Consistency in recognizing microinvasion in breast carcinomas is improved by immunohistochemistry for myoepithelial markers.

Microinvasion is the smallest morphologically identifiable stage of invasion. Its presence and distinction from in situ carcinoma may have therapeutic implications, and clinical staging also requires the recognition of this phenomenon. Microinvasion is established on the basis of several morphological criteria, which may be difficult and not perfectly reproducible among pathologists. The aim of this study was to assess the consistency of diagnosing microinvasion in the breast on traditional haematoxylin and eosin (HE) stained slides and to evaluate whether immunohistochemistry (IHC) for myoepithelial markers could improve this. Digital images were generated from representative areas of 50 cases stained with HE and IHC for myoepithelial markers. Cases were specifically selected from the spectrum of in situ to microinvasive cancers. Twenty-eight dedicated breast pathologists assessed these cases at different magnifications through a web-based platform in two rounds: first HE only and after a washout period by both HE and IHC. Consistency in the recognition of microinvasion significantly improved with the use of IHC. Concordance rates increased from 0.85 to 0.96, kappa from 0.5 to 0.85, the number of cases with 100% agreement rose from 9/50 to 25/50 with IHC and the certainty of diagnosis also increased. The use of IHC markedly improves the consistency of identifying microinvasion. This corroborates previous recommendations to use IHC for myoepithelial markers to clarify cases where uncertainty exists about the presence of microinvasion. Microinvasive carcinoma is a rare entity, and seeking a second opinion may avoid overdiagnosis.

Adenofibroma of the testis.

Adenofibromas of the testicular parenchyma are exceptional with only one case published in the literature. Whereas adenofibromas of mullerian derivatives are well described, testicular tumours resembling surface ovarian epithelium are rare. We describe a case of adenofibroma discovered incidentally while investigating for a hydrocoele in a 57-year-old patient. Histological and immunohistochemical evaluation confirmed the lesion as being a serous adenofibroma with immunohistochemical properties analogous to its ovarian counterpart. These lesions are to be considered in the differential diagnosis of unusual cystic lesions of the testis, in order not to confuse it with more sinister pathology.

Melanoma-like pigmented cutaneous metastases from breast carcinoma.

We report a case of breast carcinoma that presented with pigmented cutaneous metastases clinically mimicking malignant melanoma. The pigmented nature of the tumour was probably caused by melanin release from the damaged epidermis (following invasion and destruction by tumour cells) and subsequent phagocytosis by melanophages. Clinically visible pigmentation in cutaneous metastases from breast carcinoma has been described previously but is very uncommon. This report is followed by a review of the few such cases published in the literature.

Varicella susceptibility and vaccination strategies in young adults.

BACKGROUND: Varicella infection causes substantial morbidity in young adults. Most military basic trainees are 18 to 21 years old, yet the Army has no varicella vaccination policy. We therefore determined varicella susceptibility in a population of Army basic trainees, examined variables that might predict antibody status, and developed a vaccination strategies model. METHODS: Fifteen-hundred ninety-five trainees completed a demographic and historical questionnaire. Varicella antibody status was determined on 1201 volunteers. These data plus information from the literature were used to construct a decision tree of vaccination strategies that was applied to the total population of Army basic trainees in 1995 (n = 65,298). RESULTS: Fifty (4.2 percent) of 1201 soldiers were antibody negative. Trainees who lived with no or 1 sibling while growing up were most likely to be seronegative (P < 0.01). The positive predictive value of a history of varicella was 98.5 percent, whereas the negative predictive value of a negative history of varicella was 23 percent. In the vaccination strategies model, serologically testing soldiers with a negative history of varicella and vaccinating those without protective antibodies was the most cost-effective approach. CONCLUSIONS: In young adults a positive varicella history accurately predicts immunity, but verification of a negative history with antibody testing is recommended before vaccination.