental status changes and focal neurological deficits and skin petechia, purpura, plaques, and discolouration. Other involved organs include adrenal glands, lungs, heart, spleen, liver, pancreas, genital tract, and kidneys. Bone marrow, blood, cerebrospinal fluid, and lymph nodes are typically spared. Fever of unknown origin is another common presentation. Only one case of IVL presenting with disseminated intravascular coagulation and anasarca (generalised oedema) has been reported in the literature. This report describes a postmortem case of a patient with IVL who initially presented with disseminated intravascular coagulation complicated by intracerebral haemorrhage.
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Affiliation(s)
- P C W Lui
- Department of Pathology, United Christian Hospital, Hong Kong
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Abstract
AIMS To review 25 cases of breast hamartoma and discuss the pathological criteria, and the usefulness of imaging modalities, fine needle aspiration cytology (FNAC), and needle core biopsy in the diagnosis. METHODS The hamartomas were assessed for interlobular fibrotic stroma, stromal adipose tissue content, pseudo-angiomatous stromal hyperplasia, and epithelial changes (hyperplasia, adenosis or apocrine metaplasia, and cyst formation). All imagings, previous FNACs, and biopsies were also reviewed. RESULTS Imaging (mammography, ultrasound, and magnetic resonance imaging) was performed in 18 cases, and mostly showed encapsulated masses with a heterogeneous appearance. Microscopically, all hamartomas demonstrated good demarcation with fibrous tissue condensation. Adipose tissue was noted in all cases (5-90%; mean, 31%), and interlobular fibrosis in 21 cases. Benign epithelial hyperplasia occurred in 10 cases, and pseudo-angiomatous stromal hyperplasia or cystic ducts in eight cases each. Apocrine metaplasia, calcification, stromal giant cells, and adenosis occurred in four cases or less. Two cases showed coexisting ductal carcinoma in situ limited to within the hamartoma. Needle core biopsies (four cases) and FNAC (14 cases) were largely insufficient, inconclusive, or non-specific. CONCLUSIONS Hamartomas do not possess specific diagnostic histological features. The role of FNAC and needle core biopsy in making the diagnosis is limited, and requires clinical and radiological correlation to avoid underdiagnosis.
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Affiliation(s)
- G M K Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China.
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Abstract
AIM To review the imaging findings of diabetic mastopathy, and document the colour flow ultrasound and MR imaging features in this benign condition. MATERIALS AND METHODS Diabetic mastopathy was clinically and histologically diagnosed in eight lesions in six women. All six women underwent conventional mammography and high frequency grey-scale ultrasound. Colour flow ultrasound was performed additionally in six lesions in four women and MR imaging in four lesions in three women before biopsy. The imaging findings were reviewed and correlated with final histological diagnosis. RESULTS Mammography showed regional asymmetric increased opacity with ill-defined margins in all lesions. A heterogeneously hypoechoic mass with ill-defined margins was identified on high frequency grey-scale ultrasound in all lesions. Marked posterior acoustic shadowing was present in seven of eight (88%) lesions. Six lesions interrogated with colour flow ultrasound showed absence of Doppler signal. MR imaging in three women revealed non-specific stromal enhancement. CONCLUSION Diabetic mastopathy shows absence of Doppler signal on colour flow ultrasound and non-specific stromal enhancement on MR imaging.
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Affiliation(s)
- K T Wong
- Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Abstract
Hamartoma of the breast is an uncommon lesion. Although it can possess characteristic radiological features, the pathological appearance is not distinctive. Hamartoma is generally considered benign, but four cases have been reported with ductal and lobular carcinoma arising in hamartomas. This report describes further cases of hamartoma from which ductal carcinoma in situ arose, with one showing early invasion. In both cases, the tumours were within the hamartomas and were adequately excised during lumpectomies of the hamartomas, and the patients were well afterwards. This report emphasises the importance of adequate sampling of mammary hamartoma.
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Affiliation(s)
- G M K Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR.
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Affiliation(s)
- E W H To
- Division of Head and Neck, Plastic and Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong.
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