Immunohistochemical Characterization of a Large Cohort of Triple Negative Breast Cancer

Introduction. Triple negative breast carcinomas are characterized by a lack of hormone receptor and HER2 expression and inconsistent expression of breast-specific immunohistochemical markers. The expression of many site-specific markers in these tumors is largely unknown. The objective of the study was to examine the expression of widely used immunohistochemical markers on a large cohort of triple negative breast cancer. Methods. Sections from tissue microarrays were stained with 47 markers using routine protocols. Most markers were scored using a modified Allred method. ATRX, BAP1, SMAD4, e-cadherin, and beta-catenin were scored as retained or lost. Mammaglobin was considered positive if there was at least moderate intensity staining in any tumor cells. P16 was scored as overexpressed or not overexpressed; p53 was scored as wildtype, overexpressed, null, or cytoplasmic. Results. The cohort consisted of 639 tumors including 601 primary and 32 metastases. Overall, 96% expressed GATA3, mammaglobin, and/or SOX10 while 97% of no special type tumors expressed this panel. Carcinoma of apocrine differentiation demonstrated an AR positive, SOX10 negative, K5 negative/focal immunophenotype. PAX8 (SP348), WT1, Napsin A, and TTF1 (8G7G3/1) were never or rarely expressed while CA9, CDX2, NKX3.1, SATB2 (SATBA410), synaptophysin, and vimentin were variably expressed. Conclusions. Almost all TNBC express at least 1 of the 3 IHC markers: GATA3, mammaglobin, and/or SOX10. Carcinoma of apocrine differentiation is characterized by an AR positive, SOX10 negative, K5 negative or focal immunophenotype. Cautious interpretation of so-called site-specific markers, with knowledge of antibody clones, is required in excluding the diagnosis of triple negative breast cancer.

Squamous Cell Proliferation as a Reactive Mechanism to Laryngeal Cryptococcus Infection: A Case Report

Cryptococcus neoformans (C. neoformans) is a ubiquitous encapsulated, obligate anaerobe, a dimorphic fungus that can be pathogenic in humans. C. neoformans infections arise primarily in immunocompromised individuals, such as human immunodeficiency virus (HIV) patients, as well as those who use inhaled corticosteroids regularly. Due to the wide variety of clinical findings associated with C. neoformans, infection within the head and neck is occasionally misdiagnosed as malignancy due to its protean manifestation. In this report, we describe the case of a C. neoformans infection resulting in an initial misdiagnosis due to an overlying laryngeal squamous cell proliferation mimicking laryngeal squamous cell carcinoma (SCC). This case is intended to provide further evidence for inhaled corticosteroid use predisposing patients to fungal infections, as well as to provide insight into the possible mechanism resulting in the initial diagnosis of malignancy. A review of recent literature is also discussed.

[Malignant transformation of thyroid tissue in an ovarian dermoid cyst: case report]

INTRODUCTION

Mature cystic teratoma is the most common type of ovarian teratomas and also the most frequent tumor originating from germ cells. Usually unilateral, it is, by definition, composed of well-differentiated derivates which originate from all three layers. It is most frequently diagnosed in the female reproductive period; in its pure form, it is generally benign, but occasionally it may undergo malignant transformation in one of its elements.

CASE HISTORY

The authors report a case of a 43-year-old woman who underwent a thyroid regulation substitutive therapy 12 years after thyroidectomy which had been performed because of Basedow's disease. On the occasion of her fourth delivery by cesarean section, bilateral cystical formations in both ovaries were found. Upon ending the delivery, the right ovary with the cyst was surgically removed, as well as part of the cystically changed left ovary. The pathohistological analysis of the samples taken from the left ovary cyst pointed to the following diagnosis: dermoid cyst of the ovary a mature cystic teratoma, whereas the samples from the cystic tumor of the right ovary were diagnosed as: ovarian teratoma malignant a papillary carcinoma of the thyroid tissue and cystadenoma papillare serosum ovarii. The histological type of the malignant thyroid tissue neoplasm in the teratoma was a papillary carcinoma consisting of papillary proliferations lined by cuboidal, cylindrical and pseudostratified epithelium with charasteristic "ground glass" nuclei, but without invasion into the blood vessels.

DISCUSSION

Malignant transformation of the ectopic thyroid tissue, which is one of the elements of the ovarian cystic teratoma, is extremely rare: it is diagnosed on basis of the histological picture and criteria which are the same as for the tumor of the thyroid gland. One should not exclude a pssibility that the identical or different pathological alterations characteristic of the thyroid gland may also be detected in the ectopic thyroid tissue of a dermoid cyst.

CONCLUSION

The reported case was chosen due to its complex and rich clinical and pathohistological picture characterized by the occurrence of a bilateral dermoid cyst with the malignant transformation of the thyroid tissue. The malignant neoplasm in the mature ovarian cystic teratoma was papillary carcinoma of the thyroid tissue with all histological properties typical for the thyroid gland carcinoma. The possibility of the malignant transformation of the endodermal thyroid tissue in the mature ovarian cystic teratoma and changes in the thyroid gland of the Basedow's disease type diagnosed before are without clear causation.

[Histologic classification and terminology of precancerous lesions of the cervix]

INTRODUCTION

Precancerous changes of the cervix frequently occur in women in their reproductive age and are associated with sexually transmitted diseases. The evolution of these lesions qualifies them as precursors of malignancy, and their origination is associate with various risk factors, human papillomavirus (HPV) being the most important one. A proper clinical approach to and treatment of these changes depend on histologic diagnosis, which must be both terminologically adequate and apprehensive.

PREVIOUS CLASSIFICATIONS AND TERMINOLOGY

The continuous change in nomenclature and lack of a uniform terminology has become the source of confusion and misunderstanding between gynecologists and pathologists. The term carcinoma in situ was first introduced in 1930 to denote the lesion, which is a reliable precursor of malignancy. Less intensive epithelial changes of the cervix were classified as dysplasia. Depending on extensive the change was, dysplasias were subclassified into mild, moderate and severe. Carcinoma in situ and various degrees of dysplasias were more precisely defined at the First International Congress of Exfoliative Cytology, which has also enabled the biological differentiation between these entities. The histologic differentiation of these lesions was, however, subjective and quite unreliable. UP-TO-DATE CLASSIFICATION AND TERMINOLOGY: Cellular changes in carcinoma in situ and in severe dysplasias were mutually so similar that pathologists could not make a reproducible difference between these lesions. Therefore, a conclusion was reached that these changes were one and the same process, whereas the differences were merely of quantitative nature. This discovery resulted in a terminological change, i.e. in a unique term--cervical intraepithelial neoplasia (CIN), with its gradation from 1 to 3. The 3rd grade of cervical intraepithelial neoplasia, according to the new terminology, encompassed changes which pathologists could not properly differentiate before. Many other changes with various, mostly descriptive terminology have also been included in the CIN category, thus preventing misunderstanding between pathologists and gynecologists. Besides the CIN classification, which has been most widely used today, there is also a division into only two biologically different categories: low-grade cervical intraepithelial neoplasia (Lo-CIN) and high-grade cervical intraepithelial neoplasia (Hi-CIN). The latter modification is included in the Bethesda system of cytologic diagnoses as low-grade squamous intraepithelia lesion (L-Sil) and high-grade squamous intraepithelial lesions (H-Sil).

CONCLUSION

The use of a uniform terminology and classification minimizes the problem of diagnosing precancerous cervical lesions and enables adequate clinical treatment of these patients.

[Mesenchymoma--diagnostic dilemmas]

This is a case report on retroperitoneal localization of a tumor formed of mixed-chondromatous tissue, bone tissue, fatty tissue and connective tissue together with angiomatous areas with blood vessels having unevenly thickened walls, being histopathologically diagnosed as a mesenchymoma. Apart from presenting the tumor, this paper deals with diagnostic dilemmas in cases of mixed tumors of mesenchymal origin because of numerous disagreements in literature data on morphologic characteristics, biological behavior and diverse nomenclature.