Breast carcinoma with osteoclast-like giant cells: A cytological-pathological correlation with a literature review.

Breast carcinoma with osteoclast-like giant cells (OGCs) is a rare disease characterized by the infiltration of OGCs in the tumor; however, cytological aspects of this tumor type remain elusive. We examined the cytological features in fine needle aspiration (FNA) biopsy smears obtained from 5 patients who were histologically diagnosed with breast carcinoma with OGCs. We compared FNA and clinicopathological findings with results from the published literature. Histological assessment of the resected samples showed that all tumors exhibited a histological grade 1 phenotype with a predominant cribriform architecture. Four patients were estrogen receptor positive, and 1 patient showed a triple negative phenotype. All patients survived without tumor recurrence. In the FNA smears, tumor cells were arranged in loosely cohesive clusters, characterized by varying degrees of OGCs infiltration and rare formation of solid tumor nests. Occasionally, 2- or 3-dimensional clusters of tumor cells were found, accompanied by OGCs at the peripheral regions. In all patients, tumor cells were small without severe nuclear atypia. None of the patients showed significant background necrosis. In summary, cytological features of breast carcinoma with OGCs are characterized by loose aggregates of low grade tumor cells, the presence of OGCs, and the absence of necrosis, all of which were consistent with features reported previously. This peculiar form of breast tumors should be included in the differential diagnosis, when physicians encounter FNA findings including low grade ductal carcinoma with the admixture of multinucleated giant cells or OGCs.

Prognostic significance of mucin expression profiles in breast carcinoma with signet ring cells: a clinicopathological study.

BACKGROUND: Signet ring cells (SRCs) often accompany gastrointestinal carcinoma, referred to as SRC carcinoma; however, breast cancers containing SRCs have not been well characterized, leaving the prognostic significance of SRCs undetermined. We have described clinicopathological characteristics of patients with breast cancer containing SRCs in relation to the expression levels of MUC1, MUC2, MUC4, MUC5AC, and MUC6. METHODS: Twenty-two breast cancer cases with variable degrees of SRC population were retrospectively studied. Each case was categorized as high (>31 %) or low (<30 %) SRC tumor. The SRCs were morphologically classified into the intra-cytoplasmic lumen (ICL) type, or the non-ICL type. The expression levels of MUC1, MUC2, MUC4, MUC5AC and MUC6 were determined immunohistochemically. Depending on its subcellular localization, MUC1 was categorized as the luminal and cytoplasmic (LC) type, or the cytoplasmic with circumferential membranous accentuation (CM) type. These histological findings were compared with other clinicopathological parameters. RESULTS: The series consisted of invasive ductal carcinoma (n = 9), invasive lobular carcinoma (n = 9), and mucinous carcinoma (n = 4) cases. The SRC population accounted for 8-81 % of the tumor cells. Eight cases had ICL type SRCs, and the remaining 14 had non-ICL type SRCs. Neither the high (n = 12) and low (n = 10) percentage of SRCs, nor the SRC types affected the clinicopathological parameters. In the low MUC1 group (n = 11), larger tumors, higher nuclear grade, lymph node metastasis, and negativity for estrogen receptor was more frequently identified compared to the high MUC1 group (n = 11; p = 0.01, p = 0.002, p = 0.008, and p = 0.02, respectively). The CM group (n = 7) had more patients with large-sized tumors, lymph node metastasis, lymphovascular invasion, and higher Ki67 indices than the LC group (n = 15; p = 0.04, p = 0.001, p = 0.006, and p = 0.03, respectively). The expression levels of MUC2, MUC4, MUC5AC, and MUC6 showed no clinicopathological significance. Two patients with low MUC1 expression and CM patterns had tumor recurrence, resulting in death, while all the other patients survived without recurrence. CONCLUSION: Our results demonstrate that in breast cancers containing SRCs, low MUC1 expression and/or its CM subcellular localization patterns are associated with unfavorable clinicopathological factors. The utility of MUC1 expression as a prognostic marker remains to be verified in future studies.

Ultrasmall-incision bimanual phacoemulsification and AcrySof SA30AL implantation through a 2.2 mm incision.

Phacoemulsification and aspiration were performed with a sleeveless ultrasound tip through an ultrasmall incision (1.2 to 1.4 mm) using a 20-gauge irrigating hook through a side port to infuse the anterior chamber. After the lens was extracted, the incision was enlarged to 2.2 mm and a single-piece intraocular lens (AcrySof SA30AL, Alcon) with an optic diameter of 5.5 mm was inserted. By modifying the new injector system, the AcrySof SA30AL could be inserted through a 2.2 mm incision in 100% of cases (63 eyes) in which it was feasible to use a thin lens having a central thickness of less than 20 diopters (D). A 2.2 mm incision was also used successfully in 54% of cases (42 of 78 eyes) that required a lens with a central thickness of 20 D or higher.

6.5 mm optic AcrySof implantation through a 3.0 mm incision.

An Alcon AcrySof MA50BM intraocular lens (IOL) with an optic diameter of 6.5 mm can be implanted without further enlarging a 3.0 mm phacoemulsification incision. The IOL is placed in a Monarch II B cartridge (Alcon) designed for use with the 5.5 mm optic AcrySof SA30AL, and the tip of the cartridge is inserted in the incision but not the anterior chamber. With the cartridge tip pressing against the eye, holding up the inner edge of the corneal incision and pressing down on the outer edge of it, the plunger is advanced to insert the IOL. When the entire optic has been inserted in the eye, the cartridge is withdrawn and the trailing loop is tucked in the capsular bag. We have used this procedure to perform uneventful IOL implantation in 228 consecutive eyes, after which the incisions were 3.0 to 3.1 mm in width.