Infiltrating syringomatous adenoma of the nipple: Sonographic and mammographic features with pathologic correlation.

We report the case of a 39-year-old woman complaining of painless unilateral nipple enlargement for 3 weeks. She had no family history of breast cancer. Clinical examination revealed left nipple enlargement without pain, erythema, or skin changes m no associated palpable breast or axillary masses. Ultrasound showed several bright foci in the left nipple suggestive of microcalcifications. Neither solid nor cystic masses were detected. The mammogram performed subsequently confirmed the presence of multiple pleomorphic microcalcifications within the nipple. Wedge biopsy showed a syringomatous adenoma. Wide local excision of the nipple was performed. The postoperative course was uneventful.

Claudin-2 promotes colorectal cancer liver metastasis and is a biomarker of the replacement type growth pattern.

Claudin-2 promotes breast cancer liver metastasis by enabling seeding and early cancer cell survival. We now demonstrate that Claudin-2 is functionally required for colorectal cancer liver metastasis and that Claudin-2 expression in primary colorectal cancers is associated with poor overall and liver metastasis-free survival. We have examined the role of Claudin-2, and other claudin family members, as potential prognostic biomarkers of the desmoplastic and replacement histopathological growth pattern associated with colorectal cancer liver metastases. Immunohistochemical analysis revealed higher Claudin-2 levels in replacement type metastases when compared to those with desmoplastic features. In contrast, Claudin-8 was highly expressed in desmoplastic colorectal cancer liver metastases. Similar observations were made following immunohistochemical staining of patient-derived xenografts (PDXs) that we have established, which faithfully retain the histopathology of desmoplastic or replacement type colorectal cancer liver metastases. We provide evidence that Claudin-2 status in patient-derived extracellular vesicles may serve as a relevant prognostic biomarker to predict whether colorectal cancer patients have developed replacement type liver metastases. Such a biomarker will be a valuable tool in designing optimal treatment strategies to better manage patients with colorectal cancer liver metastases.

Epithelial-Myoepithelial Carcinoma of the Breast with Rhabdoid Features.

Epithelial-myoepithelial carcinoma of the breast is a rare biphasic tumor composed of intermixed malignant epithelial and myoepithelial components. Myoepithelial cells are known to adopt varied morphologies, including spindle, chondroid, clear cell, and rhabdoid morphologies, and can represent a diagnostic challenge when isolated on biopsy. Rhabdomyosarcoma, phyllodes tumor, metaplastic carcinoma, and myoepithelial carcinoma are primary breast tumors that all have been shown to exhibit rhabdoid features, whether representing true differentiation or morphological mimic. We here report an epithelial-myoepithelial carcinoma of the breast with rhabdoid features in a 76-year-old woman. The rhabdoid-appearing myoepithelial cells are negative for myogenin, consistent with a rhabdoid-like morphology rather than a true rhabdoid differentiation, comparably to previously described myoepithelial carcinoma with rhabdoid features. To our knowledge, this is the first reported case of epithelial-myoepithelial carcinoma of the breast with rhabdoid features and thus adds another entity to the differential diagnosis of breast lesions with rhabdoid features.

Imaging features of pure and mixed forms of mucinous breast carcinoma with histopathological correlation.

METHODS:: A cross-sectional study identified cases of mucinous breast carcinoma from pathology records (2004-2012). Two radiologists classified imaging features by consensus and two pathologists classified cases into pure or mixed subtypes. Bi-variable analyses were performed using relevant statistical tests. RESULTS:: We identified 80 lesions in 77 female patients (median age 65 years, range 29-88): 58 lesions on mammograhy, 72 on ultrasound, and 25 on MRI. Statistically significant findings (p < 0.05) are as follows. On mammography, tumour margins tended to be indistinct (12, 48%) and spiculated (11, 44%) for pure and mixed lesions, respectively. Pure mucinous masses were less microcalcified (23, 77%) and mixed masses equally so. On ultrasound, pure tumours tended towards an irregular or oval shape (44, 42%) with mixed tumours having an irregular shape (78%). More pure tumours (53%) had posterior acoustic enhancement than mixed lesions (33%), and all pure tumours lacked posterior acoustic shadowing. Pure lesions had a heterogeneous echo pattern more than mixed tumours (78% vs 39%). On MRI, pure tumours tended towards a persistent kinetic curve (42%) whereas mixed tumours predominantly had a washout pattern (75%). Most pure tumours were T2 hyperintense (83%) whereas mixed lesions were T2 isointense or hyperintense (61%, 23%), respectively. CONCLUSION:: An analysis of imaging features can help to infer underlying histology of pure and mixed forms of mucinous breast carcinoma. ADVANCES IN KNOWLEDGE:: Pure mucinous carcinomas present less suspicious imaging features than mixed mucinous carcinomas and could be mistaken for non malignant lesions. An imaging analysis of mucinous breast carcinoma can help infer their underlying histology.

Pilomatricoma of the male breast: sonographic mammographic MRI features with pathologic correlation.

We report a case of 43-year-old man who presented with an enlarging, painless, palpable mass in the left breast for one year associated with surface blue discoloration of the skin. Mammogram showed a well-defined 2.3-cm mass with microcalcifications. Ultrasound revealed a well-defined, subcutaneous hypoechoic mass adherent to the skin with multiple bright foci. Ultrasound-guided needle biopsy produced a dark-colored sample corresponding to pilomatricoma on final pathology. Bilateral breast magnetic resonance imaging showed heterogeneously hyperintense in T1- and T2-weighted images with heterogeneous enhancement toward the delayed phase. Surgical resection was carried out with wide margins.

Pilot study investigating the prognostic significance of thymidine phosphorylase expression in patients with metastatic breast cancer: a single institution retrospective analysis.

BACKGROUND: The thymidine phosphorylase (TP) enzyme is expressed in higher levels in cancer tissue when compared with normal tissue. It is involved in the intratumoral activation of widely prescribed pyrimidine-derived antimetabolites such as 5'-deoxy-5-fluorouridine and capecitabine (Xeloda(®)). The purpose of this study was to determine the clinical correlation between TP expression in tumor tissue and the clinical outcome of capecitabine-based therapy in patients with locally advanced (stage III) or metastatic breast cancer (stage IV). METHODS: The following variables were analyzed as potential determinants of benefit from a capecitabine-based therapy: TP expression, estrogen receptor (ER) and progesterone receptor (PR) status, human epidermal growth factor receptor-2 status, and Ki67 status. This was accomplished by immunohistochemical analysis of paraffin-embedded cancer tissues from 18 patients with breast cancer treated with at least one cycle of capecitabine. Clinical outcome was measured as time to progression. RESULTS: TP staining intensities in both the invasive and in situ components in patients with lobular and ductal carcinomas were reported. Higher levels of TP in the invasive component were expressed in ER-negative tumors when compared with ER-positive tumors (P<0.05). The ER-positive group expressing lower levels of TP had a median time to progression of 13 months compared with the ER-negative group expressing higher levels of TP which had a median time to progression of 7.5 months (P=0.14). CONCLUSION: Patients with ER-positive tumors expressing lower levels of TP exhibit a longer time to progression when compared with patients with ER-negative tumors. Consequently, tumor TP expression does not seem to predict the outcome of capecitabine-based chemotherapy.

Axillary metastasis from an occult tubal serous carcinoma in a patient with ipsilateral breast carcinoma: a potential diagnostic pitfall.

Axillary nodal metastasis from a nonmammary neoplasia is much rarer than diseases associated with a primary breast carcinoma. However, this has to be considered in the differential diagnosis of nodal disease in patients with a history of breast cancer. Here, we report the case of a 73-year-old female with a past medical history of breast cancer, presenting with an ipsilateral axillary metastatic carcinoma. The immunohistochemical profile of the metastatic lesion was consistent with a high grade serous carcinoma. After undergoing a total abdominal hysterectomy and salpingo-oophorectomy, thorough pathological examination revealed two microscopic foci of serous carcinoma in the right fallopian tube, not detectable by preoperative magnetic resonance imaging. In this context, the poorly differentiated appearance of the metastatic tumor and positive staining for estrogen receptor, might lead to a misdiagnosis of metastatic breast carcinoma. As the therapeutic implications differ, it is important for the pathologist to critically assess axillary lymph node metastases, even in patients with a past history of ipsilateral breast carcinoma and no other known primary tumors.