Malignancy-associated acquired vulvar lymphangioma circumscriptum: A clinicopathologic study of 71 cases.

BACKGROUND: Acquired lymphangioma circumscriptum of the vulva is rare and can occur subsequent to malignancies of the anogenital and pelvic region. We sought to investigate the clinicopathologic characteristics of malignancy-associated acquired vulvar lymphangioma circumscriptum (AVLC). METHODS: We identified all cases of AVLC within our institution with history of prior malignancy between 2005 and 2021. A similar search was performed in the PubMed database to identify published cases to date. The clinical and histopathologic information was recorded. RESULTS: A total of 71 cases were identified. The most common preceding malignancy was cervical carcinoma (71.8%, 51/71). Radiation therapy was given to 91.4% (64/70) of the patients and lymph node dissection was made on 70.2% (40/57). Median interval between the diagnosis of malignancy and the AVLC was 10 years (range 0-32 years). AVLC frequently presented as vesicular (31.6%, 18/57) or verrucous (28.1%, 16/57) lesions clinically. Common treatments for AVLC included excision (53.1%, 26/49) and laser therapy (16.3%, 8/49), with an overall recurrence rate of 42.9% (24/56) at a median follow-up interval of 1.8 years (range 0.04-32.3 years). CONCLUSION: AVLC is a rare, late complication of anogenital and pelvic malignancies causing debilitating physical symptoms and psychological stress. Further studies are warranted to determine the most effective treatment modalities to mitigate recurrence.

Immunohistochemical profile of breast cancer with respect to estrogen receptor and HER2 status.

There are a few studies that have evaluated a panel of stains on a single large data set of breast cancers, which is required for direct comparison between antibodies. The immunohistochemical panel in this study was chosen to include breast-specific markers and markers that are expressed in tumors resembling breast cancer. The individual marker positivity in decreasing order was 95% (177/186) for GATA-3, 92% (172/186) for cytokeratin (CK)7, 80% (151/189) for AR, 80% for estrogen receptor (158/198), 69% for progesterone receptor (137/198), 55% (105/190) for NY-BR-1, 52% (99/189) for mammaglobin, 31% (59/191) for vimentin, 26% (51/195) for GCDFP-15, 0.5% (1/186) for CK20, and 0% (0/188) for PAX-8. When tumors were categorized based on estrogen receptor and HER2 status; a total of 45 profiles were identified. In addition, some tumors showed an unconventional profile-although the majority of breast carcinomas were CK7-positive/CK20-negative, a CK7-negative/CK20-negative profile was seen in ∼8% of the cases. Such a profile can create confusion in investigation of a carcinoma of unknown origin. The results define the individual sensitivity of each marker and establish a baseline diagnostic profile of breast cancer in a large data set. In addition, the results support the use of immunohistochemical panel for confirming or determining breast as the source of metastasis.

Low ER+ breast cancer: Is this a distinct group?

OBJECTIVES: Estrogen receptor (ER) level can be semiquantified by immunohistochemistry (IHC) using the H-score. The score, given as the sum of the percent staining multiplied by the intensity level, ranges from 0 to 300. METHODS: Forty-nine ER+/HER2- invasive tumors with low ER expression (H-scores of 1-100, representing approximately 5% of all tumors) were studied for various morphologic parameters, progesterone receptor (PR), and Ki-67 IHC. RESULTS: Eighteen of 49 patients received neoadjuvant chemotherapy. The morphologic analysis showed that these tumors are often grade 3 and frequently demonstrate a sheet-like growth pattern, an intratumoral lymphocytic inflammatory infiltrate, and necrosis. Eighty percent of tumors showed a Ki-67 proliferation index of more than 50%, and 94% were PR-. Of the 18 patients who received neoadjuvant chemotherapy, six (33%) achieved pathologic complete response. CONCLUSIONS: The low ER+/HER2- cases have morphologic features and a response to the chemotherapy rate that are more similar to triple-negative tumors than the usual type of ER+ tumors.

Outcomes of breast cancer patients with micrometastases and isolated tumor cells in sentinel lymph nodes.

BACKGROUND: The prognostic value and clinical implication of micrometastases and isolated tumor cells (ITCs) in sentinel lymph nodes are still not clearly defined. This study was designed to collect clinical pathological data in our Institution. PATIENTS AND METHODS: Twenty-five cases of micrometastases and nine cases of ITCs were identified among 1,000 sentinel lymph node biopsies performed at our institution in the last 10 years. RESULTS: In the 25 patients with sentinel node micrometastases, 12 had completion axillary node dissection, and only one of these twelve had non-sentinel node micrometastasis. In this group, two patients developed local recurrence, and two patients developed distant metastases (one with and one without prior local recurrence) and later died. Both patients had negative non-sentinel lymph nodes. In the 9 patients with sentinel node ITCs, no patient had completion axillary node dissection and no patient developed local or distant metastases. CONCLUSION: Completion axillary node dissection may not be necessary in patients with sentinel node micrometastases and ITCs as it does not impact local recurrence. ITCs do not seem to have prognostic significance. Micrometastases, however, may be associated with local and/or distant metastasis.