23 research outputs found
Invasive lobular carcinoma with extracellular mucin production-a novel pattern of lobular carcinomas of the breast. Clinico-pathological description of eight cases
Invasive lobular carcinoma of the breast is known to produce intracellular mucin and has been recognized in single-case reports to show extracellular mucin production, as well. This latter morphology is not only rare but must also be under- or misdiagnosed. The aim was to better characterize this entity. Cases of lobular cancers demonstrating extracellular mucin formation were identified in a multi-institutional effort and their clinical and morphologic features were assessed. Immunohistochemistry was used to characterize the E-cadherin-membrane complex, neuroendocrine differentiation, and to some extent, mucin formation. All but one of the eight cases occurred in postmenopausal patients. Extracellular mucin production was present in 5 to 50% of the tumour samples and rarely also appeared in nodal and distant metastases. The tumours were completely E-cadherin negative and showed cytoplasmic p120 positivity. The majority (n = 6/8) was also completely negative for beta-catenin, but two tumours displayed focal beta-catenin positivity in the mucinous area. MUC1 and MUC2 expression was observed in all and 7/8 tumours, respectively; neuroendocrine differentiation was present in only one. Invasive lobular carcinoma with extracellular mucin formation is a rare morphologic variant of lobular carcinoma prone to be misdiagnosed and warranting further studies.Peer reviewe
Radial Basis Function Artificial Neural Network for the Investigation of Thyroid Cytological Lesions
Objective. This study investigates the potential of an artificial intelligence (AI) methodology, the radial basis function (RBF) artificial neural network (ANN), in the evaluation of thyroid lesions. Study Design. The study was performed on 447 patients who had both cytological and histological evaluation in agreement. Cytological specimens were prepared using liquid-based cytology, and the histological result was based on subsequent surgical samples. Each specimen was digitized; on these images, nuclear morphology features were measured by the use of an image analysis system. The extracted measurements (41,324 nuclei) were separated into two sets: the training set that was used to create the RBF ANN and the test set that was used to evaluate the RBF performance. The system aimed to predict the histological status as benign or malignant. Results. The RBF ANN obtained in the training set has sensitivity 82.5%, specificity 94.6%, and overall accuracy 90.3%, while in the test set, these indices were 81.4%, 90.0%, and 86.9%, respectively. Algorithm was used to classify patients on the basis of the RBF ANN, the overall sensitivity was 95.0%, the specificity was 95.5%, and no statistically significant difference was observed. Conclusion. AI techniques and especially ANNs, only in the recent years, have been studied extensively. The proposed approach is promising to avoid misdiagnoses and assists the everyday practice of the cytopathology. The major drawback in this approach is the automation of a procedure to accurately detect and measure cell nuclei from the digitized images
Mucinous cystadenocarcinoma of the breast: the challenge of diagnosing a rare entity
Mucinous cystadenocarcinoma is an extremely rare variant of primary breast tumor which is histologically similar to mucinous cystadenocarcinoma of the ovary and pancreas. Herein we report a case of a 63 years old woman diagnosed with diverse histological types of non-synchronous rare primary breast tumors, a medullary carcinoma of the right breast and a mucinous cystadenocarcinoma of the left breast. Macroscopically the neoplasm appeared multilocular filled with mucoid material. Under light microscopy the cystic areas were lined by columnar cells with abundant intracellular and extracellular mucin. Solid areas were composed of tall columnar cells with intracellular mucin. Moderate to marked atypia was noticed and tumor cells stained positive for cytokeratin 7 and negative for cytokeratin 20. Moreover tumor cells displayed a basal like immunophenotype expressed as followed: ER negative, PR negative, HER-2 negative, cytokeratin (CK5/6) positive and EGFR positive
Plexiform tumorlet in a woman with postmenopausal endometrioid endometrial carcinoma taking tamoxifen for breast cancer: A case report
Leiomyomas are the most common benign smooth muscle tumors of the female genital tract. Among the recognized histologic variants, one of the least common is plexiform leiomyoma. When they are small, even microscopic findings, they are referred to as plexiform tumorlets.In this report the authors describe a case of plexiform tumorlet found incidentally in the hysterectomy specimen of a 64-year-old woman with concomitant endometrioid endometrial carcinoma and a previous history of invasive lobular breast carcinoma. The endometrioid endometrial carcinoma arising on a polyps was diagnosed in a curettage specimen. In the hysterectomy specimen there was no residual endometrioid endometrial carcinoma. Six uterine leiomyomas were found. A small (3 mm) well circumscribed tumor was located in the uterine wall. Histologically it consisted of small nests, islands, cords, and tubules of relatively uniform, round to oval cells surrounded by loose stroma. The differential diagnosis was challenging, and included plexiform leiomyoma, uterine tumor resembling ovarian sex cord tumor, endometrial stromal tumor, and poorly differentiated endometrial or metastatic invasive lobular breast carcinoma. After careful morphologic evaluation and appropriate use of immunohistochemical stains the diagnosis of plexiform tumorlet was made
Tumor to Tumor Metastasis from Adenocarcinoma Not Otherwise Specified of the Parotid Gland to Uterine Leiomyoma: Presentation of a Unique Case
Salivary gland adenocarcinoma not otherwise specified (NOS) is a
malignant epithelial tumor composed of ductal/glandular structures with
or without cystic formation. Histologically it is classified as high
grade with relevant biological behavior. Although both minor and major
glands may be involved, the majority (60%) implicate the parotid gland.
Location, regional lymph node status, and histological grade are some of
the factors that predict the progress of the disease and the development
of metastases. Long follow-up is considered the standard option as
distant metastases (DM) may occur despite regional control. Primary
sites of DM, besides lymph nodes, include bone, lung, and liver. Herein
we report a unique case of a 68-year-old female with a previous history
of high-grade adenocarcinoma NOS of her right parotid gland. On her
biannual follow-up examination, MRI revealed an abnormal increase in the
size of a known uterine leiomyoma of the posterior uterine wall.
Positron emission tomography-CT (PET-CT) showed increased uptake in the
uterus and lungs. On frozen section, adenocarcinoma was found at the
center of the leiomyoma. Histological and immunohistochemical findings
were consistent with secondary involvement by the salivary gland
adenocarcinoma NOS. Treatment consisted of cyclophosphamide, adriamycin,
and cisplatin with poor outcome. The patient was lost to follow-up.
Review of the literature indicates that no similar case has been
reported in the English literature
Invasive Lobular Carcinoma with Extracellular Mucin Production: Description of a Case and Review of the Literature
Invasive lobular carcinoma of the breast is the second most common
subtype of breast carcinoma. It accounts for 5-15% of the breast
carcinoma cases reported. It shows a different metastatic pattern
compared to invasive carcinoma of no special type. There are several
variants of this cancer including the classic, solid, signet ring cell,
tubulolobular, alveolar, trabecular, pleomorphic, and mixed subtypes
each one with a distinctive morphology. Invasive lobular carcinoma has
been associated with intracellular mucin production, in the form of
intracytoplasmic lumina and signet ring cells whereas extracellular
mucin production has been related to carcinomas of ductal origin. A new
variant that displays extracellular mucin production was described
recently. Only nineteen cases of this rare entity have been reported to
date. In this manuscript, we report an additional case of invasive
lobular carcinoma with extracellular mucin production, describing its
clinico-pathological characteristics, and review the literature on the
same
Kidney Carcinoma Ovarian Metastasis: Review of the Literature
Ovarian metastasis is common with secondary tumors representing up to
15% of ovarian neoplasms. The malignancies most commonly involving the
ovaries are carcinomas of the stomach, colon, breast, endocervix,
endometrium, and lymphoma. Secondary ovarian involvement by kidney
carcinoma occurs very rarely and is usually associated with widespread
dissemination.
We conducted a review of kidney carcinoma with ovarian metastasis in the
literature using the keywords clear cell renal cell carcinoma, papillary
renal cell carcinoma, chromophobe renal cell carcinoma collecting duct
carcinoma, and ovarian metastasis on Google Scholar and PubMed indices
in April 2018, including a case diagnosed in our department. To date, 30
articles presenting 41 cases of kidney carcinoma with ovarian metastasis
are reported in the literature. All reviewed cases were analyzed for
diagnosis, surgical and systemic therapy, and outcome.
Diagnosis may sometimes be challenging, requiring appropriate
immunohistochemical markers in difficult cases. A combination of surgery
and adjuvant therapy offers significant benefit in disease control or
palliation of symptoms. Due to inconsistency in the reported data,
further studies are needed to make safe conclusions regarding survival
Matrix-producing Breast Carcinoma: A Rare Subtype of Metaplastic Breast Carcinoma
Matrix-producing carcinoma (MPC) is a rare subtype of metaplastic breast
carcinoma (MBC) that was first described in 1989 by Wargotz and Norris.
It accounts for less than 1% of breast carcinomas and has distinctive
clinical, morphological, and immunohistochemical features.
Histologically it consists of invasive carcinoma of no special type with
transition to cartilaginous or osseous matrix without a spindle cell
component. Data on this entity are limited with the literature
consisting mostly of case reports and a small number of case series.
We report a case of matrix-producing breast carcinoma, with excellent
clinical outcome. We also discuss the histogenesis, imaging,
histological, and immunohistochemical characteristics, treatment, and
focus on the differential diagnosis of this rare tumor
Immunoglobulin G4-related Disease: Presentation of the First Case with Isolated Pterygopalatine Fossa Involvement
Immunoglobulin G4-related disease is an immune-mediated
fibroinflammatory disease with single or multiple organ involvement.
Clinically it mimics several benign and malignant tumors, as well as
infectious, and inflammatory disorders. It typically presents as
multiple tumor-forming lesions. Histological and immunohistochemical
findings are characteristic. Serum immunoglobulin G4 levels are usually
increased. Systemic corticosteroid administration is the treatment of
choice with good response, especially in early disease stages.
We present the first case of immunoglobulin G4-related disease
presenting as an isolated tumor forming lesion of the left
pterygopalatine fossa. Imaging studies indicated a benign process.
Histological findings were consistent with IgG4-related disease. The
patient showed a good response to systemic corticosteroid treatment and
remains free of symptoms 18 months following diagnosis
DOG1-positive primary mesenteric leiomyosarcoma : report of a case and review of the literature
The mesentery constitutes a common location for the metastatic spread of malignant gastrointestinal tumors. Primary mesenteric tumors, on the other hand, are very rare; lymphomas are the most common, followed by benign and malignant mesenchymal tumors. We present a case of a 43-year-old patient operated on for a primary mesenteric leiomyosarcoma with a positive immunostain for DOG1, despite having no KIT or PDGFRa mutations on molecular analysis. Moreover, we review the pertinent literature.