Adenoid squamous cell carcinoma of the oral cavity

Because immunohistochemical features of adenoid squamous cell carcinoma (AdSCC) of the oral cavity is unclear, the author reports herein AdSCC in the gingival with an emphasis on immunohistochemical features. A 73-year-old woman presented with a left lower gingival tumor. The tumor was mildly elevated tumor measuring 1.5 x 1.5 x 0.5 cm. Dentist's diagnosis was granulation tissue, and a biopsy was taken. The biopsy showed proliferation of carcinoma cells arranged in cords, and squamous and tubular differentiations were noted in places. The biopsy diagnosis was adenosquamous carcinoma. Tumor excision with resection of mandibular bone was performed. The resected tissue showed a mixture and squamous cell carcinoma and tubular formation. Gradual merges between the two and acantholytic features of the squamous cell carcinoma element were seen. Both components were free from mucins. Both components were positive for pancytokeratins (AE1/3, CAM5.2) +++, cytokeratin (CK) 5/6 +, CK34βE12 ++, CK7 +, CK14 +++, CEA +, CA19-9 +, CA125 +, p53 +++, p63 +++, KIT + and MUC1 ++. Both components were negative for CK8, CK18, CK19, CK20, EMA, vimentin, TTF-1, desmin, myoglobin, S100 protein, melanosome, smooth muscle actin, CD34, CDX2, CD10, chromogranin, synaptophysin, NSE, CD56, lysozyme, CD68, MDM2, PDGFRA, MUC2, MUC5AC, and MUC6. Since both components were positive for squmaous cell carcinoma markers (CD5/6, CK34βE12, and p63) and adenocarcinoma markers (CEA, CA19-9, CA125, MUC1), this case of AdSCC appears an intermediate form between adenocarcinoma and squamous cell carcinoma. The margins were negative. No metastasis was found by imaging techniques. The patient is now free from tumor and is followed up carefully.     

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。     

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.     

Neuroendocrine breast carcinoma metastatic to renal cell carcinoma and ipsilateral adrenal gland

We report on a 60-year-old woman with neuroendocrine carcinoma of the left breast metastasizing to renal cell carcinoma (RCC) of the left kidney and to adrenal gland. A yellow, well-circumscribed tumor, 11 cm in largest diameter and limited to the kidney, was found. Histopathology revealed RCC with foci of neuroendocrine differentiation. Solid sheets of hyperchromatic epithelioid cells with high mitotic activity were found between typical clear cells of RCC. These cells were CAM5,2 and E-cadherin focally positive, synaptophysin and NSE weakly positive, CK19 moderately positive, and AE1-AE3 and EMA strongly positive. Chromogranin A, CD10, CK 14, CK 20, HER2 (score 1+), vimentin, and HMB45 were negative. The left adrenal gland contained multiple, separate foci of a tumor composed of neuroendocrine components. Because of the biphasic tumor in the kidney, extensive clinical examination and further analyses were recommended. Tumor in the left breast was revealed. Two months later, the patient underwent mastectomy with axillary lymph node dissection. The tumor was histologically and immunohistochemically similar to the neuroendocrine component within RCC. All axillary nodes were positive. To our knowledge, this is the first case of neuroendocrine breast carcinoma with metastasis to renal cell carcinoma and ipsilateral adrenal gland.     

20例梭形细胞癌的病理形态及免疫组织化学特征

目的:探讨梭形细胞癌的形态学及免疫组织化学特征及鉴别诊断.方法:收集20例梭形细胞癌病例的临床及病理资料,分析其形态学特征及免疫表型特征.结果:20例梭形细胞癌中男性12例,女性8例,平均年龄62.5岁.肿瘤无器官特异性,肿瘤细胞呈梭形,多数病例异型性明显,少数病例细胞温和,异形性不明显.免疫组织化学示肿瘤细胞均表达vimentin;至少表达一种上皮标志物;CK,34pE12,CK5/6,EMA和P63阳性率较高;常表达desmin,calponin,SMA;不表达CD34,S100,HMB-45,myogenin,MyoD1,ALK.结论:梭形细胞癌是一种具有独特形态学和免疫表型的肿瘤.     

肾脏黏液性管状和梭形细胞癌临床病理学观察

目的 探讨肾脏黏液性管状和梭形细胞癌的临床病理学特征、免疫表型及鉴别诊断。方法 应用常规病理、免疫组化方法观察1例肾脏黏液性管状和梭形细胞癌并复习相关文献。结果 肿物与周围肾组织分界清楚，组织学特点是排列呈管状的上皮样细胞，片状的梭形细胞和黏液性间质，无明显核的异型性，缺乏坏死。免疫组化：CK、EMA、vimentin阳性，SMA、desmin、S-100蛋白、HMB45等阴性。结论 肾脏黏液性管状和梭形细胞癌是WHO新确定的一类罕见的低度恶性肾上皮性肿瘤，预后较好，要与后肾腺瘤、肉瘤样癌和集合管癌等疾病相鉴别。     

Squamous cell carcinoma originated from an epidermal cyst

Epidermal cyst (EC) of the skin is a very common condition. Squamous cell carcinoma (SCC) very infrequently arises from EC. A 76-year-old Japanese woman was admitted to our hospital because of multiple papules in the nose and nasal cavity. The clinical diagnosis was sebaceous hyperplasia. An excisional biopsy was obtained from one papule. Histologically, the papule showed an EC. The EC communicated with the epidermis. Islands of atypical cells with hyperchromatic nuclei and infrequent pearl formation were recognized around and adjacent to EC. No connections were seen between the atypical cell islands and epidermis. The atypical cells had hyperchromatic nuclei and nucleoli. Mitotic figures and keratinous pearls were scattered. The HE diagnosis was probable SCC probably arising from EC. Immunohistochemically, the atypical cells were positive for pancytokeratin AE1/3, cytokeratin (CK) 5/6, CK14, CK18, CK 34BE14, EMA, p53, Ki-67 (labeling 90%), and p63. They were negative for pancytokeratin CAM5.2, CK7, CK8, CK19, CK20, vimentin, S100 protein, HMB45, synaptophysin, and CD56. CD68 was positive in histiocytes and giant cells in the foreign body reaction. The EC showed the same immunoprofile as the SCC, except for negative p53 and low Ki-67 labeling in the EC. The histological and immunohistochemical diagnosis was definite SCC arising from EC.     

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.     

肺多形性癌的病理学观察

目的 对１０例肺多形性癌回顾性临床病理研究,探讨肺多形性癌的临床病理特点。方法 采用组织病理学、免疫组织化学ＳＰ法标记（角蛋白、波形蛋白 Ｍａｃ３８７、结蛋白、肌动蛋白、Ｓ－１００蛋白）对１０例肺多形性癌进行研究。结果 肺多形性癌多见于５０岁以上的男性,临床首发症状咳嗽咳痰、咯血或患侧胸痛,镜下以鳞癌、腺癌等成分为主,伴有多少不等的梭形细胞或（和）巨细胞成分。肿瘤的上皮成分表达角蛋白,梭形细胞表达波形蛋白,３例上皮及梭形细胞成分同时表达角蛋白及波形蛋白。结论 肺多形性癌具有多种病理组织形态特征,病理诊断上易与癌肉瘤混淆。明确该肿瘤的组织发生,对于诊断及鉴别诊断有重要意义。     

消化道小细胞癌的临床病理分析

目的 研究消化道小细胞癌临床病理和免疫表型特征。方法 对17例消化道小细胞癌作了临床病理形态学观察和免疫组织化学检测。结果光镜形态分为3型：小细胞型8例，中间细胞型4例，混合型5例。免疫表型：EMA12例、NSE10例、keratin9例、CgA6例、S-100蛋白3例呈阳性，vimentin均阴性。结论 EMA、NSE、keratin为小细胞癌的较为可靠的标记物，支持此瘤来源于内胚层全能干细胞。     

Combined hepatocellular carcinoma and osteoclast-like giant cell tumor of the liver: Possible clue to histogenesis

Hepatic giant cell tumor is extremely rare, and only five cases have been reported of overt hepatocellular carcinoma, thus its histogenesis is controversial. Herein is reported a case of simultaneous hepatocellular carcinoma and osteoclast-like giant cell tumor in a single tumor. A liver tumor was found in a 74-year-old woman. Histologically the tumor consisted of two distinct components: mononuclear and multinuclear giant cells with osteoclastic giant cells, and a conventional hepatocellular carcinoma. The boundary between the two components showed transitional features. Immunohistochemistry showed that the osteoclast-like giant cells were CD68 and vimentin positive, but cytokeratin and AFP negative, while spindle-shaped cells were positive only for vimentin. In a portion of the hepatocellular carcinoma the cells were cytokeratin-8 and AFP positive. Ki-67 positivity was 10% for the hepatocellular carcinoma, 60% for the spindle-shaped cells, and 0% for the giant cells. It is possible that the tumor might have had a hepatocellular carcinoma origin, given the more highly proliferative sarcomatous changes and reactive osteoclast-like cells. This case provides a clue to the histogenesis of hepatic giant cell tumors.     

Small cell carcinoma of the oral cavity (cheek mucosa): a case report with an immunohistochemical and molecular genetic analysis

Small cell carcinoma (SCC) of the oral cavity is extremely rare; only one case has been reported in the English Literature. The author herein reports the second case of SCC of the oral cavity. A 59-year-old man presented with oral tumor (5 cm) in the right cheek mucosa. A biopsy was taken. The HE histology was typical SCC consisting of small epithelial cells with hyperchromatic nuclei, molded nuclei, scant nucleocytoplasmic ratio, and negative nucleoli. Immunohistochemically, the tumor cells are positive for pancytokeratin (PCK) WSS, PCK MNF-116, cytokeratin (CK) 34BE12, CK5/6, CK14, vimentin, KIT (CD117), CD56, synaptophysin, p53 protein, and Ki67 antigen (Ki-67 labeling = 70%). The tumor cells are negative for PCK AE1/3, PSK CAM5.2, CK7, CK8, CK18, CK19, CK20, EMA, NSE, chromogranin, platelet-derived growth factor-α (PDGFRA), CD45, CD45RO, CD3, CD20, CD30, CD79a, and bcl-2. A retrospective genetic analysis using PCR-direct sequencing method in paraffin sections identified no mutations of KIT (exons 9, 11, 13 and 17) and PDGFRA (exons 12 and 18) genes. Various imaging modalities including CT and MRI and upper and lower gastrointestinal endoscopy did not identified no tumors other than the oral tumor. Thus, the oral tumor was thought primary. The oral tumor rapidly enlarged, and distant metastases to cervical lymph nodes, ribs and iliac bones emerged. The patient is now treated by cisplatin-based chemotherapy 16 months after the first manifestation.     

Neuroendocrine carcinoma of the breast with Merkel cell carcinoma-like features

A case of neuroendocrine carcinoma of the breast with Merkel cell carcinoma-like features occurring In a 38-year-old female Is described. A 2.5 × 2.5 × 1.3 cm tumor in the upper-outer quadrant of the right breast was ill-defined, yellowish white and rubbery. Microscopically, the tumor was characterized by a diffuse proliferation of non-cohesive round cells. The tumor cells had round nuclei with finely dispersed chromatin and inconspicuous nucleoli. The cytoplasm was generally scant, pale to eosinophilic, and argyrophilic. There were scattered foci of small nests or intraductal proliferations. Immunohistochemically, many tumor cells showed positive reaction for CAM5.2, vimentin, chromogranin A, and synaptophysin. The tumor was also positive for neuron-specific enolase (NSE), Leu-7, calci-tonin, S-100 protein, and glial fibrillary acidic protein. Flow cytometric analysis showed that the tumor was DNA diploid. An axillary lymph node was positive for metastasis. The patient was well, without disease, for 6 years after mastectomy. It is suggested that the tumor might originate from ductal cells and show Merkel cell carcinoma-like neuroendocrine differentiation.     

Polyomavirus (BK)-associated pleomorphic giant cell carcinoma of the urinary bladder: a case report

This report describes the morphological features of a pleomorphic giant cell carcinoma with focal trophoblastic differentiation of the urinary bladder in a male, 12 years post living related donor renal transplant. The voided urine cytology demonstrated rare decoy cells admixed with markedly atypical urothelial cell clusters, papillae and giant cells. Cystoprostatectomy demonstrated a nodular mass involving the trigone and right lateral-posterior wall, adjacent to the ureteral orifice. Hematoxylin-eosin stained sections showed two synchronous malignancies: (a) pleomorphic giant cell carcinoma with focal trophoblastic differentiation of the urinary bladder, metastatic to the omentum and (b) prostatic adenocarcinoma, Gleason score 3 + 4 = 7, involving the right prostate lobe. Strong diffuse expression of polyomavirus large T antigen was demonstrated in the primary and metastatic pleomorphic giant cell carcinoma, supporting a possible role for polyomavirus (BK) in the oncogenetic pathway. The prostatic adenocarcinoma was negative for polyomavirus large T antigen. Our findings of p63, CK7 and CK903 expression in pleomorphic giant cell carcinoma suggest that the tumor is of urothelial derivation. This is the first report describing the morphological features of urinary bladder pleomorphic giant cell carcinoma with trophoblastic differentiation, positive for polyomavirus large T antigen, arising in the background of BKV reactivation.     

Pleomorphic giant cell carcinoma of the esophagus with coexpression of cytokeratin and vimentin and neuroendocrine differentiation

A pleomorphic (giant cell) carcinoma of the esophagus is reported in a 52-year-old man who had dysphagia and weakness. The 8-cm-high vegetating tumor consisted of solid sheets of poorly cohesive epithelioid cells broken into clusters by strands of stroma. Numerous giant cells showing phagocytic phenomenon were present. Immunochemical analyses demonstrated the epithelial origin of the neoplasm, although most of the tumor cells strongly expressed vimentin. Numerous tumor cells expressed synaptophysin. Neurosecretory granules were detected in some tumor cells on electron microscopic examination. The patient died 4 months after he became symptomatic. As far as we can ascertain, this is the first case report describing a pleomorphic carcinoma arising in the esophagus. This poorly differentiated carcinoma might be of neuroendocrine differentiation. In the esophagus, pleomorphic carcinoma must be distinguished from polypoid tumors such as carcinosarcoma and malignant melanoma.     

Ovarian small cell carcinoma. Histogenetic considerations based on immunohistochemical and other findings

Small cell carcinoma of the ovary is a rare, poorly understood aggressive tumor of young women, associated with paraendocrine hypercalcemia in two-thirds of the cases. Immunohistochemical staining of 15 small cell carcinomas, one-third of which were associated with hypercalcemia, 15 adult granulosa cell tumors, 15 juvenile granulosa cell tumors, and 5 Sertoli cell tumors, was performed with the use of antibodies against cytokeratins (AE-1/AE-3, CAM 5.2, 902), epithelial tumor-associated antigens (B72.3, epithelial membrane antigen [EMA]), vimentin, S-100, neuron-specific enolase (NSE), lysozyme, parathyroid hormone, and chromogranin-A in an attempt to define histogenetically this tumor type. One-third of the small cell carcinomas were positive for EMA, whereas all of them were negative for B72.3 and S-100. In contrast, one-third of the granulosa cell tumors were positive for S-100 and all of them were negative for EMA and B72.3. One of five Sertoli cell tumors were positive for EMA and two were positive for B72.3, but all were negative for S-100. Differences existed in the frequency, intensity, and/or pattern of staining for cytokeratin, vimentin, lysozyme, and NSE among the various tumor types. A single small cell carcinoma from a patient with hypercalcemia stained focally for parathyroid hormone, whereas all 30 granulosa cell tumors and 4 of 5 Sertoli cell tumors were nonreactive. Chromogranin-A staining was noted in four of five small cell carcinomas, none of ten granulosa cell tumors, and two of five Sertoli cell tumors. These immunohistochemical findings, as well as previous light and electron microscopic data, do not clearly indicate any specific cell as the cell of origin of the ovarian small cell carcinoma.     

Anaplastic carcinoma of the pancreas with rhabdoid features and hyaline globule-like structures

A 59-year-old Japanese man presented with a giant submucosal tumor with ulceration during follow-up of duodenal ulcer. Pancreaticoduodenectomy was undertaken, and subsequent histological examination of the tumor disclosed anaplastic carcinoma of the pancreas head. The carcinoma components contained adenocarcinoma and squamous cell carcinoma. Additionally, undifferentiated spindle or pleomorphic cells were seen in continuity with the carcinoma component. Undifferentiated neoplastic cells with rhabdoid features and with hyaline globule-like structures positive for PAS stain with diastase pretreatment were also observed. Immunohistochemically, cytoplasmic inclusions corresponding to rhabdoid features showed aggregates of vimentin. Ultrastructurally, hyaline globule-like structures corresponded to lysosomes. Finally, we report here the first case of anaplastic carcinoma of the pancreas with hyaline globule-like structures.     

Giant cell carcinoma of the lung--immunohistochemical and ultrastructural evidence of dedifferentiation

Ten examples of giant cell carcinoma of the lung were examined by immunohistochemistry for expression of keratin and vimentin intermediate filaments and for epithelial membrane antigen (EMA). Six cases were also examined electron microscopically. Keratin expression and, to a lesser extent, EMA immunoreactivity were reduced in comparison with better differentiated forms of lung carcinoma. Vimentin expression was increased, often taking the form of strong paranuclear staining. This may correspond to dense paranuclear aggregates of intermediate filaments seen ultrastructurally. Desmosomes were absent or sparse in most tumours. We propose that giant cell carcinoma arises by a process of dedifferentiation. The resulting loss of epithelial features gives rise to neoplastic cells which have features in common with some forms of sarcoma.     

Carcinosarcoma (pure endocrine cell carcinoma with sarcoma components) of the stomach

A case of gastric carcinosarcoma with a rare histology is reported. Grossly, a huge ulcerative tumor (Borrmann type 3 tumor, measuring 10 x 6 cm) was observed on the lesser curvature side of the stomach. Microscopically, the tumor consisted of carcinoma and sarcoma components. The main tumor component consisted of an endocrine cell carcinoma exhibiting positive reactions for cytokeratins, chromogranin A, synaptophysin, and CD56. The sarcoma component occupied less than 10% of the entire tumor area and consisted of spindle cells, some of which showed a rhabdomyosarcoma differentiation. Some of the spindle cells also showed an atypical cartilage or osseous differentiation. This sarcoma component exhibited positive staining not only for vimentin and desmin, but also for cytokeratins. Transitions between these two components were occasionally observed. These findings suggest that the sarcoma component in our case most likely originates from the endocrine cell carcinoma component.