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.     

Small cell (oat cell) carcinoma of the breast

A case of small cell (oat cell) carcinoma, which represents both the most dlstlnctlve and the least common type of mast carcinoma wtth neuroendocrine dlfterentiation and usually shows the most aggressive behavior, is described. Radlcal mastectomy was performed on a Wyearold female for a 10 cm tumor located in the outer part of the right breast with cutaneous ulceration Microscoplcally, the tumor predominantly consisted of a diffuse proliteration of small, round to ovoid cells with hyperchromatlc nuclei and ill-defined, scant cytoplasm that was reminiscent of oat cell carclnoma of the lung. There were foci of invasive ductal carcinoma and ductal carcinoma in situ . Small cell carcinoma areas constituted approximately 90% of the neoplasm. The patlent had axlllary lymph node metastasis. The small tumor cells were argyrophlllc and positive for CAM5.2, carclnoembryonic antigen, neuron-specific enolase, Leu-7, chromogranln A and synaptophysin. Flow cytometric analysis showed an aneuplold DNA content. The patient was alive and well without disease 4 years after surgery. Small cell carcinomas of the breast may exhibkt a spectrum of malignancy that is comparable to similar tumors at better known primary sites.     

Spindle cell carcinoma of the breast

A case of spindle cell carcinoma of the breast in association with myoepithelial cell hyperplasia is presented. Immunocytochemistry demonstrated labelling of tumour cells for cytokeratin, vimentin and S-100 protein. Electronmicroscopy showed desmosomes and bundles of tonofilaments as well as fine filaments in the cytoplasm. The findings in the present case point to the metaplastic spindle cell nature of squamous carcinoma of the breast. The possible role of myoepithelial cells in the origin of the spindle cell component is discussed.     

Primary signet-ring cell carcinoma of the urinary bladder

Signet-ring cell carcinoma of the urinary bladder is a rare tumour, accounting for approximately 0.24% of all bladder malignancies. In this study, the clinicopathological findings in 13 cases are described. This malignancy is far more common in men than in women (ratio 11:2). The distribution by age and clinical symptoms can not distinguish it from transitional cell carcinoma. The tumour behaves like other high grade malignancies, presenting frequently at an advanced stage, and having an unfavourable clinical outcome. No special therapy seems superior to another.     

Signet-ring cell adenocarcinoma of rectum: a histological, histochemical and electron microscopic study

A signet-ring cell adenocarcinoma of rectum removed from a 71-year-old woman was examined by light and electron microscopy. Most of the mucin in the signet-ring cells was of the neutral type, although acidic, mostly non-sulphated, mucin was also present. Three other types of neoplastic cells. The similarities between this tumour and tumours described in the stomach, appendix and breast care discussed.     

Signet-ring cell carcinoid of the gallbladder

A case of signet-ring cell carcinoid of the gallbladder is reported. The tumour diffusely infiltrated the gallbladder wall and extensively ulcerated the mucosa. Neoplastic nests were composed of numerous signet-ring cells mixed with clear endocrine cells. The latter expressed chromogranin A, gastrin and somatostatin and contained neurosecretory granules. The diagnostic problem of differentiating between signet-ring cell carcinomas and composite adenocarcinoma-carcinoid tumours is discussed.     

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.     

Primary signet ring cell carcinoma of the breast

Summary Light microscopic (LM), histochemical, and electron microscopic (EM) investigations of a case of signet ring cell carcinoma (SRC) of the breast indicate that SRC is a variant of mucin-producing carcinoma and that in this particular case, it is of ductal origin.     

A case of extensively spreading acinic cell carcinoma of the breast with microglandular features

Acinic cell carcinoma (ACC) is an exceptionally rare type of breast carcinoma with a low-grade morphology and a favorable prognosis. It is postulated to be a type of invasive carcinoma arising in microglandular adenosis (MGA). We report a case of extensively spreading ACC of the breast with MGA-like features. Macroscopically, yellowish nodules were widely distributed throughout the right breast, up to the axilla, without mass formation. Microscopically, the tumor consisted of two distinct carcinoma components: one was multiple nodular lesions showing invasive carcinoma with fused solid nests, and the other was a widely spreading lesion exhibiting MGA-like features with uniform small single glands. Immunohistochemically, both components were negative for ER, PR, and HER2, and expressed EMA, S100 and lysozyme. The distinct morphology and molecular expression indicated ACC. The single glands in the MGA-like area lacked myoepithelial cells but were linearly surrounded by type IV collagen, a basement membrane component. This case supports the hypothesis that ACC and MGA have the same lineage and indicates that ACC is not necessarily a low-grade malignancy and can be aggressive.     

Small cell neuroendocrine (oat cell) carcinoma of the male breast

Summary A case of small cell neuroendocrine (oat cell) carcinoma of the breast in a 52-year old male is presented. Oat cell carcinomas have been reported in various extrapulmonary sites, but this is the second case of a primary oat cell carcinoma of the breast and the first one to have been documented in a male. The tumor was investigated histologically, immunocytochemically and ultrastructurally. The relationship to so-called carcinoid mammary tumors is discussed.Dedicated to Prof. Dr. J. Kracht on the occasion of his 60th birthday     

Metaplastic lipid-rich carcinoma of the breast

A case of lipld-rich mammary carcinoma identified in a lumpectomy specimen from a 56year-old female is presented. The tumor showed features of poorly differentiated invasive ductal carcinoma of clearcell phenotype. Cytoplasmic lucency was mainly accounted for by the accumulation of neutral fat and, to a lesser degree, glyco-gen. Tlnctorial properties Included positivity of tumor cells with Sudan iii dye and diastasesensitive periodic acid-Schiff staining. Ultrastructural examination confirmed the presence of abundant cytoplasmic lipid droplets and some glycogen rosettes. On immunohistochemistty, most tumor cells reacted for cytokeratin, vimentin and S-100 protein, and there was focal expression of carclnoembryogenic antigen. A minority of tumor cell nuclei expressed progesterone receptors. As an additional feature, part of the leslon exhibited chondroid metaplasia. Lipid-rich carcinoma of the breast is exceedlngly rare and, to our knowledge, no such example harboring metaplastic elements has been described previously.     

Primary squamous cell carcinoma of the breast with unusual basal-HER2 phenotype

Objectives: To report three cases of primary squamous cell carcinoma of the breast with an unusual “basal-HER2” phenotype. Methods: Clinical data were analyzed. Morphological features were observed. Immunohistochemical study for ER, PR, HER2, Ki-67, CK 5/6, CK10/13, CK14, EGFR, P63 and FISH detection of HER2 gene amplification were performed. Results: Three patients were all female with 26, 57 and 66 years old. The tumors were 3 cm, 4 cm and 5 cm in size respectively. Morphologically, all three tumors were pure squamous cell carcinoma and entirely composed metaplastic squamous cells. Two tumors were moderately differentiated and one was poorly differentiated. All three patients were positive for P63 or CK10/13. All three tumors exhibited basal-HER2 phenotype: negative for ER and PR, positive for HER2 protein and HER2 gene amplification, and positive for at least two basal markers. Conclusions: SCC with basal-HER2 phenotype is an extremely rare subset of breast carcinoma. Since it may have worse prognosis than typical basal-like SCC, recognization of this unusual SCC in routine work may have obvious clinical significance.     

Poorly differentiated myoepithelial cell rich carcinoma of the breast

Three unusual cases of invasive breast carcinoma are reported, each comprising a dual malignant cellular proliferation consisting of 'ordinary' epithelial cells as well as myoepithelial cells haphazardly intermingled. The cases displayed features which did not match any of the four main types of invasive malignant breast tumours containing myoepithelial elements, i.e. adenomyoepithelioma, adenoid cystic carcinoma, pure myoepithelioma and low-grade adenosquamous carcinoma. The designation of 'poorly differentiated myoepithelial cell rich carcinoma' (PDMC) is proposed for these tumours.     

乳腺原发性腺泡细胞癌临床病理诊断

目的探讨乳腺原发性腺泡细胞癌的临床病理特征及诊断和鉴别诊断。方法对1例乳腺原发性腺泡细胞癌进行光镜观察及免疫组化标记。结果癌细胞由同种细胞组成,排列成实性巢状,细胞核圆形,胞质内富含颗粒,胞质嗜酸性或空泡状,透明细胞常见;免疫组化特征性表达CK、lysozyme、α-anti-chymotrypsin等抗体,有助于与其他肿瘤鉴别。结论乳腺腺泡细胞癌非常罕见,需要与乳腺浸润性导管癌、腺肌上皮瘤、颗粒细胞癌等鉴别。     

Pure primary squamous cell carcinoma of the breast: a rare presentation and clinicopathologic comparison with usual ductal carcinoma of the breast

Pure and primary squamous cell carcinomas of the breast are exceedingly uncommon lesions. To the best of our knowledge, based up on review of the literature, only four studies of patients with these tumors, which presented clinically as breast abscess, have been reported previously. We present a woman who sought medical attention for breast pain and was initially diagnosed with a breast abscess. When she did not respond to antibiotic therapy, an incision as well as drainage was performed. Histologic examination of the material revealed a pure squamous cell carcinoma. An extensive work up ruled out other primary sites. She was treated with mastectomy and radiation therapy and has seen disease-free 3 years postdiagnosis. We also review the literature for presenting features, value of imaging studies, role of cytology in diagnosis, and therapy of such tumors in comparison to the usual ductal carcinomas of the breast.     

Poorly differentiated myoepithelial cell rich carcinoma of the breast

Three unusual cases of invasive breast carcinoma are reported, each comprising a dual malignant cellular proliferation consisting of ‘ordinary’ epithelial cells as well as myoepithelial cells haphazardly intermingled. The cases displayed features which did not match any of the four main types of invasive malignant breast tumours containing myoepithelial elements, i.e. adenomyoepithelioma, adenoid cystic carcinoma, pure myoepithelioma and low-grade adenosquamous carcinoma. The designation of ‘poorly differentiated myoepithelial cell rich carcinoma’ (PDMC) is proposed for these tumours.     

Primary signet ring cell carcinoma of the breast

Three examples of primary signet ring cell carcinoma of the breast are described. This form of breast carcinoma deserves recognition as an entity because its prognosis may differ from colloid carcinoma of the breast and because of potential difficulty in distinguishing it from metastatic carcinoma.