联合检测CK7、CK20和SATB2在卵巢原发性黏液腺癌和转移性结直肠腺癌中的表达及鉴别意义

目的探讨联合检测CK7、CK20和SATB2在卵巢原发性黏液腺癌和转移性结直肠腺癌中的表达及鉴别意义。方法收集安徽医科大学第一附属医院2011～2016年确诊的卵巢原发性黏液腺癌26例、卵巢转移性结直肠腺癌29例、结直肠原发性黏液腺癌50例。采用免疫组化EnVision两步法检测CK7、CK20和SATB2的表达。结果 CK7在卵巢原发性黏液腺癌中的阳性率显著高于卵巢转移性结直肠腺癌和结直肠原发性黏液腺癌,差异有统计学意义(P0.05);CK20和SATB2在卵巢转移性结直肠腺癌和结直肠原发性黏液腺癌中的阳性率显著高于卵巢原发性黏液腺癌,差异有统计学意义(P0.05);CK7~+/CK20~-、CK7~-/CK20~+和CK7~+/CK20~+在卵巢原发性黏液腺癌和转移性结直肠腺癌中的表达,差异有显著性(P0.05);CK7~-/CK20~-在两者中的表达差异无显著性(P0.05),卵巢原发性黏液腺癌以CK7~+/CK20~-常见,卵巢转移性结直肠腺癌以CK7~-/CK20~+常见;CK7、CK20和SATB2检测的灵敏度分别为82.8%、75.9%、65.5%,特异度分别为80.8%、61.5%、100%。结论 SATB2是鉴别卵巢原发性黏液腺癌和转移性结直肠腺癌高度特异性的免疫组化标志物,可以联合检测CK7、CK20和SATB2提高卵巢黏液性腺癌病理诊断的准确性。     

30例肺腺癌组化和免疫组化研究

报道30例肺腺癌组化和免疫组化研究结果。PAS染色对肺差分化腺癌的确诊优于其他指标(配对X~2,P<0.05;配伍设计秩和检验,P<0.01)。角蛋白(Keratill)和癌胚抗原(CEA)标记阳性检出率与肺腺癌分化程度无明显差异(P>0.10)。表达异位人绒毛膜促性腺激素(HCG)者(63%),大多分化较差。     

肺肠型腺癌和肺转移性结直肠腺癌中SATB2和CK7的表达及意义

目的探讨肺肠型腺癌和肺转移性结直肠腺癌中SATB2、CK7的表达及两者的相关性。方法采用免疫组化En Vision法检测10例肺肠型腺癌组织和15例肺转移性结直肠腺癌组织中多种免疫组化标志物的表达,并结合临床和病理特点进行分析。结果 SATB2和CK7在肺肠型腺癌和肺转移性结直肠腺癌组织中的表达差异均有统计学意义(P0.05),联合检测SATB2和CK7可提高诊断两种疾病的特异度。结论 SATB2和CK7在肺肠型腺癌和肺转移性结直肠腺癌中的表达差异有助于两者的鉴别,其中SATB2表达可作为重要的免疫组化检测指标。     

直肠腺癌伴发的肛周Paget病1例

患者女性,66岁,因便后肛门疼痛2个月伴瘙痒入院。体检见肛缘有一圈质硬肿块,尤以1～3点钟方向明显,直肠内未见明显异常肿块。术中取肛缘一直径0.8 cm硬结作冷冻切片,病理诊断黏液腺癌,遂行Mile术。病理检查眼观:切除直肠带肛门组织,齿状线上方直肠内见一大小为2.5 cm×1.4 cm×1 cm灰红息肉状隆起型肿块,肛周皮肤呈灰白色湿疹样改变,局部伴浅表溃疡形成,     

伴或不伴印戒细胞成分的结直肠黏液腺癌的临床病理特征及基因突变谱分析

目的探讨结直肠黏液腺癌的临床病理特征及基因突变。方法收集101例结直肠黏液腺癌的病理资料,采用二代测序法对石蜡包埋样本中31个热点基因进行分析,并比较结直肠黏液腺癌伴和不伴印戒细胞分化的临床病理特征和基因突变谱的差异。结果 101例患者中,有15例(14.9%)有印戒细胞分化,86例(85.1%)无印戒细胞成分。两组男性均多于女性(黏液腺癌伴和不伴印戒细胞分化中男性分别为60.0%、58.1%),晚期疾病比例较高(Ⅲ、Ⅳ期疾病分别占57.1%、57.6%)。伴印戒细胞分化的肿瘤体积较小,年龄较小,好发于近端结肠,分期较高。伴与不伴印戒细胞分化的结直肠黏液腺癌,与患者年龄和肿瘤大小差异有统计学意义(P 0.05)。无印戒细胞分化的结肠癌KRAS突变频率明显高于有印戒细胞分化者(P=0.001)。结论黏液腺癌的伴戒细胞分化与不伴印戒细胞分化相比,具有不同的临床病理特征和分子基础。     

SATB2在卵巢转移性Krukenberg瘤诊断中的应用价值:70例与CDX2、CK7、CK20、CgA、Syn免疫组化对比性研究

正SATB2是结直肠腺癌的敏感指标之一,目前尚未发现其在卵巢转移性Krukenberg瘤(MKTs)诊断中应用价值的研究。作者对70例来源于不同器官:胃27例,结直肠13例,阑尾20例包括19例除外杯状细胞类癌的转移性腺癌(AdexG CC)和1例具有印戒细胞特征的传统型差分化癌,乳腺5例,膀胱3例,肺2例的MKTs行SATB2免疫组化染色,评估其诊断价值。作者对比分析了SATB2与CDX2、CK7、CK20、CgA、Syn     

结直肠浸润性微乳头状癌8例临床病理分析

目的探讨结直肠浸润性微乳头状癌(invasive micropapillary carcinoma,IMPC)的临床病理学及免疫表型特征。方法对8例结直肠IMPC行HE及免疫组化染色,观察其临床病理学及免疫表型特征,并复习相关文献。结果 8例结直肠IMPC微乳头成分主要见于肿瘤浸润边缘部分,脉管浸润较常见,8例均可见肠系膜淋巴结转移。免疫组化染色EMA呈特征性外侧缘阳性及癌周空隙存在。8例中除2例分别存活24、28个月外,其他均在1年内死亡。结论结直肠IMPC是恶性程度较高的恶性肿瘤,其具有较高的侵袭性、高淋巴结转移率,预后差;应与其他结直肠腺癌区分鉴别。具有微乳头结构的黏液腺癌也应引起重视,黏液癌与前者可能是处于相同谱系的不同阶段,预后同样较差。     

结直肠癌mdm2,p21和p53蛋白的表达

一、材料与方法1.标本 :89份石蜡组织取自 1991～ 1994年期间本院结直肠腺癌手术切除标本 ,术后随访 3～ 6年。其中高分化腺癌 30例 ,中分化腺癌 44例 ,低分化腺癌 15例。按Ｄｕｋｅｓ临床分期 ,无Ａ期病例 ,Ｂ期 42例 ,Ｃ期 37例 ,Ｄ期 10例。纤维结肠镜及病理检查未发现异常的结直肠粘膜活检标本 12例做对照。组织均常规甲醛溶液固定 ,石蜡包埋 ,连续切片 ,分别作常规ＨＥ染色 ,ｍｄｍ2、ｐ2 1、ｐ5 3蛋白免疫组化染色。2 .免疫组化染色 :采用ＳＰ法 ,鼠抗ｍｄｍ2 (ＳＭｐ14)、ｐ5 3(Ｄｏ 1)、ｐ2 1(187)为ＳａｎｔａＣｒｕｚ公司试剂 ,Ｓ…     

原发性膀胱腺癌26例临床病理分析

目的 探讨原发性膀胱腺癌的临床病理特征、诊断及鉴别诊断。方法 对26例确诊原发性膀胱腺癌进行HE、组织化学和免疫组化染色标记。结果 原发性膀胱腺癌的细胞形态、组织结构与其它部位腺癌极其相似,黏液组化及免疫组化染色显示半数以上的肿瘤具有胃肠癌的分化特征。免疫表型：CK7强阳性(18／26),CK20弱阳性(14／26),PSAP阳性(10／26),CEA阳性(21／26),CA19-9阳性(12／26),PSA阴性。结论 膀胱原发性腺癌与膀胱转移性腺癌具有相似的组织学形态,诊断时需排除其它部位腺癌,PSAP、PSA、CK7、CK20标记对鉴别诊断具有重要参考价值。     

恶性上皮性肿瘤中CK20的表达及其临床意义

目的　研究单克隆抗体CK2 0在恶性上皮性肿瘤和卵巢转移性腺癌组织中的表达及其意义。方法　应用S P法对鼻咽非角化性癌、乳腺浸润性导管癌、肺的鳞癌和腺癌、卵巢黏液性囊腺癌、胃腺癌和结肠直肠腺癌各组总计 6 7例和 4 1例分别进行了CK2 0和CK19检测。结果　CK2 0阳性率 :肺腺癌 1/ 7(14 3% ) ,卵巢浆液性和黏液性腺癌 3/ 12 (33 3% ) ,胃腺癌 3/ 9(33 3% ) ,结肠直肠腺癌组 2 1/ 2 2 (95 5 % ) ,其他癌组织均呈阴性。结肠直肠腺癌组组与其他各组间比较差异有显著性 (P <0 0 1)。CK19在上述 4 1例癌组织中均呈强阳性表达。结论　CK2 0表达对鉴别结肠腺癌和直肠腺癌与肺腺癌和乳腺浸润性导管癌具有高度特异性和较高的敏感性 ;CK2 0高表达对鉴别卵巢原发性腺癌与卵巢的结肠腺癌或直肠腺癌转移具有一定的意义     

Synchronous primary perianal Paget's disease and rectal adenocarcinoma: report of a hitherto undescribed phenomenon

Perianal Paget's disease is rare. It usually represents intraepidermal extension of an invasive carcinoma from an adjacent internal organ, but some cases represent primary intraepithelial cutaneous apocrine adenocarcinomas. Here, we report a unique case, which we interpret as synchronous primary perianal Paget's disease and lower rectal adenocarcinoma. Immunohistochemical stains demonstrated that the Paget's cells were CK7+/ CK20-/GCDFP+, whereas the rectal adenocarcinoma was CK7+(variable)/CK20+/GCDFP-. This discordant immunoprofile supported our impression that the Paget's disease in this patient was of cutaneous apocrine origin rather than a pagetoid extension from the patient's nearby rectal adenocarcinoma-to our knowledge a hitherto undocumented occurrence.     

Pancreatic Carcinoma with Multilineage (Acinar, Neuroendocrine, and Ductal) Differentiation

The preponderance of pancreatic tumors is adenocarcinoma of the ductal type; carcinomas with multiple lineage differentiation are extremely rare. We report an unusual case of pancreatic carcinoma with combined acinar and neuroendocrine differentiation and minor ductal component with concurrent acinar-ductal metaplasia (ADM), an early lesion implicated in ductal carcinogenesis. The patient is a 56-year-old man with vague complaints of dull left upper quadrant pain with radiation across the mid-portion of his abdomen. A computer tomography scan revealed an irregular enlargement of the distal 3.2 cm of the pancreatic body. A distal pancreatectomy was then performed. Histologic examination revealed a pancreatic carcinoma with cellular features of eosinophilic granular cytoplasm and salt-pepper nuclei. The acinar differentiation of the carcinoma was confirmed by positivity on periodic acid-Schiff stain resistant to diastase digestion (dPAS), positivity for antitrypsin on immunohistochemistry (IHC), and presence of zymogen granules on electron microscopy (EM). The neuroendocrine differentiation was evident by positive synaptophysin and chromogranin stain on IHC and neuroendocrine granules on EM. The ductal component was only visible by PAS stain and immunostains for CEA and CK19A and accompanied by a number of the acinar-ductal metaplasia lesions adjacent to the main tumor. Thus, the histological, histochemical, immunohistochemical and electron-microscopic evidence all suggested that the pancreatic carcinoma underwent trilineage differentiation.     

Serous oligocystic adenoma of the pancreas: a clinicopathological and immunohistochemical study of three cases with ultrastructural findings

AIMS: Serous oligocystic adenoma of the pancreas is an uncommon benign neoplasm and is a recently described entity. To date, there are 19 adult cases of this tumour. We report three additional cases, two with macrocystic and one with unilocular types. We describe their clinicopathological, immunohistochemical and ultrastructural findings and review the world's literature. METHODS: For a 10-year period, we reviewed all benign cystic lesions of the pancreas with emphasis on serous oligocystic adenoma. We characterised serous oligocystic adenoma as an ill-demarcated or encapsulated mass, composed largely or exclusively of macrocysts (cysts measuring 20mm or more) but few in number (oligolocular). Grossly, it may contain only a single cyst (unilocular) of any size with a few satellite cysts observed on histological examination. Special stains and immunohistochemistry as well as electron microscopy were performed on three and two cases of serous oligocystic adenoma, respectively. RESULTS: Between 1990 and 2000, we collected 26 benign cystic lesions of the pancreas, three of which were serous oligocystic adenomas (two with macrocystic and one with unilocular types). Many of the cells lining the cysts showed PAS positivity. There was negative staining for PAS with diastase digestion, Alcian blue and mucicarmine. All cases showed positive staining for CAM5.2, AE1/AE3, EMA and CK7. The proliferation index marker was low. There was negative staining for CK20, insulin, glucagon, somatostatin, synaptophysin, chromogranin A, CEA and p53. Ultrastructural studies on two cases revealed similar findings. The single row of uniform epithelial cells lining the cysts was composed of simple cuboidal to flat cells which rested on a thin basal lamina. Their nuclei were round to ovoid. Glycogen granules were identified in the cytoplasm. Short microvilli emerged from the epithelial apical surface. Adjacent tumour cells were connected by microfilaments. CONCLUSIONS: Serous oligocystic adenomas of the pancreas are uncommon benign tumours. Prior to this study, 19 adults with these lesions were reported in the world's literature. No correct pre-operative diagnosis was carried out on all 22 cases. The 20 patients with follow-up ranging from 2 months to 5 years did not show tumour recurrence or malignant transformation.     

Markers for metastatic adenocarcinoma in serous effusion specimens

A variety of stains have been proposed as useful adjuncts to the morphologic diagnosis of serous effusion specimens. This study evaluates the sensitivity and specificity of nine stains for the detection of metastatic adenocarcinoma in effusions. Mucin cytochemistry with the Periodic acid-Schiff reaction after diastase digestion (PASd) and the mucicarmine method, as well as immunochemical staining for five glycoprotein antigens, was undertaken on 153 effusion specimens with histological and/ or clinically confirmed diagnoses. Immunochemical stains included three antibodies to CEA (Dako polyclonal, 4E7 and A5 B7) and antibodies to HEA (Ber-EP4), TAG 72 (B 72.3), CD15 (LeuMl) and Epithelial membrane antigen (EMA) were evaluated. The sensitivity of the stains for adenocarcinoma (102 cases) was: PASd 37%; mucicarmine 24%; polyclonal anti-CEA 69%; 4E7 52%; A5B7 21%; EMA 91%; B72.3 44%; Ber-EP4 32%; LeuMl 24%. With the exception of EMA, none of the stains reacted with any cases of benign mesothelial cells (11 cases), reactive mesothelial cells (34 cases), or with six cases of mesothelioma. However, EMA staining was present in two cases (6%) of reactive mesothelial cells and all cases of mesothelioma. The optimal combination of stains for use in a panel was polyclonal anti-CEA/B72.3/PASd. Combined results from these three stains yielded a sensitivity of 83% for adenocarcinoma with no false positive results. It is concluded that special staining may provide valuable information to assist in the classification of difficult effusion cases. Diagn Cytopathol 1994;ll:237–245. © 1994 Wiley-Liss, Inc.     

Eosinophilic globules in Kaposi's sarcoma. A histochemical, immunohistochemical, and ultrastructural study

Of the 12 cases, 2 (17%) showed eosinophilic globules in the typical cutaneous type of Kaposi's sarcoma. The globules were stained with periodic acid-Schiff (PAS), periodic acid-Schiff reagent after diastase digestion, and phosphotungstic acid hematoxylin (PTAH), but were not stained with Mayer's mucicarmine, and alcian blue. As the results, these globules might be glycoprotein. The shape of the globules was very similar to glycoprotein globules of yolk sac tumor (endodermal sinus tumor) in the tissue of the ovary and testis. In the yolk sac tumor, similar globules are stained with alpha-fetoprotein, beta-subunit of human chorionic gonadotropin, and alpha-1-antitrypsin using immunohistochemical techniques. Immunoperoxidase investigations were done with antibodies to alpha-fetoprotein, beta-subunit of human chorionic gonadotropin, alpha-1-antitrypsin, and carcinoembryonic antigen in the eosinophilic globules of Kaposi's sarcoma, but these antigens were detected in the globules. The morphogenesis of the glycoprotein globules is not clear yet. A better understanding of the source of globules in Kaposi's sarcoma awaits further research.     

Use of a panel of markers in the differential diagnosis of adenocarcinoma and reactive mesothelial cells in fluid cytology.

To evaluate the use of a panel of markers to differentiate adenocarcinoma and the reactive/inflammatory process in fluid cytology, we stained 29 formalin-fixed, paraffin-embedded cell blocks of effusion fluid from patients with metastatic adenocarcinoma and 24 cell blocks from patients with benign effusion with mucicarmine and antibodies to carcinoembryonic antigen (CEA), B72.3, and calretinin. Positive staining with CEA, B72.3, and mucicarmine was seen in 22 (76%), 20 (69%), and 18 (62%) adenocarcinoma cases, respectively. All except 1 adenocarcinoma was negative for calretinin. No benign cases were positive for B72.3 and mucicarmine. In 1 benign case, scattered epithelial cells demonstrated weak positivity for CEA. The majority of combinations were 100% specific for adenocarcinoma. The highest sensitivity (86%) for adenocarcinomas was achieved with the staining combination of negative for calretinin and positive for any adenocarcinoma marker (CEA, B72.3, or mucicarmine). The use of a panel of markers that recognize adenocarcinoma and mesothelial cells is useful in the differential diagnosis between metastatic adenocarcinoma and the reactive/inflammatory process. The profile of positive staining with at least one of the adenocarcinoma markers and negative calretinin staining is highly specific and sensitive for identifying adenocarcinoma in fluid cytology.     

Mammary and extramammary Paget's disease: an immunohistochemical study of 83 cases

AIM: Mammary Paget's disease (MPD) and extramammary Paget's disease (EMPD) are rare neoplasms. The aim of this study was, by the use of immunohistochemistry, to derive further information about the cell(s) of origin, find a diagnostically useful immunohistochemical panel and investigate candidates for possible targeted therapy. MATERIAL AND RESULTS: Sixty MPD and 23 EMPD cases were studied using antibodies to cytokeratin (CK) 34betaE12, CK8/18, CK7, CK5/6, CK20, gross cyctic disease fluid protein (GCDFP)-15, MUC1-8, epidermal growth factor receptor (EGFR) (HER1), HER3 and HER4. In all MPD cases CK7 and MUC1 were positive. CK8/18 was positive in 59/60 cases. GCDFP-15, MUC2, MUC3, MUC4, MUC7, MUC8 were positive in 29/60, 3/60, 35/47, 4/40, 3/43 and 2/45 cases, respectively. In all EMPD cases CK8/18 and CK7 were positive. MUC1, GCDFP-15, MUC5AC, MUC3, MUC8 and CK20 were positive in 22/23, 19/23, 8/19, 3/19, 1/19 and 3/23 cases, respectively. With the remaining antibodies no immunoreactivity was observed. CONCLUSION: MUC1 and low-molecular-weight CKs in conjunction with immunonegativity for high-molecular-weight CKs are the most diagnostically useful markers. MPD is caused by the epidermotropic spread of underlying tumour cells, whereas EMPD probably arises from intraepithelial cells of sweat gland origin. Targeted therapy with antibodies against EGFR (HER1), HER3 or HER4 is unlikely to prove of clinical value.     

EOSINOPHILIC GLOBULES IN KAPOSI'S SARCOMA

Of the 12 cases, 2 (17%) showed eosinophilic globules in the typical cutaneous type of Kaposi's sarcoma. The globules were stained with periodic acid-Schiff (PAS), periodic acid-Schiff reagent after diastase digestion, and phosphotungstic acid hematoxylin (PTAH), but were not stained with Mayer's mucicarmine, and alcian blue. As the results, these globules might be glycoprotein. The shape of the globules was very similar to glycoprotein globules of yolk sac tumor (endodermal sinus tumor) in the tissue of the ovary and testis. In the yolk sac tumor, similar globules are stained with alpha-fetoprotein, beta-subunit of human chorionic gonadotropin, and alpha-1-antitrypsin using immunohistochemical techniques. Immunoperoxidase investigations were done with antibodies to alpha-fetoprotein, beta-subunit of human chorionic gonadotropin, alpha-1-antitrypsin, and carcinoembryonic antigen in the eosinophilic globules of Kaposi's sarcoma, but these antigens were detected in the globules. The morphogenesis of the glycoprotein globules is not clear yet. A better understanding of the source of globules in Kaposi's sarcoma awaits further research. ACTA PATHOL. JPN. 36: 1327–1333, 1986.     

Pagetoid variant of actinic keratosis with or without squamous cell carcinoma of sun-exposed skin: a lesion simulating extramammary Paget's disease

BACKGROUND: Extramammary Paget's disease usually occurs in anogenital skin. We present five cases of squamous cell carcinoma in situ of sun-exposed skin and non-squamous cell carcinoma in situ actinic keratosis that displayed atypical keratinocytes disposed in intraepithelial cell nests and immunohistochemical staining simulating extramammary Paget's disease. METHODS AND RESULTS: Two pilot cases--one squamous cell carcinoma in situ and one non-squamous cell carcinoma in situ actinic keratosis with formation of intra-epidermal nests of atypical keratinocytes with a pagetoid spread pattern--were encountered at our institution. Fifty-four consecutive cases of squamous cell carcinoma in situ including bowenoid actinic keratosis and 34 cases of non-squamous cell carcinoma in situ actinic keratosis were reviewed to identify pagetoid spread of atypical cells. Representative sections of all cases with pagetoid spread of atypical keratinocytes were submitted for special stains for mucin, and immunostaining for cytokeratin 7 (CK7), cytokeratin 20 (CK20), cytokeratin CAM 5.2 (CAM 5.2), carcinoembryonic antigen (CEA), vimentin and S100 protein. In the group of squamous cell carcinoma in situ, 10 cases displayed pagetoid spread of atypical keratinocytes with cytoplasm ranging from clear to pale and atypical hyperchromatic nuclei. One review squamous cell carcinoma in situ was multicentric with three separate lesions. The atypical keratinocytes tended to form well to poorly defined cell groups extending from the basal cell layer to the corneal layer. No similar cases were identified in the group of non-squamous cell carcinoma in situ actinic keratosis. Two pilot cases and three of 10 review cases with a total of seven separate lesions displayed a moderate to marked immunohistochemical reactivity for CK7 similar to extramammary Paget's disease. CEA immunoreactivity was also detected in two of these cases. In addition, two of 44 squamous cell carcinomas in situ without pagetoid spread of atypical keratinocytes showed a moderate reactivity for CK7 in very occasional atypical keratinocytes. The remaining seven squamous cell carcinomas in situ with pagetoid spread of atypical keratinocytes were not immunoreactive for CEA and CK7. Immunostaining for CK20, vimentin, S100 protein was negative in all atypical cells in all study cases. CONCLUSIONS: Actinic keratosis, particularly squamous cell carcinoma in situ of sun-exposed skin, may have histopathological and immunohistochemical features similar to extramammary Paget's disease and probably represents a variant of actinic keratosis. Awareness of the pagetoid variant of actinic keratosis arising in sun-exposed skin is helpful to avoid the over-diagnosis of extramammary Paget's disease.     

Toker cells are probably precursors of Paget cell carcinoma: a morphological and ultrastructural description

The present paper documents an investigation of the morphology, immunohistochemistry, and ultrastructure of Toker cells (TC), aiming for a better definition of these elements and better understanding of their histogenesis. We studied 12 nipples removed for nipple adenoma from twelve patients and a case of supernumerary nipple. In addition four cases of Paget's carcinoma (PC) restricted to the nipple without underlying tumor were studied for comparison. All cases were stained with hematoxylin and eosin (H&E), Alcian blue pH 2.5 and periodic acid-Schiff (PAS) preceded by diastase digestion and with immunohistochemistry using antisera anti cytokeratin 7, cytokeratin 20, protein S100, GCDFP-15, c-Erb-B2, CAM 5.2, and epithelial membrane antigen (EMA). Two cases from the nipple adenoma series were studied by electron microscopy. In seven cases within the series of 12 nipple adenomas as well as in the case of supernumerary nipple, keratin 7 antibody highlighted numerous cells located within the nipple epidermis which in three cases showed dendritic processes. These same elements were also positive with CAM 5.2. All these same elements were negative with Alcian Blue (AB), PAS and the other antisera employed. Ultrastructural examination demonstrated that these cells differed from keratinocytes while they presented the same features as the glandular cells seen in the related nipple adenoma. The cells constituting Paget's carcinoma showed more irregular nuclei and were more easily seen in the context of the epidermis. The immunocytochemical profile of the cancer cells was similar to that of TC, but in addition the neoplastic cells were c-Erb-B2 and EMA positive in all cases, and one case also displayed numerous cells immunoreactive with anti GCDFP-15 antibody. Keratin 7 highlighted dendritic cells in two cases and AB, PAS was negative in all patients. The immunocytochemical profile and the ultrastructural features of TC are similar to those of the glandular cells constituting the ducts and the adenoma. These findings together with the localization of TC near or around the openings of the lactiferous sinuses indicate that TC might be ductal cells with a dendritic aspect and migrate through the galactophorous ostia. PC cells not related to ductal carcinomas have a similar but not superimposable immunohistochemical profile to TC, and in two cases the neoplastic elements were also dendritic which suggests that these same cells are likely to be the neoplastic counterpart of TC.