Lobular Carcinoma Arising in a Fibroadenoma

A case of lobular carcinoma arising in a fibroadenoma of the breast in recorded. Twenty-two such cases found in literature are examined and a detailed discussion of histopathology, prognosis and therapy is carried out.

Endocrine Differentiation in Basal Cell Carcinoma

Argyrophilic cells have been found in 2 different basal cell carcinomas (BCC), and membrane-bound endocrine-like granules, in the carcinoid range, have been observed in 4 consecutive cases of such tumors. It is postulated that BCC can occasionally display cells showing an endocrine differentiation.

Epithelial-Myoepithelial Carcinoma of the Parotid Gland: A Clinico-Pathologic and Immunohistochemical Study of Seven Cases

Seven cases of epithelial-myoepithelial carcinoma of the parotid gland are reported. Immunohistochemical evidence for the dual (glandular secretory and myoepithelial) differentiation of the cells composing these lesions is presented. Three of the cases recurred locally and two gave rise to metastases. The biologic behavior does not appear to be correlated with the histologic features that constitute the morphologic spectrum of epithelial-myoepithelial carcinoma.

Kasabach-Merritt Syndrome Associated to Angiosarcoma of the Breast. A Case Report and Review of the Literature

Introduction

Kasabach-Merritt syndrome is characterized by the association of a consumptive thrombohemorrhagic disorder and angioma occurring usually in children. In the present study, a case of Kasabach-Merritt syndrome associated to an angiosarcoma of the breast is reported.

Clinical History

The tumor together with the thrombohemorrhagic disorder manifested in a 28-year-old woman. The patient underwent mastectomy. The tumor recurred in the same site 2 years later. The patient died of severe anemia 8 years after the first appearance of the angiosarcoma.

Material and Methods

Tissues were formalin fixed and paraffin embedded; in addition, selected sections were immunohistochemically stained.

Results and Conclusions

A well-differentiated angiosarcoma was visible throughout the removed organ. A review of the literature showed that only 6 cases of Kasabach-Merritt syndrome associated to malignant vascular tumors have been previously reported. All these 6 cases occurred in adult patients. On the contrary, Kasabach-Merritt syndrome associated to benign vascular tumors affects children. This is the first case occurring in the breast.

Malignant Peripheral Nerve Sheath Tumor Arising in a « De Novo » Ganglioneuroma. A Case Report

A case of a « de novo » ganglioneuroma showing an internal area of malignant nerve sheath tumor is described. The tumor arose in an 18-year-old girl without a history of von Recklinghausen's disease. Immunohistochemically, the ganglioneuromatous component was positive with anti-synaptophysin, anti-S100 protein and anti-vimentin antisera, whereas the malignant part was immunoreactive only with anti-S100 protein and anti-vimentin antisera. The patient is free of disease 4 years after surgery. The clinicopathologlc features of this rare case are discussed.

Masson's Intravascular Vegetant Hemangioendothelioma

Eleven cases of Masson's hemangioendothelioma are reported. This benign condition must be distinguished histologically from numerous malignant endothelial lesions. Two different papillary structures were observed; one defined as « inflammatory papilla » was constantly associated with a thrombus; the other, defined as «fibrous papilla» was observed in 4 cases where no thrombus could be found. It is postulated that the inflammatory papillae are an exuberant endothelial growth during the normal organisation of a thrombus; fibrous papillae, it is suggested, might be reactive to blood or lymph stasis.

Nucleolar Organizer Regions in Normal Skeletal Muscle and Benign and Malignant Rhabdomyoblastic Tumors

The silver staining of interphase nucleolar organizer regions (NORs) has been shown to have an important application in diagnostic histopathology for distinguishing some benign from malignant conditions. In this study, normal fetal and adult skeletal muscles and tissue from fetal and adult rhabdomyomas as well as rhabdomyosarcomas were stained with the silver method for NORs. The morphologic distribution of NORs in rhabdomyosarcomas was found to be very different from that in normal skeletal muscles. In addition, cases of rhabdomyoma were easily differentiated from rhabdomyosarcomas. Statistical analysis of data, from all cases, regarding the diameter of NORs and number per nucleus confirmed these observations.

Strumal Carcinoid of the Ovary: An Immunohistochemical and Electron Microscopic Study

A case of strumal carcinoid of the ovary is reported. The follicles contained T4-immunoreactive substance, whereas the carcinoid component of the tumor had a trabecular structure and showed argyrophilic elements. Pancreatic-polypeptide and enteroglucagon were localized in these cells by an immunocytochemical method. The same cells displayed small electrondense endocrine-like granules. A common precursor for the thyroid and carcinoid components is postulated.

Inflammatory Pseudotumor of the Liver: Report of two Cases

Inflammatory pseudotumor of the liver is a rare benign lesion which clinically and grossly is often interpreted as a neoplastic condition. It usually arises in children or young adults. Only 11 cases have been described in the literature, and its etiology is still uncertain. Two new cases of inflammatory pseudotumor in adult male patients are reported here. Morphologically, these cases summarize all the features seen in the other cases described previously. They showed fibrous bands delimiting microabscesses made up of granulocytes, mononuclear elements and foamy macrophages. These lesions have in common the symptomatology which is amenable to infectious disease. The purpose of this paper is to draw attention to the existence of a lesion that clinically simulates a neoplastic condition of the liver. This lesion should be histologically recognized to avoid excessive surgical treatment.

Benign Smooth Muscle Cell Metaplasia in Breast

Three different benign breast lesions showing smooth muscle cells in the stroma are reported. Benign smooth muscle cells are rarely found in the breast, and it is likely that they originate from metaplastic changes of the stroma itself.

A Two-Stage Immmunocytochemical Method for Oestrogen Receptor Analysis: Correlation with Morphological Parameters of Breast Carcinomas

An immunocytochemical method for oestrogen receptor (ER) analysis of breast carcinomas is described and compared with the dextran-coated charcoal (DCC) assay and a cytochemical method. The method described is superior to the purely cytochemical, especially in terms of sensitivity, demonstration of nuclear receptors and correlation with the DCC assay. The DCC assay is reliable except in the case of poorly cellular tumours: in these the immunocytochemical method is far superior, being independent of tumour cellularity. With this new method, lobular carcinomas are shown to be ER-rich compared with their ductal counterparts, a conclusion currently disputed, largely because methods employed mostly fail to take account of tumour cellularity. A combination of the DCC assay and the immunocytochemical method here described gives the maximum information about the ER-status of a particular carcinoma.

Hypophosphatemic Oncogenic Osteomalacia: Report of Three new Cases

Three cases of connective tissue tumors causing hypophosphatemic osteomalacia are reported and the literature is reviewed. In two of our patients the tumors were completely excised with total disappearance of the symptoms. In one case a total excision was not possible and the symptoms of this patient have not completely disappeared. The substance responsible for the syndrome has not been identified yet, but probably interferes with vitamin D renal hy-droxylation, thus causing osteomalacia. As more than 30 per cent of cases of this condition have been reported in the last 5 years, it is suggested that these tumors are more frequent than previously believed.

Elastofibroma Dorsi

A case of elastofibroma dorsi arising from the subscapular region in a 57-year-old Sardinian woman is recorded. The degenerative origin of the neoplasia from collagen is emphasised.

The Fast-Track Biopsy (FTB): Description of a Rapid Histology and Immunohistochemistry Method for Evaluation of Preoperative Breast Core Biopsies

Thirty-six core breast biopsies from 32 patients were paraffin embedded by use of an automated microwave processor. In addition, a quick immunohistochemical method was used in selected cases. The quality of the hematoxylin and eosin (H&E) slides was very satisfactory, as were also the immunohistochemical stains for ER, PR, and Ki67 when compared to those obtained with the use of a conventional automated immunostainer. The time required to process the tissue to the final H&E stage averaged 2 hours 52 minutes, and the immunohistochemical method required 90 to 100 minutes. This procedure, which we named “fast-track biopsy” (FTB), is quick enough to be competitive with FNAC (fine-needle aspiration biopsy) in terms of turnaroundtimes. The superiority of core biopsy over FNA in terms of the morphologic information provided is widely acknowledged, the only major argument currently mentioned in favor of FNAC being the shorter duration of the procedure. With the advent of FTB, it would appear that even this last remaining advantage has been erased.

Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

BACKGROUND

As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years.

METHODS

Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients.

RESULTS

Two hundred sixty-seven GBM patients (median age, 64 y; range, 29-84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2-12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0-18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248-0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388-0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328-0.986; P = .0446).

CONCLUSIONS

The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.

Duct carcinoma in situ of the breast: an overview

DCIS of the breast is a lesion that was uncommon in the past (1% of the breast nodules) and now very frequent, representing not less than 20% of the mammographic lesions seen in any mammographic screening programme. This is consequent to the fact that mammography is more sensitive than palpatory clinical examination which was the diagnostic procedure offered 25 years ago.

Is acinic cell carcinoma a variant of secretory carcinoma? A FISH study using ETV6'split apart' probes

AIMS

Acinic cell carcinomas (ACCs) and secretory carcinomas (SCs) of the breast are rare, low-grade malignancies that preferentially affect young female patients. Owing to the morphological and immunohistochemical similarities between these lesions, they have been proposed to be two morphological variants of the same entity. It has been demonstrated that SCs of the breast consistently harbour the t(12;15)ETV6-NTRK3 translocation. The aim was to determine whether ACCs also harbour ETV6 gene rearrangements and are thus variants of SCs.

METHODS AND RESULTS

Using the ETV6 fluorescence in situ hybridization DNA Probe Split Signal (Dako), the presence of ETV6 rearrangements in three SCs and six ACCs was investigated. Cases were considered as harbouring an ETV6 gene rearrangement if >10% of nuclei displayed 'split apart signals' (i.e. red and green signals were separated by a distance greater than the size of two hybridization signals). Whereas the three SCs displayed ETV6 split apart signals in >10% of the neoplastic cells, no ACC showed any definite evidence of ETV6 gene rearrangement.

CONCLUSIONS

Based on the lack of ETV6 rearrangements in ACCs, our results strongly support the concept that SCs and ACCs are distinct entities and should be recorded separately in breast cancer taxonomy schemes.

Discrepancies in current practice of pathological evaluation of sentinel lymph nodes in breast cancer. Results of a questionnaire based survey by the European Working Group for Breast Screening Pathology

AIMS

To evaluate aspects of the current practice of sentinel lymph node (SLN) pathology in breast cancer via a questionnaire based survey, to recognise major issues that the European guidelines for mammography screening should address in the next revision.

METHODS

A questionnaire was circulated by mail or electronically by the authors in their respective countries. Replies from pathology units dealing with SLN specimens were evaluated further.

RESULTS

Of the 382 respondents, 240 European pathology units were dealing with SLN specimens. Sixty per cent of these units carried out intraoperative assessment, most commonly consisting of frozen sections. Most units slice larger SLNs into pieces and only 12% assess these slices on a single haematoxylin and eosin (HE) stained slide. Seventy one per cent of the units routinely use immunohistochemistry in all cases negative by HE. The terms micrometastasis, submicrometastasis, and isolated tumour cells (ITCs) are used in 93%, 22%, and 71% of units, respectively, but have a rather heterogeneous interpretation. Molecular SLN staging was reported by only 10 units (4%). Most institutions have their own guidelines for SLN processing, but some countries also have well recognised national guidelines.

CONCLUSIONS

Pathological examination of SLNs throughout Europe varies considerably and is not standardised. The European guidelines should focus on standardising examination. They should recommend techniques that identify metastases > 2 mm as a minimum standard. Uniform reporting of additional findings may also be important, because micrometastases and ITCs may in the future be shown to have clinical relevance.

Consistency of staining and reporting of oestrogen receptor immunocytochemistry within the European Union—an inter-laboratory study

To assess the variability of oestrogen receptor (ER) testing using immunocytochemistry, centrally stained and unstained slides from breast cancers were circulated to the members of the European Working Group for Breast Screening Pathology, who were asked to report on both slides. The results showed that there was almost complete concordance among readers (kappa=0.95) in ER-negative tumours on the stained slide and excellent concordance among readers (kappa=0.82) on the slides stained in each individual laboratory. Tumours showing strong positivity were reasonably well assessed (kappa=0.57 and 0.4, respectively), but there was less concordance in tumours with moderate and low levels of ER, especially when these were heterogeneous in their staining. Because of the variation, the Working Group recommends that laboratories performing these stains should take part in a external quality assurance scheme for immunocytochemistry, should include a tumour with low ER levels as a weak positive control and should audit the percentage positive tumours in their laboratory against the accepted norms annually. The Quick score method of receptor assessment may also have too many categories for good concordance, and grouping of these into fewer categories may remove some of the variation among laboratories.

Breast tumor resembling the tall cell variant of papillary thyroid carcinoma: report of 5 cases

Five cases of a hitherto undescribed breast tumor having histologic features similar to those of the tall cell variant papillary thyroid carcinoma are described. They were composed of columnar mitochondrion-rich to oxyphilic cells arranged in nests, papillae, and follicle-like structures. In addition, the neoplastic cells showed numerous nuclear grooves and, in two cases, nuclear pseudo-inclusions. None of the patients had previous concomitant or subsequent evidence of a thyroid tumor. Immunohistochemistry further excluded a metastasis from the thyroid in the four cases tested, as they were consistently thyroglobulin and thyroid transcription factor 1 negative.

Pathological work-up of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines

Controversies and inconsistencies regarding the pathological work-up of sentinel lymph nodes (SNs) led the European Working Group for Breast Screening Pathology (EWGBSP) to review published data and current evidence that can promote the formulation of European guidelines for the pathological work-up of SNs. After an evaluation of the accuracy of SN biopsy as a staging procedure, the yields of different sectioning methods and the immunohistochemical detection of metastatic cells are reviewed. Currently published data do not allow the significance of micrometastases or isolated tumour cells to be established, but it is suggested that approximately 18% of the cases may be associated with further nodal (non-SN) metastases, i.e. approximately 2% of all patients initially staged by SN biopsy. The methods for the intraoperative and molecular assessment of SNs are also surveyed.

Salivary gland-like tumours of the breast: surgical and molecular pathology

Breast glands and salivary glands are tubulo-acinar exocrine glands that can manifest as tumours with similar morphological features, but that differ in incidence and clinical behaviour depending on whether they are primary in breast or salivary glands. Salivary gland-like tumours of the breast are of two types: tumours with myoepithelial differentiation and those devoid of myoepithelial differentiation. The first and more numerous group comprises a spectrum of lesions ranging from "bona fide" benign (such as benign myoepithelioma and pleomorphic adenoma), to low grade malignant (such as adenoid cystic carcinoma, low grade adenosquamous carcinoma, and adenomyoepithelioma), to high grade malignant lesions (malignant myoepithelioma). The second group comprises lesions that have only recently been recognised, such as acinic cell carcinoma, oncocytic carcinoma of the breast, and the rare mucoepidermoid carcinoma.

Malignant neoplasms infiltrating pseudoangiomatous' stromal hyperplasia of the breast: an unrecognized pathway of tumour spread

AIMS

To describe five malignant tumours in the breast (two invasive carcinomas and three non-Hodgkin's lymphomas) showing an unusual pattern of spread within anastomosing spaces consistent with those described in pseudoangiomatous stromal hyperplasia.

METHODS AND RESULTS

The histological and immunohistochemical features of the cases are presented. In all cases, the neoplasms consisted of non-cohesive E-cadherin-negative cells located within anastomosing vascular-like channels. These channels showed morphological and immunohistochemical features consistent with those seen in pseudoangiomatous stromal hyperplasia: they were lined by flattened cells that expressed CD34, bcl2 and smooth muscle actin, while CD31 was consistently negative.

CONCLUSIONS

The open channels of pseudoangiomatous stromal hyperplasia have been regarded as spaces due to loss of cohesiveness between stromal fibroblasts if not artefacts. The fact that neoplastic cells spread through these spaces suggests that the spaces are true open channels that may represent part of a complex network of stromal channels (pre-lymphatics) connected to the main lymphatic system of the breast. This finding opens new insights into the routes of tumour spread.

Merkel cell carcinoma of the parotid gland associated with Warthin tumour: report of two cases

AIMS

Two cases of Merkel cell carcinoma occurring simultaneously and in close association with a Warthin tumour of the parotid gland are reported.

METHODS AND RESULTS

The patients were a 65-year-old man and a 70-year-old man, respectively. The Merkel cell carcinoma component was immunoreactive for chromogranin and keratin 20 and contained neuroendocrine-type granules at the ultrastructural level.

CONCLUSIONS

The histogenesis of this heretofore undescribed combination is discussed.

CGH analysis of ductal carcinoma of the breast with basaloid/myoepithelial cell differentiation

2-18% of ductal carcinoma-No Special Type (NST) are reported to express basal cell keratin 14 and such tumours may have a different metastatic pattern and prognosis. We performed immunohistochemistry for cytokeratins 19 (luminal) and 14 (basal) on 92 ductal carcinoma-NST. Those tumours showing CK14 expression were further characterized by immunohistochemistry for myoepithelial cell phenotype and analysed by comparative genomic hybridization. The 7 cases of ductal carcinoma-NST exhibiting a basal cell phenotype were all grade III tumours and showed a molecular cytogenetic profile similar to more conventional myoepithelial cell carcinomas. Therefore it appears that grade III invasive ductal carcinomas contain a subset of tumours with specific morphological and cytogenetic characteristics, and probably prognosis for the patient.

Complete replication of human cytomegalovirus in explants of first trimester human placenta

Tissue integrity and viability of first trimester placenta explants were obtained in culture for 3 weeks. Explants were infected with human cytomegalovirus (HCMV), several cycles of HCMV replication were obtained and the progression of the infection was observed within a tissue that maintains its normal cellular organization. In agreement with recent clinical data, 3 weeks were necessary for the virus to colonize the placenta fully. Complete HCMV replication was observed in trophoblasts, followed by subsequent transmission of the infection to the stromal fibroblasts and fetal endothelial capillary cells. Viral DNA replication was monitored and the production of infectious viral progeny documented.

[Endocrine differentiation in basocellular carcinoma]

Three (propositus) cases of basal cell carcinoma (BCC) showing endocrine differentiation at the immunohistochemical level were studied using reverse transcriptase-polymerase chain reaction (RT-PCR) to determine the presence of mRNA of chromogranin A. Moreover, 20 (consecutive) cases of BCC were studied with immunohistochemistry alone using chromogranin A, synaptophysin, S100 protein, cytokeratin 20, and neuron-specific enolase antibodies (NSE). The three propositus cases of BCC showed positive results when RT-PCR for mRNA of chromogranin A was performed. Eleven out of 20 consecutive cases of BCC were focally positive for chromogranin A antibody. These results confirm the presence of endocrine differentiation in BCC, demonstrated both with immunohistochemistry and with RT-PCR.

Gynecomastia in type-1 neurofibromatosis with features of pseudoangiomatous stromal hyperplasia with giant cells. Report of two cases

We describe the histological finding in two cases of gynecomastia in patients with von Recklinghausen's disease. The histological and immunohistochemical features of the two cases were reviewed and compared with those of five cases of gynecomastia in men without clinical evidence of neurofibromatosis. In both patients bearing von Recklinghausen's disease, the breast stroma showed features consistent with pseudoangiomatous stromal hyperplasia (PASH). It was characterised by anastomosing empty spaces lined by spindle and multinucleated giant cells which were positive with CD34 and anti-vimentin antisera and negative with anti-FVIII and CD31 antisera. In two of five of the control cases without neurofibromatosis, the mammary stroma showed focal areas with features of PASH, but no multinucleated giant cells were present in any case. PASH with giant cells should be recognised as a feature of gynecomastia in von Recklinghausen's disease. The presence of multinucleated giant cells is very unusual and, although more cases have to be studied, these cells seem to be a feature of PASH occurring in patients with von Recklinghausen's disease.

Treatment of carcinoma of the parotid gland: the results of a multicenter study

PURPOSE

This study analyzed the prognostic factors for carcinoma of the parotid gland and the role of surgery alone or with radiotherapy in treating these lesions.

METHODS

Forty-five patients with malignant parotid tumors were studied retrospectively. Patients were treated by combined surgery and radiation therapy between 1984 and 1995 at the Maxillo-Facial Departments of the General Hospitals of Bologna and Parma. Resection was conservative when possible, depending on the extent of the tumor. The median follow-up time was 54 months. Data regarding incidence, tumor stage and grade, local control, distant metastases (calculated with the Kaplan-Meier method), and survival were analyzed. Cox's multiple linear regression was used to identify patient and tumor characteristics with the greatest prognostic significance.

RESULTS

The actuarial 5- and 8-year disease-free survival rates were 81% and 62%, respectively. Multivariate analysis showed that tumor stage was a more prognostic variable than tumor grade. Residual microscopic disease at the excision margins was also an important prognostic variable. Laterocervical metastases affected 4 patients (9%), and distant metastases appeared in 8 patients (18%).

CONCLUSIONS

Postoperative irradiation is indicated for patients with stage III and IV disease, patients with positive excision margins, and for patients with lymph node metastases.

[Giant-cell reaction in the breast after fine-needle aspiration]

We report two cases in which fine needle aspiration (FNA) in the breast generated changes histologically mimicking malignant lesions. In both cases a population of giant cells was present; the cells were osteoclast-like in the first case and 'atypical' multinucleated stromal giant cells in the second. The underlying lesion was pseudoangiomatous stromal hyperplasia (PASH) in both cases. The reactive nature was confirmed by retracing the needle tract and by the uneventful follow-up of 7 or 2 years, respectively. We propose that giant cell reaction be included in the list of FNA-generated changes.

Molecular cytogenetic comparison of apocrine hyperplasia and apocrine carcinoma of the breast

The relationship of apocrine metaplasia to invasive breast cancer is controversial. Different authors have reported that apocrine differentiation in proliferative lesions may be a risk factor, a precursor lesion, or have no association with malignancy. The aim of this study was to compare the genetic alterations in benign apocrine hyperplasia with apocrine ductal carcinoma in situ (DCIS) and invasive apocrine carcinomas of the breast using comparative genomic hybridization. The mean number of alterations in apocrine hyperplasia was 4.1 (n = 10) compared to 10.2 in apocrine DCIS (n = 10) and 14.8 (n = 4) in invasive carcinoma. The most common alterations in apocrine hyperplasia were gains of 2q, 13q, and 1p and losses of 1p, 17q, 22q, 2p, 10q, and 16q. Apocrine DCIS and invasive carcinomas showed gains of 1q, 2q, 1p, and losses of 1p, 22q, 17q, 12q, and 16q as their most common DNA copy number changes. Apocrine hyperplasia is considered to be a benign lesion and its relationship to invasive carcinoma remains unclear. Our data suggest that some apocrine hyperplasias may be clonal proliferations. The mean number of alterations are lower in apocrine hyperplasia, however the changes show considerable overlap with those identified in in situ and invasive apocrine carcinoma. These alterations are also commonly seen in nonapocrine breast cancer. The data are consistent with apocrine hyperplasia as a putative nonobligate precursor of apocrine carcinoma.

Lymphoepithelioma-like carcinoma of the breast: lack of evidence of Epstein-Barr virus infection

AIMS

Six cases of lymphoepithelioma-like carcinomas of the breast were studied in order to better define the morphology of this type of breast tumour and to see if these neoplastic lesions are related to Epstein-Barr virus (EBV) infection by analogy with histologically similar tumours located in other organs.

METHODS AND RESULTS

The cases were studied with immunohistochemistry using several antibodies and with in-situ hybridization method employing different types of nucleotides in four cases. The cases presented the distinctive morphology of the lymphoepithelioma-like carcinomas as seen in other organs. Specifically Rigaud and Schminke's patterns of growth were observed. In addition, at the edge of the neoplastic lesions, a lymphoepithelial lobulitis was seen. In-situ hybridization failed to reveal any positivity for EBV genome.

CONCLUSION

Lymphoepithelioma-like carcinoma is a specific type of breast tumour, but its relation to EBV has yet to be proven. The differential diagnosis with medullary carcinoma is discussed.

Thyroglobulin mRNA expression helps to distinguish anaplastic carcinoma from angiosarcoma of the thyroid

The existence of angiosarcoma (AS) of the thyroid has been a matter of debate for many years, because some authors believe that most if not all ASs are in fact "angiomatoid" anaplastic carcinomas (ACs). Immunohistochemistry alone was not successful in solving the problem, since cytokeratin expression is a known occurrence in AS. Therefore, we wanted to compare nine cases of AS with ten cases of AC, assessing whether thyroglobulin (TG) mRNA was still transcribed in undifferentiated tumors and could be helpful to distinguish AC from AS. The cases were analyzed for TG mRNA expression by means of radioactive in situ hybridization. The silver grains were counted using an automated device, and their amount was compared with that of stroma, background, and peritumoral thyroid. A weak signal was present in all AC but not in AS (mean counts 35.7 and 9.6 arbitrary units, respectively: P<0.01). In two cases of AC, residual areas of poorly differentiated insular carcinoma had a strong signal (similar to that of peritumoral thyroid). These findings further confirm that AC and AS of the thyroid are unrelated malignant tumors.

Causes of inconsistency in diagnosing and classifying intraductal proliferations of the breast. European Commission Working Group on Breast Screening Pathology

It is now widely recognised that classifying ductal carcinoma in situ (DCIS) of the breast and diagnosing atypical ductal hyperplasia are associated with significant interobserver variation. Two possible reasons for this inconsistency are differences in the interpretation of specified histological features and field selection where morphology is heterogeneous. In order to investigate the relative contribution of these two factors to inconsistent interpretation of intraductal proliferations, histological sections of 32 lesions were sent to 23 European pathologists followed 3 years later by images of small parts of these sections. Kappa statistics for diagnosing hyperplasia of usual type, atypical ductal hyperplasia and ductal carcinoma in situ were 0.54, 0.35 and 0.78 for sections and 0.47, 0.29 and 0.78 for images, respectively, showing that most of the inconsistency is due to differences in morphological interpretation. Improvements can thus be expected only if diagnostic criteria or methodology are changed. In contrast, kappa for classifying DCIS by growth pattern was very low at 0.23 for sections and better at 0.47 for images, reflecting the widely recognised variation in the growth pattern of DCIS. Higher kappa statistics were obtained when any mention of an individual growth pattern was included in that category, thus allowing multiple categories per case; but kappa was still higher for images than sections. Classifying DCIS by nuclear grade gave kappa values of 0.36 for sections and 0.49 for images, indicating that intralesional heterogeneity has hitherto been underestimated as a cause of inconsistency in classifying DCIS by this method. More rigorous assessment of the proportions of the different nuclear grades present could lead to an improvement in consistency.

[Metastasis of pleural malignant mesothelioma to the brain and upper maxilla: description of 2 cases]

Two cases of malignant mesothelioma metastatic to the brain and maxillary bone respectively are reported. This latter localization has never been described in literature. The diagnosis resided primarily on immunohistochemistry.

Acinic cell carcinoma of the breast: an immunohistochemical and ultrastructural study

The clinicopathological features of six cases of breast carcinomas showing features of acinic cell differentiation, which are similar to those seen in homologous tumors of salivary glands, are presented. The patients, all women, were 35-80 years of age. One case recurred after 4 years, and in two cases axillary lymph node metastases were found at the time of surgery. Histologically the tumors showed a microglandular pattern merging with solid areas. Cytologically, immunohistochemically, and ultrastructurally the tumors were very similar to cases of acinic cell carcinoma of the parotid gland. The differential diagnostic criteria with microglandular adenosis and carcinomas showing granular cytoplasm are discussed. It seems that acinic cell carcinomas of the breast have to be added to the long list of tumors that affect the salivary glands and can also arise in the breast.

Comparative genomic hybridization analysis of myoepithelial carcinoma of the breast

Although there seems to be a common stem cell for the two epithelial cell types in the breast, the vast majority of breast cancers exhibit a luminal phenotype. Pure myoepithelial carcinomas are rare. We report our findings of genetic alterations in these tumors. We have analyzed 10 cases of pure myoepithelial cell carcinomas using laser capture microdissection and comparative genomic hybridization. The mean number of changes was 2.1 (range 0-4), compared with a mean of 8.6 (range 3.6-13.8) in unselected ductal carcinomas. Common alterations included loss at 16q (3/10 cases), 17p (3/10), 11q (2/10), and 16p (2/10), regions also commonly deleted in ductal carcinomas. The single case in which both pure myoepithelial carcinoma and invasive ductal carcinoma was present showed 2 alterations in the myoepithelial tumor (losses at 17p and 17q), whereas the invasive ductal component showed 15 alterations (5 gains and 9 losses), including loss at 17p. The sharing of 17p loss in myoepithelial and ductal carcinoma is consistent with a common stem cell model in the breast. The relatively few genetic alterations in otherwise aggressive neoplasms suggests that myoepithelial tumors may be a good model for the delineation of genes important in breast tumorigenesis.

[Malignant glial tumor with skeletal muscle differentiation. Description of a case]

A case of CNS gliomyosarcoma, in a 71-year-old female with skeletal muscle differentiation is presented. The tumor was composed by two cell types: one showed features typical of glial cells, the other was constituted by elements having immunohistochemical positivity with desmin, sarcomeric actin, myoglobin and myogenin antisera. It is postulated an origin from a cell capable of dual differentiation.