Fine needle aspiration cytology of glycogen-rich clear cell carcinoma of the breast: review of 37 cases with histologic correlation.

OBJECTIVE: To analyze fine-needle aspiration cytology (FNAC) material from 37 cases of breast glycogen-rich clear cell cancer (GRCC) and correlate cytomorphologic features with histologic appearance to determine characteristics of GRCC on FNAC. STUDY DESIGN: We reviewed cytologic features of 37 cases of breast GRCC from the archives of Ege University Hospital diagnosed between 1994 and 2006. RESULTS: Thirty-seven patients with available aspirate and confirmed GRCC were identified. The female patients ranged from 32 to 81 years (mean 52 years). The initial cytologic diagnoses were adenocarcinoma for 27 and atypical or suspicious for cancer for 10. The cytologic picture was characterized by hypercellular tumor cells in loosely cohesive syncytial groups and some single cells. Most tumor cells had abundant, finely granular eosinophilic cytoplasm or foamy to clear cytoplasm with well-defined cytoplasmic membranes and moderate to marked nuclear pleomorphism with prominent nucleoli. Histologic examination confirmed all cases to be pure GRCC. CONCLUSION: Breast GRCC is a rare, distinct category with cytologic features that overlap considerably with those of other carcinomas. Awareness of variability in cytomorphologic appearance of GRCC and routine assessment for glycogen facilitate accurate diagnosis of these lesions by FNAC and enable prompt treatment of these poor-prognosis breast cancers.

Inhibin alpha and beta expression in ovarian stromal tumors and their histological equivalences.

Inhibin is a heterodimeric protein hormone that appears to be a sensitive immunohistochemical marker of sex cord-stromal tumors. Although sex cord-stromal tumors can usually be distinguished from ovarian epithelial tumors or their metastases by morphology or by using antibodies against intermediate filaments, the diagnosis remains difficult in rare situations in such cases as sarcomatoid granulosa-theca cell tumors, ovarian small cell carcinomas, or soft-tissue sarcomas. The purposes of this study were to examine inhibin alpha and beta immunoreactivity in a wide range of gonadal stromal neoplasms and to assess its value in the differential diagnosis of problematic tumors. A total of 108 paraffin-embedded ovarian and extraovarian tumors were examined immunohistochemically by using anti-alpha inhibin and anti-beta inhibin. Inhibin alpha immunostaining was identified in 46 (81%) of 57 gonadal stromal tumors, one (14%) of seven endometrial stromal tumors, and one (50%) of two primary ovarian carcinoid tumors. Inhibin beta immunostaining was detected in 55 (96%) of 57 gonadal stromal tumors, two (29%) of seven endometrial stromal tumors, one (50%) of two dysgerminomas, and in all of two (100%) primary ovarian carcinoid tumors. Inhibin alpha expression was not detected in any ovarian surface epithelial tumor cells. Some surface epithelial tumors showed stromal inhibin alpha (15% of cases) and inhibin beta (48% of cases) positivity. Weak immunoreactivity for inhibin beta was found in most (83% of cases) ovarian surface epithelial tumors. Two ovarian Burkitt lymphomas were negative for inhibin alpha and beta. Inhibin alpha is a sensitive immunohistochemical marker of gonadal stromal tumors and is of value in the differential diagnosis of ovarian neoplasia. Inhibin beta is a nonspecific marker for ovarian neoplasms, showing expression on tumor and stromal cells of different epithelial or stromal tumors.

Effect of chemotherapy on primordial follicular reserve of rat: an animal model of premature ovarian failure and infertility.

AIM: To determine the effect of paclitaxel and cisplatin in the reduction of primordial follicular reserve in rat. MATERIAL AND METHODS: Thirty young female rats were divided randomly into three groups of 10 rats each. Paclitaxel 7.5 mg/kg and cisplatin 5 mg/kg were administered intraperitoneally in a single dose sterile technique to paclitaxel (n=10), and cisplatin (n=10) groups, and sterile saline solution was given to a control group (n=10). To assess the effects of chemotherapeutic agents on the primordial follicles, the rats were oophorectomised 7 days after the administration of chemotherapeutic agents. Haematoxylin and eosin staining was used to determine the number of primordial follicles. Primordial follicles were identified by the presence of an oocyte encapsulated partially or completely by a single layer of flattened follicular cells without a theca layer at the ovarian cortex. RESULTS: The number of primordial follicles in the control group was 23.1 +/- 16.1 follicles. The number of primordial follicles were decreased significantly in both paclitaxel and cisplatin groups compared to control group (10.3 +/- 13.0 and 13.9 +/- 15.2 follicles, respectively) (P=0.001 and P=0.01, respectively). The difference in the number of primordial follicles between the paclitaxel and cisplatin groups was insignificant (P=0.465). CONCLUSION: The administration of high dose paclitaxel and cisplatin to young rats causes the depletion of primordial follicles. However, no significant difference was observed between the two agents.

Large cell neuroendocrine carcinoma of the uterine cervix: a report of a case and review of the literature.

INTRODUCTION: Large cell neuroendocrine carcinoma is a rare aggressive cervical neoplasm, considerably rarer than the well-recognized small cell neuroendocrine carcinoma of the cervix. Cervical large cell neuroendocrine carcinomas are distinctive cervical carcinomas that are frequently misdiagnosed and have an unfavorable outcome, similar to that of small cell carcinoma. CASE REPORT: We report a 45-year-old woman with large cell neuroendocrine uterine cervical carcinoma.

Neuroendocrine differentiated carcinomas of the breast: a distinct entity.

UNLABELLED: Some primary carcinomas of the breast have been classified as neuroendocrine. In this paper we report on 12 cases of neuroendocrine carcinoma of the breast displaying common and uncommon histological features. MATERIALS AND METHODS: All patients were aged from 43 to 79 (median 66.5) years. The tumors were unilateral and ranged from 0.8 to 7 cm (median 2.35 cm) in diameter. Four tumors were classified as solid cohesive, two as solid papillary, one as Merkel cell-like, two as cellular mucinous, two as cellular mucinous with micropapillary features and one as cellular mucinous with prominent signet ring cells. The tissues were fixed in formalin and routinely processed. All materials were stained with PAS, Alcian blue and also hematoxylin and eosin. Immunohistochemical examination was carried out by the avidin-biotin method using the following antibodies: estrogen receptor protein, progesterone receptor protein, p53, cerbB-2, Ki67, neuron-specific enolase, chromogranin, and synaptophysin. RESULTS: In all cases the tumor cells were stained positively with NSE. Synaptophysin and chromogranin positivity was detected in 11 and five cases, respectively. The prominent histological features were: extensive intraductal growth, pseudorosettes and palisades, low-grade cytologic atypia, plasmacytoid appearance of the tumor cells, and intracellular and extracellular mucin. CONCLUSION: Neuroendocrine-differentiated carcinoma of the breast is a rare and distinct category with different histological subtypes.

Neuroendocrine differentiated breast carcinoma: imaging features correlated with clinical and histopathological findings.

The aim of this study was to describe the imaging features of neuroendocrine differentiated breast carcinoma (NEDBC) and to correlate the radiological findings with the clinical and histopathological findings. A retrospective review of the mammograms of 1845 histopathologically proven breast cancer cases revealed five NEDBC. The clinical, imaging, and histopathological findings were analyzed. On mammography, a high-density mass was seen in all patients. The shape of the mass was round in 4 and irregular in 1 patient. The margins were spiculated in 2, indistinct in 1, microlobulated in 1, and partially obscured in 1 patient. On sonography, 4 patients had homogeneously hypoechoic masses with normal sound transmission. In 1 patient the mass was heterogeneously hypoechoic with mild posterior acoustic enhancement. The margins were microlobulated in 2, irregular in 2, and well-circumscribed in 1 patient. Neuroendocrine differentiated breast carcinoma should be included in the differential diagnosis of mammographically dense, round masses with predominantly spiculated or lobulated margins. Sonographically, they mostly present as irregular or microlobulated, homogeneously hypoechoic masses with normal sound transmission.

Sclerosing adenosis: mammographic and ultrasonographic findings with clinical and histopathological correlation.

OBJECTIVE: To evaluate the mammographic and ultrasonographic findings of sclerosing adenosis, a relatively uncommon entity which may sometimes mimic carcinoma. MATERIALS AND METHODS: A retrospective review of the records of 33,700 women, who have undergone mammographic examination at our institution between January 1985 and July 2001 revealed 43 histopathologically proven sclerosing adenosis. The history, physical examination, mammographic and ultrasonographic findings were analyzed in all patients. In 30 patients, the nonpalpable lesions were preoperatively localized by the needle-hookwire system under the guidance of mammography (n=22) or ultrasonography (US) (n=8). Radiological features were correlated with histopathological findings. RESULTS: The age of the patients varied between 32 and 55 years (mean, 43.7 years). Only two patients had a family history of breast cancer. In six patients, the presenting complaint was mastalgia. A palpable mass was present in 13 cases. The mammographic findings were; microcalcifications in 24 (55.8%) (clustered in 22, diffuse in two), mass in five (11.6%), asymmetric focal density in three (6.9%), and focal architectural distortion in three (6.9%) patients. Four of the masses were irregularly contoured, while one was well-circumscribed. On US, focal acoustic shadowing without a mass configuration was noted in the three patients who showed asymmetrical focal density on mammography. In eight patients, who showed normal mammograms, a solid mass was detected on US. Two masses had discrete well-circumscribed oval or lobulated contours, while six showed microlobulation and irregularity. In one case, the irregularly contoured mass had marked posterior acoustic shadowing. Two of the three patients, who had focal architectural distortion on mammograms, had an irregularly contoured solid mass, while the third presented as focal acoustic shadowing without a mass configuration. CONCLUSION: Sclerosing adenosis mostly presents as a nonpalpable lesion with different mammographic and sonographic appearances. The most common finding is microcalcifications on mammograms. Awareness of the possible imaging features will enable us to consider sclerosing adenosis in the differential diagnosis. The radiological features may sometimes mimic malignancy, so histopathologic examination is mandatory for definite diagnosis.

Fine-needle aspiration biopsy of invasive micropapillary carcinoma of the breast: a report of five cases.

Invasive micropapillary carcinoma of the breast is an uncommon variant of infiltrating ductal carcinoma. Observing its distinctive cytologic appearance and aggressive behavior is important for early diagnosis by fine-needle aspiration cytology (FNAC). There are only a few reported cases in the literature. Five women presented with breast masses. FNAC showed malignant epithelial tumors, and mastectomy materials showed invasive micropapillary carcinoma for all of them. Three patients had axillary lymph node metastases. Invasive micropapillary carcinoma, with its angulated papillary clusters lacking a fibrovascular core, and irregular crowded nuclei, has a distinctive cytologic appearance which correlates with its histological features. A differential diagnosis from other primary or metastatic papillary lesions of the breast may be possible using immunohistochemistry and some cytologic features. The limited experience with invasive micropapillary carcinoma should not discourage others from undertaking further studies.

Invasive micropapillary carcinoma of the breast: clinical, mammographic, and sonographic findings with histopathologic correlation.

OBJECTIVE: The purpose of our study was to investigate the imaging features of invasive micropapillary carcinoma of the breast, which is a recently described, rare variant of infiltrating ductal carcinoma. CONCLUSION: Invasive micropapillary carcinoma of the breast usually manifests as a firm, immobile mass. Findings on mammography are of a spiculated, irregular or round, high density mass with or without associated microcalcifications. On sonography, the common findings are of a homogeneously hypoechoic, irregular or microlobulated mass with posterior acoustic shadowing or normal sound transmission. Axillary lymph nodes are frequently involved. Although these findings are not specific and may be seen with other breast malignancies, invasive micropapillary carcinoma should be included in the differential diagnosis for breast masses with these imaging features. Also, radiologic findings may help in the histopathologic differentiation of cases that are difficult to diagnose, such as metastatic tumors.

Breast carcinomas with choriocarcinomatous features: case reports and review of the literature.

Breast cancer with choriocarcinomatous features is rare. This report describes four cases of breast cancer with choriocarcinomatous features. The tumor cells were positive for human placental lactogen (hPL) and human chorionic gonadotropin (hCG) by immunohistochemistry. The cases reported in the literature had a poor prognosis and the patients died within a few months after the diagnosis. In this series, two cases were lost to follow-up, but the other two have had disease-free survival for 2 and 4 years, respectively.

p53 and Ki-67 expression as prognostic factors in cystosarcoma phyllodes.

We have reviewed the histopathological, clinical outcome and immunohistochemical status in 21 women with cystosarcoma phyllodes (CSP) tumors of the breast. We assessed 12 tumors as histopathologically benign and 9 tumors as malignant. The median patient ages in benign and malignant CSP tumors were 39.6 and 45.4 years of age, respectively. The stromal cellularity, stromal cellular atypism, high mitotic activity, atypic mitoses, stromal overgrowth, infiltrative tumor contour, and heterologous stromal elements were significant features of the malignant CSP tumors. Benign CSP tumors were predominantly of fibroadenomatous architecture with cellular stroma (mild or moderate) and some distortion and elongation of glandular elements. Five malignant CSP tumors were stained positively with p53, and 6 malignant CSP tumors were stained immunohistochemically with Ki-67. All benign CSP tumors were negatively stained for p53 and Ki-67. The patients with benign CSP tumors were treated with local excision ( n=11) and with subcutaneous mastectomy ( n=1). Malignant CSP tumors were treated with wide local excision ( n=1), partial mastectomy ( n=1), simple mastectomy ( n=2), and modified radical mastectomy ( n=5). Two patients with a high mitotic rate and high values of p53 and Ki-67 received additional radiotherapy and chemotherapy. One case had liver metastasis. This tumor had high mitotic figures, stromal overgrowth, severe stromal cellularity, and 20% Ki-67 and mild p53 positivity. We suggest that p53 and Ki-67 can play an important role in predicting prognosis and yielding additional therapy besides conventional prognostic factors in the treatment of the CSP patients.