Cystic change in thyroid cancer

BACKGROUND: To determine the incidence of cystic change of thyroid cancer detected by ultrasonography and to compare the diagnostic accuracy of fine-needle aspiration cytology (FNAC) postultrasonography in solid and cystic thyroid nodules. METHODS: This retrospective study collected data for 6219 patients with thyroid nodules. Mean patient age was 49.7 +/- 13.6 years. Of these 6219 patients, 1983 had cystic changes of thyroid nodules and 4236 had solid masses as detected by ultrasonography. Following FNAC, 506 of the patients with solid masses (11.9%) underwent surgical treatment, compared with 143 of those with cystic change of thyroid masses (7.2%). RESULTS: Of the 649 nodules treated surgically in the solid and cystic change groups, 29.8% (151/506) and 9.1% (13/143) were malignant, respectively. Overall, after surgical treatment, 0.65% of cystic changes to thyroid lesions were diagnosed as thyroid cancer. Diagnostic accuracy of FNAC in cystic changes of the thyroid masses after ultrasonographic examination resembled that in solid thyroid nodules. CONCLUSIONS: Cystic changes of thyroid masses are common. Positive predictive value in diagnosing papillary carcinoma of thyroid masses with cystic changes is high. Notably, preoperative accurate diagnosis is difficult.     

Pre‐operative radiotherapy for rectal carcinoma? Has the case really been made for short course pre‐operative radiotherapy if surgical standards for rectal carcinoma are optimal?

Recent publications on early results of the Dutch trial on pre‐operative radiotherapy combined with total mesorectal excision (TME) for resectable rectal cancer have initiated a major swing towards routine radiotherapy of this type. However, detailed analysis of the data so far published shows 23.3% microscopic margin involvement and 23.9% macroscopically poor specimens in a sample group. Since only mobile tumours were selected these figures are too high to validate the claim that the whole series represents ‘standardized TME surgery’. The role of pre‐operative radiotherapy for resectable rectal cancer undergoing optimal surgery therefore remains open. It may be expected that in future the individual indication for pre‐operative radiotherapy will be based on the findings of pre‐operative modern fine slice high resolution magnetic resonance imaging (MRI).     

Matrix‐producing Carcinoma: A Rare Variant of Metaplastic Breast Carcinoma with Heterologous Elements

Abstract: Matrix‐producing carcinoma (MPC) of the breast is a rare variant of the uncommon group of malignancies categorized as metaplastic breast carcinomas with heterologous elements. The major criterion for a diagnosis of MPC is the presence of invasive breast carcinoma with the direct transition to a cartilaginous or osseous stromal matrix without an intervening spindle cell component. The cellular origin of MPC remains unclear. It has been suggested that tumor cells in MPC have combined epithelial and mesenchymal features. Several reports have suggested that the tumor cells originate from myoepithelial cells. The prognosis of patients with MPC was originally described as similar to invasive mammary carcinomas of no special type (NST) of the same stage, but a more recent study has shown a worse prognosis than same‐stage NSTs.     

Breast Carcinoma in Young Women: No Evidence of Increasing Rates of Metastatic Breast Carcinoma in a Single Tertiary Center Review

Breast carcinoma in young women aged less than 40 years attracts a high level of mainstream media coverage, and there is a gap between societal perceptions of the disease as a growing problem and epidemiological trends. Several population studies have reported that the overall incidence of breast carcinoma in young women is stable, while one recent article suggested that the relative proportion of breast carcinoma in young women that is metastatic at diagnosis is growing. We sought to establish whether these trends were apparent at our institution. In this study, the clinical database at a breast carcinoma tertiary center was reviewed in terms of clinicopathologic data on patient age, diagnosis, clinical and pathologic stage, hormone receptor status, and HER‐2 overexpression status for the period 2000–2011. Over the study period, young patients represented a decreasing proportion of all breast carcinoma cases (10.8% [2000–2003] to 8.7% [2008–2011]; p < 0.0001) treated at our institution. Young patients were more likely than patients aged 40 years or older to present with metastatic (M1) disease (5.4% versus 4.4%; p = 0.009), to be triple negative (21.6% versus 13%; p < 0.001), or to be HER‐2 positive (24.3% versus 14.8%; p < 0.01). Young patients with HER‐2‐positive cancers were significantly more likely to present with metastatic disease (8.3% versus 4.8%; p = 0.004). This study showed no demonstrable increase in the relative proportion of breast cancer occurring in patients aged <40 years over the 12‐year period 2000–2011 and no increase in the proportion of young patients presenting with metastatic disease.     

Clinicopathologic Characteristics and Prognosis of Glycogen‐Rich Clear Cell Carcinoma of the Breast

Glycogen‐rich clear cell carcinoma (GRCC) of the breast is a rare type of breast carcinoma. Knowledge about the characteristics of this type is fragmentary, and the prognosis is on debate. In this study, we aimed to summarize the clinical, pathologic, and biologic characteristics of GRCC of the breast and analyze the survival. We reviewed the cases of breast cancer in our hospital between January 1999 and December 2009 and identified 28 patients as GRCC of the breast. The routine hematoxylin–eosin staining, periodic acid‐Schiff (PAS) staining, and diastase PAS staining were performed on the tumor tissues. The expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER‐2), Ki67 and P53 were evaluated by immunohistochemistry. Tumors with a HER‐2 score of 2+ were confirmed by fluorescent in situ hybridization test. Each GRCC case, who had complete follow‐up data, was compared with four cases of usual invasive ductal carcinomas as controls in the same database and matched with age, year of diagnosis, tumor size, nodal status, and immunophenotype. The chi‐squared test and the Fisher's exact test were used to compare the characteristics of GRCC cases and controls. The univariate analysis was used to study the prognosis, and Kaplan–Meier method was used to compare the survival of two groups. The clinicopathologic and imaging features were analyzed in the GRCC cases. Tumor sizes ranged from 0.8 to 7.5 cm (mean, 3.2 cm). Thirteen cases (46.4%) had positive lymph nodes. The positivity of ER and PR was 61.5% (16 of 26). HER‐2 was positive for three cases (12%). The positivity of Ki67 and P53 were 87.5% and 45.8%, respectively. Twenty‐four cases were followed up from 19 to 158 months. The prognosis of GRCC of the breast was significantly related with the number of positive lymph nodes (p < 0.001), and patients with more than 10 positive lymph nodes were at high risk of recurrence or metastasis. There was no significant difference in overall survival (p = 0.547), and disease‐free survival (p = 0.900) between GRCC of the breast and the usual invasive ductal carcinomas. GRCC of the breast may not have a worse survival.     

Invasive lobular carcinoma with papillary features: A newly described variant that poses a difficult histologic differential diagnosis

Recently, a new variant of ILC with papillary architecture has been described, which may mimic solid and encapsulated papillary carcinomas of the breast. We report the fifth case of ILC with a solid papillary‐like growth pattern, which was initially misdiagnosed as an encapsulated papillary carcinoma. Subtle discohesion in the tumor cells, coupled with the presence of classic invasive lobular carcinoma infiltrating beyond the capsule of the papillary tumor, prompted evaluation with E‐cadherin, confirming the diagnosis. We review the histologic differential diagnosis and stress the importance of correct classification to ensure appropriate management for patients.