Collapsing benign cystic nodules of the thyroid gland: sonographic differentiation from papillary thyroid carcinoma.

BACKGROUND AND PURPOSE: The US features of benign and malignant nodules overlap, and benign thyroid lesions can mimic thyroid malignancy on US. Benign cystic nodules after spontaneous collapse or needle aspiration, can mimic malignant thyroid nodules. Our aim was to evaluate the US features of CBCNs of the thyroid that distinguish such nodules from malignant thyroid nodules. MATERIALS AND METHODS: US and clinical findings in 13 patients, each with a single CBCN, were evaluated to determine if they showed >50% cystic content on initial US or CT and >30% decrease in maximum diameter on follow-up US. We compared these findings with those of 26 patients, each with a single surgically confirmed PTMC. US scans were analyzed for internal content, shape, margin, echogenicity, presence of echogenic dots suggesting micro- and macrocalcification, inner isoechoic rim, and low-echoic halo. RESULTS: Six of the 13 (46%) CBCNs were classified as malignant on US due to their marked hypoechogenicity, microcalcification, or spiculated margins. US features that differed between CBCNs and PTMCs were shape (ovoid-to-round versus taller-than-wide, P = .016); margins (ill-defined versus spiculated, P < .000); low-echoic halo (P < .000); inner isoechoic rim (P < .000) with high negative predictive values (100%, 91%, 91%, and 89%, respectively); and clinically acceptable diagnostic accuracy (59%, 80%, 82%, and 85%, respectively). CONCLUSIONS: US features helpful for differential diagnosis of CBCNs from PTMCs include shape, margin, and the presence of an inner isoechoic rim and a low-echoic halo. Familiarity with US features suggesting CBCNs may be helpful in reducing unnecessary repeated FNABs.

Tissue microarray-based study of patients with lymph node-negative breast cancer shows that HER2/neu overexpression is an important predictive marker of poor prognosis.

BACKGROUND: Despite good prognosis in most cases of lymph node (LN)-negative breast cancer, individual patients may have markedly different clinical outcomes. Here, we investigated the prognostic significance of HER2/neu overexpression in these tumors. MATERIALS AND METHODS: We employed a tissue microarray to examine HER2/neu overexpression by immunohistochemical staining in 359 consecutive patients diagnosed with LN-negative breast cancer, who underwent surgery from January 1993 to December 1998. RESULTS: HER2/neu overexpression was detected in 81 of 359 (23.1%) patients. The 10-year disease-free survival (DFS) values (81.2% versus 61.8%, P value 0.000) and overall survival (OS) rates (85.7% versus 63.9%, P value 0.000) were significantly different between cases with HER2/neu-negative or HER2/neu-positive tumors. After multivariate analysis, HER2/neu status and tumor size were identified as independent prognostic factors for 10-year OS. Moreover, HER2/neu overexpression was significantly associated with poorer clinical outcomes in an intermediate-risk group identified by the St Gallen classification (10-year DFS, 79.6% versus 61.8%, P value 0.000; 10-year OS, 84.7% versus 63.9%, P value 0.000). CONCLUSIONS: Our results show that HER2/neu overexpression is an important independent prognostic factor for LN-negative breast cancer cases and support the theory that more intensive adjuvant chemotherapy is required in the population with HER2/neu overexpression.

Genetic changes in bilateral breast cancer by comparative genomic hybridisation.

The aim of this study is to find any specific genetic defect occurring frequently in bilateral breast cancer by examining the genetic changes of each chromosome using comparative genomic hybridisation (CGH). CGH was conducted for 36 breast cancer tissues taken from patients treated with surgery for bilateral breast cancer. Tumour and control DNAs were hybridised to metaphase chromosome with differential staining with fluorescein and rhodamine-dUTP. An average rate of green (DNA of tumour cell) against red (DNA of a normal peripheral blood lymphocyte) was calculated in these captured metaphase chromosomes and a ratio of more than 1.17 was defined as an acquisition, less than 0.85 as a loss and, finally, more than 2 as amplification. Twenty-six out of 36 cases (72.2%) showed a change in the number of DNA copies by CGH in one or more regions of gene. On average, 5.3 alterations for each chromosome (range, 1-14) were found, and gain was present more than loss at a ratio of 1.3:1. Loci that showed amplification were X, 17q, Xq, 8q, 14q11-21 and 17q22-qter. The locus showing the most gain was the X chromosome, which was observed in 15 (57.7%) out of 26 cases. Loss was most frequently observed in the short arm of chromosome 8. The concordance of genetic transformation of primary cancer and secondary cancer in bilateral breast cancer was an average of 18.7% in synchronous and 10.7% in metachronous cancer, showing higher similarity in synchronous breast cancer.

Comparative genomic hybridization in extramammary Paget's disease.

BACKGROUND: Extramammary Paget's disease (EMPD) is a distinct skin cancer of unknown histogenesis. Data from genome-wide surveys for chromosomal aberrations in EMPD are limited. OBJECTIVES: To identify chromosomal aberrations that are present in EMPD. METHODS: Fifteen cases of EMPD were analysed by comparative genomic hybridization (CGH). We used pooled DNA CGH, instead of studying a single sample. In addition, immunohistochemistry was performed for detection of androgen receptor (AR). RESULTS: The most recurrent change was amplification at chromosomes Xcent-q21 and 19, and loss at 10q24-qter. In addition, expression of AR, located in chromosome X, was found in six cases. CONCLUSIONS: Results suggest that AR may play a role in EMPD tumorigenesis.

Comparative genomic hybridization in epithelioid sarcoma.

BACKGROUND: Epithelioid sarcoma is a rare mesenchymal neoplasm of unknown histogenesis. Data on genome-wide surveys for chromosomal aberrations in epithelioid sarcoma are limited. OBJECTIVES: To investigate genetic aberrations in epithelioid sarcoma. METHODS: We analysed seven cases of epithelioid sarcoma (classic type, three cases and proximal type, four cases) by comparative genomic hybridization (CGH), and correlated findings with the results of additional immunohistochemical study. RESULTS AND CONCLUSIONS: CGH analysis showed DNA copy number changes at one to five different genomic sites in six of seven cases (86%). The majority of the changes were gains. The most frequent gain was at 22q (six cases). Other recurrent changes include gains of 12q24-qter (four cases), 17 (four cases), and 5q32-qter (three cases). High-level homology was seen in chromosomal aberration in both types. In addition, expression of interleukin-2 receptorbeta, located in 22q, was revealed by immunohistochemical method in six cases with gain of 22q, suggesting it may play a role in epithelioid sarcoma tumorigenesis.

Xanthogranulomatous cholecystitis: radiologic findings with histologic correlation that focuses on intramural nodules.

OBJECTIVE: The purpose of this study was to histologically classify intramural nodules associated with xanthogranulomatous cholecystitis and to evaluate the radiologic findings for each type of nodule. MATERIALS AND METHODS: Pathologic slides and radiologic studies including 14 sonographic and 16 CT examinations in 19 patients (12 men, seven women; mean age, 61 years) with xanthogranulomatous cholecystitis were reviewed. Radiologic findings were correlated with the histologic type of intramural nodule: abscess, xanthogranuloma, or a combination of the two. The duration of symptoms for each type of intramural nodule was also evaluated. RESULTS: Histologically, all patients had intramural nodules that were either abscesses (n = 11), xanthogranulomas (n = 5), or a combination of the two (n = 3). Radiologic studies revealed nodules in 10 patients (52.6%; four abscesses, four xanthogranulomas, and two combinations). For abscesses, the mean interval from onset of symptoms to surgery was 25 days; for xanthogranulomas, 70 days (p = .0057). Abscesses were associated with more complications of xanthogranulomatous cholecystitis. CONCLUSION: Intramural nodules in patients with xanthogranulomatous cholecystitis were found to represent abscesses or xanthogranulomas at histology. Xanthogranulomas were more often revealed radiologically than were abscesses. Abscesses caused more clinical complications. Because symptoms lasted longer for xanthogranulomas, we hypothesized that abscesses may become xanthogranulomas.

Fine needle aspiration cytology of cystic hypersecretory carcinoma of the breast. A case report.

BACKGROUND: Cystic hypersecretory carcinoma (CHC) of the breast is a rare variant of intraductal carcinoma. It is characterized by a multicystic, yellow-brown lesion with gelatinous material grossly and cystically dilated ducts with an eosinophilic secretion microscopically. The histologic or cytologic features can be deceptively bland. CASE: A 37-year-old female presented with an 8-cm-diameter, firm mass in the breast. Radical mastectomy was performed after fine needle aspiration (FNA). The moderately cellular smear had a characteristic background of proficient, intensely staining secretion with bubbling. The cellular components were various, ranging from sheets of benign hyperplastic ductal cells to three-dimensional clusters or papillae of frankly malignant ductal cells, with varying degrees of secretory activity. The background consisted of inflammatory cells, naked nuclei and foamy histiocytes. The cytologic findings correlated well with the histologic features of the tumor, which showed both micropapillary intraductal carcinoma with apocrine metaplasia and focal high grade invasive carcinoma in a background of cystic hypersecretory hyperplasia. CONCLUSION: This was the first reported case of FNA cytology of an invasive form of CHC. CHC has characteristic features on FNA, and so a reliable diagnosis can be made.

Cytogenetic analysis of meningiomas.

Cytogenetic analysis of 4 cases of meningiomas from 3 male and 1 female patients is reported. One of male patients suffered from neurofibromatosis type 2. Histologically, the meningiomas were meningotheliomatous (1), transitional (2), and psammomatous (1). Chromosomal abnormalities were found in all cases with a karyotype 45,XY,-22, 45,XY,-16, 45,XX,-2, and 45,XY,t (15p;22q), respectively. Monosomy of chromosome 22 was detected only in the patient with neurofibromatosis type 2. These cytogenetic analysis demonstrates that variable clonal karyotype aberrations exist in meningiomas.