Hyperplastic and neoplastic endocrine cells of the pancreas in aspiration biopsy

Aspiration biopsy of four primary endocrine tumors of the pancreas showed single and large sheets of tumor cells. Tumor cells were polygonal in shape with ill-defined, filmy or granular cytoplasm and regular round nuclei containing a finely granular chromatin pattern and inconspicuous or prominent nucleoli. Focal gland-like arrangement was seen in several sheets of tumor cells. Aspirate from liver metastases of an endocrine tumor of the pancreas showed single and clustered oval cells with granular cytoplasm and eccentrically located round and hyperchromatic nuclei. Smears prepared from aspirates of three fibrotic pancreata containing nodules of hyperplastic endocrine cells showed smaller fragments of endocrine-cell epithelium with focal gland-like arrangement. Individual hyperplastic endocrine cells displayed granular, filmy, and ill-defined cytoplasm and round to oval hyperchromatic nuclei showing a finely granular chromatin pattern. Nuclear pleomorphism was noted in some cell groups.     

Granular cell tumors of the abdominal wall

Granular cell tumors (GCT) are found in virtually any body site, including the tongue, skin, subcutaneous tissue, breast, rectum and vulva. However, they are rarely seen in the abdominal wall. We report here on a rare case of GCT in the rectus muscle of the abdominal wall. A 44-year-old woman presented with a non-tender, hard mass in the right lower abdominal wall. Upon microscopic examination, the tumor was found to comprise of large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei. Upon immunohistochemical staining, the large cells showed S-100 and CD68 positive granular aggregates in the cytoplasm. Many lysosomes of variable size were observed in the cytoplasm.     

分泌型乳腺癌的临床病理特征

目的：探讨乳腺分泌型癌的临床病理特征、诊断和鉴别诊断要点。方法 ：分析14例分泌型乳腺癌患者的临床病理资料,进行光镜观察,部分病例进行组织化学及免疫组化染色,并复习文献。结果：分泌型乳腺癌临床及病理大体观察与其他类型乳腺癌无明显区别,主要表现为乳房内肿块,多位于乳晕区,大体观察肿物大多连界不清、质地硬,光镜下肿瘤细胞主要排列成实性、小囊性和导管性三种结构,瘤细胞有颗粒性嗜酸性胞质,瘤细胞内外有大量均质嗜伊红PAS阳性分泌物。腋下淋巴结转移较少（2/14）。无局部复发或远处转移（随访3～14年）。结论：分泌型乳腺癌为罕见且预后较好的乳腺癌,确诊必须依靠病理检查。     

Colocalized granular cell tumor and infiltrating ductal carcinoma of the breast

A 57-year-old woman presented with a 2-year history of a palpable mass in the upper inner quadrant of the right breast. A 1.1-cm, poorly circumscribed, firm tumor nodule was noted, consisting of 2 histologically distinct lesions in the same location, with some areas showing purely well-differentiated invasive ductal carcinoma and others composed of granular cell tumor. In 1 area, the 2 tumors collided and infiltrated each other. The invasive ductal carcinoma was admixed with ductal carcinoma in situ of solid and cribriform types. To our knowledge, this is the first case report demonstrating colocalization of these 2 neoplasms, which raises questions regarding causal relationship. We also review the literature on granular cell tumor of the breast.     

Fine-needle aspirates of granular cell lesions of the breast: Report of three cases,with emphasis on differential diagnosis and utility of immunostaining for CD68 (KP1)

Fine-needle aspiration biopsy (FNA) has been recognized as a safe and reliable procedure for evaluating breast lesions. We herein report cytologic findings for needle aspirates from three granular cell nodules of the breast. The nodules were detected by diagnostic imaging and ranged from 0.6 to 1 cm in diameter. Ultrasound-guided FNA was used in all cases and revealed cellular aspirates with similar cytomorphologic features consisting of sheets of large granular cells intersected by arborizing thin-walled blood vessels. The cells had round to oval nuclei, inconspicuous nucleoli, and abundant, often ill-defined granular cytoplasm. Tissue sections of resected specimens yielded final diagnoses of granular cell metaplasia of histiocytes and stromal cells in one case and granular cell tumor (GCT) in the other two cases. FNA smears in all three cases were strongly positive for the lysosomal marker CD68 (KP1) and S-100 protein; therefore, it was not possible to distinguish true GCT from granular cell metaplasia/granular histiocytes. When breast aspirates reveal granular cell changes, excisional biopsy should be done for a definitive diagnosis. Diagn Cytopathol 1996;15:403–408. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of glycogen-rich carcinoma of breast: report of a case and review of literature

Glycogen-rich carcinoma (GRC) of the breast is a rare histological subtype of breast cancer having a poor prognosis. There are very few case reports describing the cytological features of GRC on fine-needle aspiration cytology (FNAC). In this report we present the case of a 34-yr-old woman who underwent FNAC of a clinically palpable breast lump. The aspirate was cellular showing tumor cells in groups, clusters and lying singly. The tumor cells had abundant eosinophilic, finely granular to vacuolated cytoplasm with moderate to marked nuclear pleomorphism. With a cytological diagnosis of carcinoma, a wide local excision was performed. On histology a diagnosis of GRC was made with the tumor cells showing abundant glycogen. The presence of cells with abundant granular to finely vacuolated cytoplasm in a case of breast carcinoma, should point toward the possibility of GRC and other clear cell tumors of the breast. Demonstration of glycogen is required to make a definite diagnosis on cytology.     

Bronchial granular cell tumor with osteopontin and osteonectin expression: a case report

The case of a 52-year-old Japanese man with bronchial granular cell tumors with osteopontin and osteonectin expression is reported here because there have been few investigations of their expression in benign tumors. He was admitted because of sudden hematemesis. A bronchoscopic examination revealed a lobulated polypoid tumor located in the left and right bronchi. Histologically, most tumor cells had abundant granular eosinophilic cytoplasm and were immunoreactive for S-100, neuron-specific enolase (NSE), CD68 and vimentin. Moreover, osteopontin-positive tumor cells were randomly distributed in the tumor tissue, but few stromal cells were positive. In contrast, osteonectin was mainly expressed in the peripheral tumor cells and was also distributed in the stromal cells. Blood vessels at the tumor border in which osteonectin-positive tumor cells were distributed, proliferated moderately. These results suggest that osteopontin and osteonectin may play a role in the progression of granular cell tumors and in the interaction between the tumor and host or angiogenesis around the tumor, respectively.     

Invasive ductal carcinoma of the breast with signet-ring cell and mucinous carcinoma components: diagnostic utility of immunocytochemistry of signet-ring cells in aspiration cytology materials

Breast cancer with signet-ring cells is very rare. In this article, we present a case of invasive ductal carcinoma with signet-ring cells and mucinous carcinoma components, which could be diagnosed as a primary cancer by immunocytochemical study of fine-needle aspiration cytology material. A 73-yr-old Japanese woman noticed a palpable mass in the left breast. The aspiration cytology disclosed the monotonous proliferation of signet-ring cell with cytological atypia. The immunocytochemical examination of neoplastic cells showed a positive reaction for estrogen receptor. The extensive examination of body before the operation did not disclose any tumors in other anatomic sites. The histological examination of surgically resected breast tumor showed invasive ductal carcinoma with foci of signet-ring cell and mucinous carcinomas. Finally, our preliminary report suggests that immunocytochemical examination of aspiration cytology materials may provide useful information in searching the primary site of breast carcinoma with signet-ring cells.     

An Unusually Large Granular Cell Tumor of the Pharynx: A Case Report and Literature Review

We report a granular cell tumor of the pharynx in a 53 year-old woman who presented with a large retropharyngeal mass. Surgical excision revealed a 5.5 cm tan rubbery unencapsulated but circumscribed mass. Histologically, the tumor is composed of diffusely arranged oval and spindle cells with abundant eosinophilic granular cytoplasm and mildly pleomorphic nuclei without necrosis or mitoses. Immunostains show the tumor cells to be positive for S-100, vimentin, non-specific esterase and focally positive for inhibin. In addition to its unusual location, this tumor is extremely large while most granular cell tumors are small (<2 cm). This case represents a unique example of a large granular cell tumor at a rare location: the pharynx.     

Breast leiomyoma: a case report and review of the literature

Breast leiomyoma is a rare and benign tumor which arises from a smooth muscle in nipple and areola or smooth muscle metaplasia of myoepithelial cells or myofibroblastic cells. Common differential diagnosis of the breast leiomyoma was as follows: fibroadenoma, myoepithelioma, phyllodes tumor, and leiomyosarcoma. We present here a rare case of solitary leiomyoma of the breast. We described a case of breast leiomyoma diagnosed in an otherwise healthy 37-year-old woman at the Rajaee Hospital. The patient presented with a palpable mass in her right breast since 2 years. Physical examination showed a mobile and smooth mass, without any axillary lymphadenopathy. The radiologic examinations revealed a well-circumscribed ovoid mass, 5 cm in diameter. Excisional biopsy disclosed a well-circumscribed cellular tumor by interlacing fascicles of spindle cells with fibrillary and eosinophilic cytoplasm. The tumoral cells were immunoreactive for smooth muscle actin. There were not any evidences of disease recurrence for 20 months of follow up. Histopathological study and immunohistochemical examinations help in the discrimination between leiomyoma and other benign and malignant breast lesions and determination of outcome.     

Spontaneous regression of malignant lymphoma of the breast

A complete spontaneous regression of diffuse large B cell lymphoma involving the right breast, confirmed by aspiration cytology, is reported. The patient visited a hospital due to the rapid growth of a tumor in the right breast. Five years previously she underwent a craniotomy for a brain tumor, diagnosed as B-cell malignant lymphoma, and received several courses of irradiation to the brain. Analysis of the breast tumor cells obtained by aspiration revealed lymphoma cells morphologically, which were similar to the tumor cells in the brain expressing CD20. While waiting for further examination, the tumor regressed rapidly and was not palpable after 20 days. An excisional biopsy of the breast exhibited no definite malignant lymphoma cells among a diffuse population of CD45RO and CD8-positive small lymphocytes. Nucleotide sequencing of HCDR3s of the brain tumor and breast tumor cells showed a completely matched sequence, revealing the breast mass to be a metastatic lesion from the tumor of the brain. Although there was no tumorous lesion, the patient received additional chemotherapy and has shown no sign of recurrence in the breast for 7 years. We were able to confirm that the breast lymphoma shown in the aspiration cytology was a metastatic one, which was not proven histologically prior to chemotherapy, and regard the present case as a malignant lymphoma of the breast showing spontaneous regression. The present case shows a rare occurrence of spontaneous regression of diffuse large B cell malignant lymphoma after aspiration and suggests that CD8-positive T cells might be related to the regression.     

The Cytology of a Thyroid Granular Cell Tumor

Granular cell tumor (GCT) of the thyroid is rare. Before this report, only four cases of thyroid GCT have been reported, none of which presented a cytopathological examination. In this paper, we report the fine needle aspiration cytology and pathological analysis of a thyroid GCT from a 12-year-old girl who presented with a painless neck mass. The tumor cells were single, in syncytial clusters, or pseudofollicles, contained small round, oval, or spindle nuclei, indistinct nucleoli, and a large amount of grayish, granular fragile cytoplasm. The background contained granular debris and naked nuclei. A differential diagnosis of thyroid GCT with more frequent thyroid lesions containing cytoplasmic granules, including Hurthle cells, macrophages, follicular cells, and cells of black thyroid syndrome, was also performed.     

Malignant granular cell tumor with unusual histological features

Malignant granular cell tumor, although uncommon, should be differentiated from a number of granular cell-containing tumors. Reported herein is a distinctive variant of malignant granular cell tumor, clinically presenting as a rapidly enlarging scrotal mass, in which some areas morphologically displayed features indistinguishable from Kaposi sarcoma. Cells in areas simulating Kaposi sarcoma were immunohistochemically the same as typical granular cells in other portions of the tumor. The recognition of this pattern is important because it may predominate and overshadow the original nature of tumor.     

Malignant phyllodes tumor of the breast with osteoclast-like giant cells: a case report

Breast tumors, particularly of stromal origin, containing multinucleated osteoclast-like giant cells (OLGC) are rarely reported in the literature. We report here the first case of a malignant phyllodes tumor associated with OLGC occurring in a 43 year-old African woman who presented with a painful palpable mass of the outer upper quadrant of the right breast. After surgical excision, histological examination showed a malignant phyllodes tumor in which the stromal component displayed evident sarcomatous changes and was densely populated with benign multinucleated OLGC. These cells expressed the CD68 histiocytic marker. No evidence of osseous or cartilaginous differentiation was seen throughout the lesion. This lesion ressembles giant cell tumor of bone. However, the nature of the OLGC is not well precised yet.     

乳腺神经内分泌型导管内癌

目的对乳腺神经内分泌型导管内癌（E-DCIS）的临床病理特点、预后和鉴别诊断进行探讨。方法用光镜、免疫组织化学EnVision法行嗜铬素A、突触素和神经元特异性烯醇化酶（NSE）染色和消化PAS、消化阿辛蓝和嗜银染色,对18例具有E-DCIS特征的乳腺癌进行观察。结果具有E-DCIS特征的乳腺癌具有以下特点：（1）好发于老年女性,平均年龄71岁。最常见的临床症状为乳腺肿块或乳头溢液。（2）E-DCIS呈导管内肿瘤细胞的膨胀性生长,在肿瘤周边常可见导管内乳头状瘤。（3）肿瘤细胞呈多边形,卵圆形或梭形,胞质丰富,嗜酸性或细颗粒状。细胞核往往只有轻一中度异型,消化PAS或AB染色显示细胞内或细胞外存在黏液,有些肿瘤细胞呈印戒细胞样。（4）〉50％的肿瘤细胞表达嗜铬素A、突触素和NSE中的至少两种,部分病例CD56和CD57染色阳性。（5）E-DCIS中常可见到肿瘤细胞向邻近导管的派杰样扩散,且在膨胀性生长的导管内不存在肌上皮成分。这两点有助于E-DCIS与导管上皮增生的鉴别。结论E-DCIS是一种低度恶性的乳腺导管内癌,有其独特的组织形态、免疫组织化学特征,应作为一种独立的导管内癌类型加以认识。     

Granular cell tumor arising metachronously in the bronchus and esophagus

We present a case of granular cell tumor (GCT) occurring in the esophagus 7 years after operation for bronchial GCT. A 59-year-old Japanese man complained of epigastralgia, and endoscopic examination of the upper digestive tract disclosed a submucosal tumor in the lower esophagus. Histological examination of the endoscopic mucosal resection of the esophageal tumor showed a proliferation of neoplastic cells with an eosinophilic and granular cytoplasm. The cytoplasm of the neoplastic cells was histochemically positive for PAS stain and immunohistochemically positive for S-100. This tumor did not fulfill any of the diagnostic criteria for malignancy at either the macroscopic or microscopic level. I believe that this is the first case of GCT occurring metachronously in the respiratory and digestive tracts. Clinicians and pathologists should bear in mind that GCT may arise metachronously in the respiratory and digestive tracts.     

Interdigitating dendritic cell tumor with breast and cervical lymph-node involvement: a case report and review of the literature

Interdigitating dendritic cell tumor (IDCT) is an extremely rare malignancy. It occurs primarily in lymph nodes, but extranodal involvement has also been reported. A 38-year-old woman with IDCT with breast and cervical lymph-node involvement is reported in this paper. To our knowledge, this is the first case of IDCT originating from the breast. In the breast and lymph node, the tumor displayed diffuse sheets, fascicles and storiform growth pattern. It was composed of oval to spindle cells with pale to eosinophilic cytoplasm, ill-defined cell outlines, oval nuclei with vesicular chromatin and prominent eosinophilic nucleoli. Mitotic activity was three per ten high-power fields. The neoplastic cells were intermingled with small mature lymphocytes and plasma cells. Immunohistochemical studies showed that the tumor cells were strongly and diffusely positive for vimentin, CD68, S-100 protein, CD45/leukocyte common antigen and fascin and focally positive for lysozyme, alpha-1 antitrypsin and CD4. Ki-67 labeling index was 10%. The patient was treated with combined therapeutic approaches, including surgery, radiotherapy and chemotherapy. IDCT has the potential for an aggressive clinical course. However, 32 months after the initial diagnosis, the patient is still alive and being followed with a stable tumor burden.     

颗粒细胞瘤15例临床病理分析

目的探讨颗粒细胞瘤的组织起源及临床病理学特征。方法回顾分析15例颗粒细胞瘤的临床资料及组织学形态特征,并采用免疫组化(SP法)观察其免疫表型。结果良性颗粒细胞瘤13例,恶性颗粒细胞瘤2例。男性5例,女性10例,年龄19~69岁,平均年龄41·6岁,2例恶性颗粒细胞瘤年龄分别为67岁和69岁。良性颗粒细胞瘤直径0·4~5·3cm,平均2·3cm,2例恶性颗粒细胞瘤直径分别为6和14cm。均为单发病例,临床上主要表现为真皮、皮下或黏膜下孤立性无痛性结节,分别位于腰部3例、腋下、胸壁各2例,乳腺、上臂、子宫、肛周、声带、食管、结肠、舌部各1例。病理组织学上,良性颗粒细胞瘤的肿瘤细胞通常有比较丰富的嗜酸性颗粒状胞质和小而深染的胞核,而恶性颗粒细胞瘤的肿瘤细胞中可见带有明显核仁的空泡状核,细胞核明显异型及部分细胞呈梭形。免疫组化示神经标记物NSE、S-100蛋白强阳性,表达溶菌酶的标记物CD68也强阳性,而表达平滑肌和横纹肌的标记物SMA、MG均阴性。结论颗粒细胞瘤为来源于雪旺细胞的肿瘤,恶性者少见,大多发生在年龄大的患者,且肿瘤体积比较大。     

Medullary breast carcinoma: a case report with cytological features and histological confirmation

We report the case of a 83-year-old woman who presented with a left-breast lump. On physical examination the patient had a well-demarcated mass located in the upper outer quadrant of her left breast with a palpable unilateral axillary lymph node. Mammography and ultrasonography depicted a heterogeneous well-defined lesion measuring 6 cm in diameter without calcifications. Fine-needle aspiration cytology of the lesion was performed. Cytological examination revealed highly cellular smears containing large atypical cells arranged in syncytial sheets and intimately admixed with lymphocytes and neutrophils. The nuclear to cytoplasmic ratio was high in tumor cells whose nucleus exhibited coarse chromatin with one or more conspicuous nucleoli. The diagnosis of medullary breast carcinoma, which was strongly suspected by cytology, was confirmed by histological examination of the surgical specimen after a modified radical mastectomy with axillary dissection.     

Combined salivary duct carcinoma and squamous cell carcinoma suspected of carcinoma ex pleomorphic adenoma

A 76‐year‐old Japanese woman had noticed an asymptomatic and palpable mass in her left parotid gland region for 20 years. The tumor had showed rapid growth during the last two months. Therefore, the tumor was clinically suspected of being a malignant tumor and was surgically resected. A histopathological examination revealed that the tumor consisted of two different histopathological neoplastic components accompanied by hyalinized fibrosis at the center of the tumor. The two‐neoplastic components were squamous cell carcinoma and salivary duct carcinoma. The tumor was suspected to be a carcinoma ex pleomorphic adenoma after considering the clinical course and the histopathological findings, such as hyalinized fibrosis at the center of the tumor. There was no evidence of recurrence at 30 months after the surgical resection.