含破骨巨细胞样细胞的胰腺多形性癌1例及文献复习

目的 探讨含破骨巨细胞样细胞的胰腺多形性癌的临床病理特征。方法 对1例含破骨巨细胞样细胞的胰腺多形性癌进行临床、病理组织学和免疫组织化学观察。结果 患者为58岁女性，因中上腹部持续性隐痛2个月余就诊，B超、CT检查发现胰腺占位。切除标本示实性结节状肿块，灰白、灰黄色，存灶性坏死。镜下见肿瘤由低分化腺癌伴梭形肉瘤样细胞构成，两种细胞均示CK、Vim、α-AT阳性。可见多灶性巨细胞瘤样结构，由单核瘤细胞和形态上良性的破骨巨细胞样细胞构成；前者见CK散在阳性，Vim和α-AT阳性；后者仅见CD68和Vim阳性。结论 含破骨巨细胞样细胞的胰腺多形性癌是多形性胰腺癌的一种亚型，破骨巨细胞为反应性细胞，非肿瘤成分。     

伴破骨细胞样巨细胞或反应性肉芽肿的乳腺癌

目的 探讨伴破骨细胞样巨细胞或反应性肉芽肿的乳腺癌的临床病理特点。方法 复习11例伴破骨细胞样巨细胞的乳腺癌（carcinoma with osteoclastic giant cells,COGC）和8例伴反应性肉芽肿的乳腺癌（carcinoma with responsive granuloma,CRG）的临床病理资料,部分病例行免疫组化染色和特殊染色。结果 COGC患者平均年龄40.6岁,CRG患者平均年龄53.6岁,均因发现乳腺包块就诊。COGC多呈界限清楚的结节状,切面多为灰红、灰褐色。COGC肿瘤类型包括浸润性导管癌5例、浸润性乳头状癌、浸润性微乳头状癌和浸润性筛状癌各2例。肿瘤内破骨细胞样巨细胞大小形态各有差异,分布弥散或不均匀,与肿瘤细胞关系密切。肿瘤间质内尚见不同程度的新旧出血、血管和纤维组织增生。腋窝淋巴结癌转移灶保留原发灶的形态学特点。CRG形态多不规则,切面多为灰白色。肿瘤类型均为浸润性导管癌,伴随出现的肉芽肿多密切围绕在癌巢周围,由上皮样细胞和朗汉斯型巨细胞构成。抗酸染色和六胺银染色无阳性发现。进行免疫组化染色病例的破骨细胞样巨细胞和肉芽肿均呈CD68（KP1和PGM1）阳性,S-100蛋白和Ⅷ因子呈阴性。CD34染色显示COGC的微血管密度为（21.9±4.2）/HPF,与对照组浸润性导管癌无明显差异（P〉0.05）。获得随访资料的6例COGC和2例CRG在随访期内无复发、转移或死亡。结论 乳腺COGC和CRG均属少见肿瘤,前者的大体和组织学具有一定的特异性。破骨细胞样巨细胞和肉芽肿出现的预后意义尚需积累更多的病例进行分析。     

Breast carcinoma with osteoclastic giant cells: case report and review of the literature

Breast carcinoma with osteoclastic giant cells (OGCs) are uncommon. Here, we report a 46-year-old woman with a painless lump in her left breast that has been proved clinically and radiographically. Microscopical examination showed OGCs accompanying invasive ductal carcinoma. Immunohistochemical assay revealed that OGCs derived from macrophages. Despite positive lymph node metastasis, the patient has been well without evidence of recurrence or metastasis one year after the operation. To date, the influence of OGCs on the prognosis of patients is still controversial. Our case may provide insights into further understanding beast carcinoma with OGCs.     

伴破骨细胞样巨细胞的乳腺癌

目的 :探讨伴破骨细胞样巨细胞乳腺癌的临床病理特点。方法 :观察 4例伴破骨细胞样巨细胞癌的病理形态学改变。结果 :浸润性导管癌型 (Ⅱ～Ⅲ级 ) 2例 ,乳头状癌型和筛状癌型各 1例。破骨细胞样巨细胞在癌细胞周围分布。结论 :此种类型的癌需和伴反应性肉芽肿的癌、伴破骨细胞样巨细胞的化生性癌、间质反应性巨细胞、叶状肿瘤伴破骨细胞样巨细胞、癌肉瘤伴破骨细胞样巨细胞、肉瘤伴破骨细胞样巨细胞等鉴别。     

Squamous cell carcinoma of lung associated with osteoclast-like giant cells: report of a case

Resently, we treated a 69-year-old patient with squamous cell carcinoma of lung with osteoclast-like giant cells which were similar with the giant cell tumor of bone. The clinical and pathological characteristics of this case were presented, and the literatures were reviewed. The tumor differed histologically from the pleomorphic carcinoma, which occurs most commonly in the lung and showed diverse pleomorphic manifestation with benign looking osteoclast-like multinucleated cells and bizarre giant cells. In addition, undifferentiated carcinoma with a sarcoma-like appearance containing small areas of papillary adenocarcinoma was evident in the tumor. Histological features and immunohistochemical staining could be helpful in differential diagnosis.     

Cytology of anaplastic giant cell carcinoma of the thyroid with osteoclast-like giant cells--a case report

Anaplastic carcinoma of the thyroid is known for its highly aggressive behaviour and rapid spread. While the giant cell variant is a well recognized morphologic pattern, the presence of osteoclast-like giant cells is a rare occurrence. We report a case of anaplastic carcinoma of the thyroid with focal presence of osteoclast-like giant cells occurring in an elderly male patient, diagnosed on aspiration cytology.     

Ductal carcinoma in situ of the breast with osteoclast-like giant cells

Mammary carcinoma with multinucleated osteoclast-like giant cells (OGCs) is a rare, distinctive variant of breast carcinoma. To date, all of these instances have been described as part of an invasive carcinoma. Here, we report a case of ductal carcinoma in situ of the breast with numerous admixed OGCs present within gland lumens without an associated invasive component. Similar to invasive carcinomas with OGCs, both the in situ carcinoma and the OGCs exhibited overexpression for vascular endothelial growth factor. This case expands the spectrum of tumors associated with OGCs and provides further evidence for the possible role of vascular endothelial growth factor in the stromal-epithelial interactions of in situ mammary carcinoma.     

Pleomorphic lobular carcinoma in situ of the breast composed almost entirely of signet ring cells

Some examples of lobular carcinoma in situ (LCIS) may be composed in part of signet ring cells. Such proliferations have been considered examples of pleomorphic LCIS based on pathological features of the more conventional component. However, the occurrence of LCIS composed entirely of signet ring cells is extraordinarily rare. This report describes an example of an in situ proliferation that was composed almost entirely (>95%) of signet ring cells, which was unassociated with an invasive carcinoma and which showed comedo-type necrosis. There was only focal lobulocentric distention by lesional cells, as is typical of classic LCIS. However, discrete, ductal-type cross-sectional profiles showed a purely intraepithelial proliferation of remarkably discohesive signet ring cells. The signet ring cells had intermediate-grade nuclear atypia, no significant mitotic activity and were positive for mucicarmine and PAS stains (the latter with and without diastase predigestion). The cells displayed marked immunoreactivity for high-molecular-weight keratin (stained by 34beta E12 antibody), MUC1, gross cystic disease fluid protein-15, cytokeratin 7 and were negative for cytokeratin 20, E-cadherin, progesterone receptor and HER2/neu. It is concluded that this is an example of a purely signet ring variant of pleomorphic LCIS.     

Pleomorphic carcinoma of the breast with expression of macrophage markers: report of two cases

Pleomorphic ductal carcinoma of the breast is a rare variant included in the morphological group of infiltrating ductal carcinoma. The pleomorphic carcinoma is composed predominantly of epithelial and multinucleated tumor giant cells. We report here two cases presenting a lesion composed microscopically of a proliferation of large pleomorphic cells with a predominance of multinucleated giant cells. These lesions were negative for estrogen receptor, progesterone receptor and Her2-neu (triple-negative phenotype). Basal markers (cytokeratin 5/6, cytokeratin 17 and epidermal growth factor receptor [EGFR]) were present, accompanied by the presence of histiocyte marker CD163 in most neoplastic giant cells. High-grade pleomorphic breast carcinomas with the triple-negative phenotype and expression of basal markers might be included in the basal subtype. This is the first report about the co-expression of macrophage marker CD163, with tumor (P53) or epithelial markers (CAM5.2), as indicated by double immunohistochemistry in pleomorphic ductal carcinoma of the breast.     

Pleomorphic lobular carcinoma: a distinctive clinical and molecular breast cancer type

Monhollen L, Morrison C, Ademuyiwa F O, Chandrasekhar R, Khoury T
(2012) Histopathology  61, 365–377 Pleomorphic lobular carcinoma: a distinctive clinical and molecular breast cancer type Aims: Pleomorphic lobular carcinoma (PLC) is an aggressive variant of invasive lobular carcinoma. The aim of this study was to redefine PLC in terms of molecular classification. Methods and results: Cases of PLC were selected between 1995 and 2010. Key clinicopathological features were recorded for most of the patients. A panel of immunohistochemical stains including E‐cadherin, oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), cytokeratin (CK)5/6, CK14, CK17, anti‐cytokeratin (CAM) 5.2, CD117, vimentin, epidermal growth factor receptor (EGFR), p53 and gross cystic disease fluid protein‐15 (GCDFP‐15) were performed. HER2 test by fluorescence in‐situ hybridization (FISH) was also performed. The log‐rank test was used for statistical analyses. Forty cases fulfilled the criteria for PLC (26 with available tissue). The median age was 61 years and median tumour size was 2.0 cm. There were five of 38 (13.2%) triple‐negative cases. The basal type was seen in one of 25 cases (4%), which had a triple‐negative phenotype. HER2 was amplified in 14 of 38 cases (35%). Older patients and negative hormonal receptor status correlated significantly with worse clinical outcome (P < 0.03). The 5‐year recurrence‐free and overall survival was 54.9% and 76.2%, respectively. Conclusions: Pleomorphic lobular carcinoma is a distinctive breast cancer subtype. It has hybrid clinicopathological characteristics of ductal and lobular carcinoma.     

Pleomorphic carcinoma of breast: a case report and review of literature

Pleomorphic carcinoma of the breast is a rare variant of invasive breast carcinoma. Here, we report a case in a 45-year-old woman presenting a lesion composed microscopically of predominantly pleomorphic giant cells, squamous metaplastic component and focal conventional ductal carcinoma. Immunohistochemical assay showed different immunologic manifestation in respective malignant components. Despite positive lymph node metastasis, the patient has been well without evidence of recurrence or metastasis two years after operation. The implication of this report is to provide insights into further understanding of this rare tumor with review of the literature.     

Aspiration cytodiagnosis of a rare carcinoma of breast with bizarre malignant giant cells

On a review of our experience with 14,526 fine-needle aspiration cytology (FNAC) studies of the breast which were done from January 1983 to July 1994, five cases of the rare breast carcinoma were diagnosed in which bizarre, pleomorphic malignant giant cells formed an integral part of the tumour. In all the five cases, immunocytochemical studies were done on aspirated samples. Based on our present findings, in FNAC samples and in keeping with the findings recently described by us in a case, it is stressed that the bizarre malignant giant cells in this type of breast carcinoma are indeed of an epithelial origin. The differential diagnoses of other breast conditions in which giant cells may be seen in FNAC samples is appropriately discussed. Diagn Cytopathol 1996;15:66–69. © 1996 Wiley-Liss, Inc.     

Pleomorphic lobular carcinoma in a male breast: a case report with review of the literature

Invasive lobular carcinoma (ILC) is a distinct type of breast carcinoma and represents 5-15% of invasive breast carcinomas in female. However, the occurrence of ILC is exceptional in male breast, and the incidence is 1.5-1.9% of male breast carcinomas. Herein, we report a case of pleomorphic lobular carcinoma in a male breast. A 76-year-old Japanese male with a history of treatment with a progestational agent for prostate cancer presented with a right breast tumor. Magnetic resonance imaging showed gynecomastia of bilateral breasts and an irregular-shaped nodule in his right breast. Histopathological study revealed infiltrative neoplastic growth of discohesive tumor cells arranged in single-filed linear cords or trabeculae. These neoplastic cells had variable-sized large nuclei containing occasional nucleoli. Immunohistochemically, these tumor cells lacked E-cadherin expression. Accordingly, an ultimate diagnosis of pleomorphic lobular carcinoma was made. This is the third documented case of pleomorphic lobular carcinoma of male breast. Our analyses of the clinicopathological features of this type of tumor revealed that patients were middle-aged or elderly men, and all cases were free from lymph node metastases or recurrence. Gynecomastia and a history of hormonal agent intake were present only in the current case. The most commonly proposed risk factor for the development of male breast cancer is elevated level of estrogen, and a possible link between the development of male breast cancer and estrogen therapy for prostate cancer has been suggested. The clinicopathological features of ILC of male breast remains unclear; therefore, additional studies are needed to clarify them.     

Pleomorphic leiomyosarcoma of the adrenal gland with osteoclast-like giant cells

Pleomorphic leiomyosarcoma (PLMS) of the adrenal gland is a rare tumor in an unusual location. A primary PLMS of the left adrenal gland is reported in a 59-yr-old Mexican women who presented progressive flank pain and weight loss. The tumor measured 16 cm in diameter, showed markedly pleomorphic and osteoclast-like giant cells, necrosis, and high mitotic activity (average 15 per 10 high-power fields). The phenotype was supported by light microscopy and corroborated by immunohistochemistry. The neoplastic cells were strongly positive for muscle-specific actin, desmin, vimentin, and p53. They were negative for CD34, HMB45, estrogen receptors, and S-100 protein. The percentage of Ki-67 positive neoplastic cells was 7.6%. DNA content analysis by flow cytometry showed that tumor was diploid, with a high level of apoptosis. Extra-adrenal primary sites of origin were clinically excluded. The patient developed local recurrence and liver metastases 12 mo after initial treatment. She then received adjuvant chemotherapy and radiotherapy and the metastasis was resected. Twenty-four months later, she is alive with no evidence of disease. This is the second case of adrenal PLMS reported. This case exhibited a high histologic grade, aggressive behavior, and p53 overexpression, but diploid DNA content.     

Pleomorphic ductal carcinoma of the breast with predominant micropapillary features

An 83-year-old woman with long-standing chronic ischemic cardiac and obstructive pulmonary disease, presented with a painless tumor in her right breast. Microscopically the tumor consisted of micropapillary formations and loosely cohesive nests and strands of large, highly pleomorphic cells. Micropapillary formations were surrounded by peritumoral retraction clefting, and the papillae lacked a true fibrovascular core. Multinucleated giant and bizarre tumor cells were also present and numerous. Within the tumor a high-grade intraductal component with the same cell morphology and necrosis and mucin production was found. Micropapillary pattern occupied approximately 60% of the tumor mass, loosely cohesive nests and strands approximately 20% and an intraductal component was noted in approximately 20% of the tumor mass. On immunohistochemistry the tumor cells were positive for pan-cytokeratin, epithelial membrane antigen (EMA), S100 protein and E-cadherin while estrogen and progesterone receptors, HER2-neu and Bcl2 were negative. EMA staining was diffuse and observed in the outer and inner margins of neoplastic nests. The diagnosis of pleomorphic breast carcinoma with predominant micropapillary features was established. In summary, micropapillary carcinoma can be distinguished from other types of breast carcinoma with micropapillary growth pattern on the basis of reverse cell polarity, which is easily confirmed on immunohistochemistry.     

Pleomorphic carcinoma of the breast: clinicopathological analysis of 26 cases of an unusual high-grade phenotype of ductal carcinoma

AIMS: Pleomorphic carcinoma is a poorly described entity whose phenotype is not well recognized as within the morphological spectrum of breast carcinoma. The purpose of this report is to describe the clinicopathological features of this tumour, and to promote its recognition as an unusual high-grade morphological variant of mammary ductal carcinoma. METHODS AND RESULTS: Histological slides of breast carcinomas (N = 64) coded between 1978 and 1995 as having pleomorphic or anaplastic features were reviewed. Pleomorphic carcinoma (N = 26) was diagnosed when > or = 50% of the tumour manifested a pleomorphic cell population (> sixfold variation in nuclear size). Tumours of lobular origin were excluded. All neoplasms occurred in women with a mean age of 53 years. Patients underwent biopsy and/or mastectomy (n = 24) or lumpectomy (n = 2). The tumours' mean size was 54 mm. All were high-grade neoplasms. The pleomorphic cell population comprised 50-100% of the tumour; 31% had a prominent spindled morphology. Fifty-eight per cent of the tumours were initially misclassified by referring pathologists as sarcomas or carcinomas, possibly metastatic. Adjacent DCIS or a transition to classic ductal carcinoma was present in 73%. Five (19%) patients were stage I and three (12%) had stage IV disease. Axillary dissections yielded > or = 3 (mean 7.2) positive lymph nodes in 52%. Most (68%) tumours were aneuploid; a high S-phase (> 10%) was present in 63%. All neoplasms were ER negative and all but one were PR negative. p53 expression was present in 71%; none expressed bcl-2. c-erbB-2 was detected in four (19%) node-positive and in 0 (0%) node-negative cases (P = 0.01). Of 16 patients with follow-up, 6 (38%) were disease-free (mean, 74 months), four (25%) alive with disease (mean, 33 months) and six (38%) dead of disease at a mean of 22 months. CONCLUSIONS: Pleomorphic carcinoma is a prognostically unfavourable lesion and represents the extreme end of the morphological spectrum of grade III infiltrating ductal carcinoma.     

Esophageal pleomorphic giant cell carcinoma combined with small cell carcinoma

Herein is presented the case of an esophageal pleomorphic giant cell carcinoma combined with small cell carcinoma (SCC). The patient, a 77-year-old man, initially presented with dysphagia and hoarseness, and endoscopy indicated a large esophageal tumor. Despite chemoradiation therapy, the patient died from widespread local extension of the tumor and distant metastases approximately 8 months after onset of the symptoms. Histologically, the primary tumor was composed of pleomorphic tumor components, SCC components, and a tiny focus of squamous cell carcinoma. The pleomorphic tumor cells, consisting of solid sheets of poorly cohesive epithelioid cells and numerous multinucleated giant cells with abundant eosinophilic cytoplasm, were immunohistochemically positive for vimentin and desmin, with scattered positivity for epithelial membrane antigen (EMA) and neuron-specific enolase (NSE), but negative for myoglobin. These findings were histopathologically compatible with pleomorphic giant cell carcinoma occurring at other sites such as the lung. SCC cells, morphologically similar to their pulmonary counterpart, were positive for EMA and some neuroendocrine markers such as chromogranin A and NSE, and occasionally positive for vimentin and desmin. Esophageal pleomorphic giant cell carcinoma can occur in close association with SCC, and should be included in the differential diagnosis of esophageal tumors showing pleomorphism.     

Undifferentiated carcinoma with osteoclast-like giant cells arising in a mucinous cystic neoplasm of the pancreas

A 26-year-old woman presented with pain in the left hypochondrium, for which pancreatectomy and splenectomy was performed, with total gross excision of a mass. A tumor measuring 11 × 9 cm was found in the pancreas. On cut surface there were two cysts filled with a necrotic substance and hemorrhagic content. Spindle or ovoid-shaped cells, in the sarcomatous component, had diffusely infiltrated along the inner side of the walls of one cyst. Osteoclast-like giant cells (OGC) were also contained in the sarcomatous component. Adenoma components of mucinous epithelium with foci of borderline and adenocarcinomatous components were seen on the inner side of the other cyst. An ovarian-type stroma beneath the epithelial component was seen in the cyst wall. A diagnosis of undifferentiated carcinoma with OGC arising in a mucinous cystic neoplasm (MCN) of the pancreas, was made. Seven months after the initial operation the patient had a local recurrence, and the tumor was removed. One month after the second operation, the patient was free of symptoms. Only four cases of undifferentiated carcinoma with OGC arising in MCN, involving an ovarian-type stroma of the pancreas, have been reported.     

Undifferentiated pancreatic carcinoma with osteoclast-like giant cells: Report of a case with osteochondroid differentiation

We report a case of an undifferentiated pancreatic carcinoma with osteoclast-like giant cells with focal osteochondroid differentiation in a 66-year-old man, who presented with painless jaundice, pruritis, and weight loss. Imaging studies revealed an inhomogeneous mass in the head of the pancreas. A pylorus preserving pancreaticoduodenectomy was performed. The resection specimen revealed a 9.5×4.2×3.2 cm³ solid neoplasm in the pancreatic head with direct extension into duodenum and common bile duct. Microscopy showed a cellular neoplasm composed of pleomorphic mononuclear cells (pancytokeratin, and EMA-positive; LCA, and CD68 negative) and osteoclast-like multinucleated giant cells (vimentin, LCA, and CD68-positive; pancytokeratin, and EMA-negative) consistent with OGTP. The tumor contained a focal area of osteochondroid differentiation. Evidence supports that the tumor giant cells are non-neoplastic and of histiocytic origin. Osteochondroid differentiation within undifferentiated carcinoma is unusual; its presence might suggest a sarcoma diagnosis on biopsy material.