Tubular adenoma of the gallbladder with squamoid spindle cell metaplasia. Report of three cases with immunohistochemical study.

Three cases of tubular adenoma of the gallbladder with squamoid spindle cell metaplasia are reported. Two of the three patients, who were middle-aged Japanese, had a solitary polyp in the gallbladder, and the other had three polyps. All the lesions were detected incidentally by ultrasonography. The polyps were pedunculated with a fine or frail stalk, and ranged from 0.5 to 3.9 cm in diameter. Histologically, they were tubular adenomas accompanied by scattered foci composed of a compact collection of short-spindle or oval cells with mild atypia. These cells did not retain intercellular bridges, and lacked intracellular keratinization. Immunohistochemically, the spindle cells stained positively for high-molecular-weight cytokeratin (EAB 903, a marker of squamous cell differentiation), whereas adenoma cells lining the tubules were negative for this antigen. Therefore, the spindle cell component is considered to represent squamoid metaplasia of adenoma cells.     

Tubular adenoma with focal squamous metaplasia of the ascending colon

A case of tubular adenoma with focal squamous metaplasia of the ascending colon in a 66-year-old male is reported. The tumor was a pedunculated polyp with a size of 1.5 X 1.4 X 0.9 cm. Histologically, the tumor showed tubular adenoma with moderate to severe atypia, was accompanied by focal squamous metaplasia. It is thought that squamous epithelial polyp may be derived from colonic adenoma with squamous metaplasia, and that the malignant change of colonic adenoma with squamous metaplasia may lead to squamous cell carcinoma, adenosquamous carcinoma, and mucoepidermoid carcinoma. Only seven cases of colonic adenoma with squamous metaplasia have been reported previously in the literature, and it is yet necessary to discuss the histogenesis, significance, and natural history of colonic adenoma with squamous metaplasia.     

Colonic adenoma with squamous metaplasia

Squamous metaplasia arising within colon adenomas is a rare occurrence, with a 0.4% incidence noted predominantly in elderly males. A case of squamous metaplasia arising in a tubulovillous adenoma of the cecum, associated with adenocarcinoma, is described. Squamous metaplasia was immunoreactive for beta-catenin, but negative for cytokeratin 20, CDX2, p63, estrogen receptor, progesterone receptor, p16, and human papilloma virus. Squamous differentiation may serve as a precursor lesion for squamous neoplasia of the colorectum.     

Tubular adenoma of breast

A recent classification of adenomas of the breast included tubular adenoma. This uncommon lesion can be distinguished from fibroadenoma by the predominance of epithelium and relative lack of stroma. This is, to our knowledge, the first report of a tubular adenoma studied by aspiration cytology as well as light and electron microscopy. A 4-cm, slightly tender mass was found in the upper outer quadrant of the breast of a 26-year-old woman. Aspiration cytology showed abundant epithelial fragments, similar to those seen in fibroadenoma, but without the spindle cell component often seen in aspirates of that lesion. Light microscopic study of the excised mass showed a well-demarcated tumor of tubular glands and scanty stroma. By electron microscopy, the epithelial stromal junction was intact. This contrasts with the findings in fibroadenoma, and confirms that this difference can distinguish these lesions.     

Spindle cell metaplasia of the thyroid arising in association with papillary carcinoma and follicular adenoma

Spindle cell proliferations of the thyroid have been described in association with reactive processes and aggressive malignant neoplasms. We describe spindle cell proliferations in 10 patients arising in association with papillary carcinoma and follicular adenoma. The spindle proliferations were 0.3 to 3.0 cm in size, constituted from 1% to 95% of the primary neoplasm, and were either admixed with the neoplastic elements or peripherally located within the primary tumor Cytologically, these proliferations showed bland-appearing spindle cells with fine chromatin and subtle nucleoli. Mitoses were rare, and inflammation was minimal. Immunostains showed reactivity with thyroglobulin, indicating their follicular origin. We believe it is important to recognize these metaplastic proliferations and distinguish them from aggressive malignant neoplasms.     

Widespread mucous metaplasia of the urinary bladder with nephrogenic adenoma

We describe widespread metaplastic changes observed in nonexstrophic urinary bladder mucosa in a 32-year-old man. Extensive areas of the luminal surface were covered by two types of metaplastic epithelium. One type was bilayered while the other was single layered with columnar cells of varying electron density as well as mucus-secreting cells. An area of adenomatoid metaplasia was also observed.     

Adenosquamous carcinoma of the gallbladder with spindle cell features. A light microscopic and immunocytochemical study of a case

A case of adenosquamous carcinoma of the gallbladder showing extensive spindle transformation is presented. By light microscopy, areas showing interwoven fascicles of fusiform, poorly differentiated cells closely resembling a sarcoma were seen to merge imperceptibly with areas showing more obvious glandular and squamous cell features. Immunocytochemistry utilizing tissue-specific antibodies against intermediate filaments demonstrated the exclusive presence of prekeratin antibodies in both components of the tumour, thus establishing the epithelial nature of this neoplasm. The importance of immunological phenotyping in the differential diagnosis of epithelial tumours of the gallbladder showing pseudosarcomatous features is underscored.     

乳腺伴梭形细胞化生腺癌2例及文献复习

目的 探讨乳腺伴梭形细胞化生腺癌的临床病理特点及鉴别诊断要点。方法 复习2例乳腺伴梭形细胞化生腺癌的临床资料,并行免疫组化标记。结果 组织学特点：癌组织由梭形细胞构成,细胞异型不明显,核分裂象不多,呈片巢状、条索状、编织状排列,梭形细胞内可见腺癌的管状成分。免疫组化染色显示：癌细胞呈上皮性免疫表型,CK(pan)、EMA阳性,ER、PR、C—erbB-2常阴性,不表达S-100蛋白、desmin和vimentin。结论 乳腺伴梭形细胞分化的腺癌是上皮性特殊性乳腺癌中乳腺化生性癌的1种,其诊断主要依靠组织病理学及免疫组化标记。     

Basaloid squamous carcinoma with a spindle cell component and osseous metaplasia presenting as a polyp of the hypopharynx

We report a case of basaloid squamous carcinoma with a spindle cell component of the hypopharynx, in a 61-years-old-man. An excisional biopsy of a pedonculated and polypoid tumour was performed by endoscopy. The histologic examination revealed a biphasic tumour with both a basaloid carcinomatous and a spindle cell component. Focally, osseous metaplasia was seen. The spindle cell component demonstrated immunoreactivity with the p63 epithelial marker. The patient was treated with chemotherapy followed by radiotherapy. The patient has been free of disease for one year. It's the ninth case reported in the literature of a biphasic carcinoma with both a basaloid squamous and a spindle cell component and the first case with osseous metaplasia.     

Concurrent tubulovillous adenoma and transitional cell carcinoma associated with diffuse gastric and intestinal metaplasia of the defunctioned ureter

Villous adenoma is a common lesion of the gastrointestinal tract, but it is rare in the ureter. Thus, as far as we know, only one case limited to this location has been described. Intestinal metaplasia of the urothelium is not rare. However, only one case of gastric metaplasia with pseudopyloric glands has been described in the literature. We here report in detail on a tubulovillous adenoma of the ureter associated with diffuse gastric and intestinal metaplasia and a concurrent primary, solid, high grade transitional cell carcinoma, with extensive clear cell change, in a 56-year-old male patient. He had undergone a left nephrectomy for renal tuberculosis twenty years earlier, and the lesions developed in the ureteric stump. To the best of our knowledge, such a combination of lesions has not been reported previously either in the ureter or in the rest of the urinary tract. The coexistence of diverse lesions in our case might represent the pluripotentiality of the urothelium in association with chronic inflammation and neoplastic induction. The present report also emphasizes the metaplastic and malignant potential of a defunctioned urothelial structure. This case is of particular interest, because these coexistent lesions arose simultaneously with an anatomically separate adenocarcinoma of the rectum (Dukes' B). The patient died 76 days after admission. The dismal prognosis of our case was determined by the advanced anatomical stage and the histological high grade of the transitional cell carcinoma of the ureter.     

Squamous cell carcinoma of the gallbladder associated with squamous metaplasia and adenocarcinoma in situ of the mucosal columnar epithelium

A case of well-differentiated squamous cell carcinoma of the gallbladder is presented. Unlike most previously reported cases, the tumor developed in association with squamous metaplasia as well as dysplastic and in situ adenocarcinomatous changes of the gallbladder epithelium. The significance of these lesions is discussed in relation to the histogenesis of squamous cell carcinoma or adenosquamous carcinoma of this organ.     

Intestinal, gastric body- and antral-type mucosal metaplasia in the gallbladder.

The material consisted of two intestinal, one gastric body-type and 14 antral-type cases of mucosal metaplasia in the gallbladder. Outside the mucosal areas mentioned, the epithelium of the gallbladder had undergone great changes. It usually consisted of goblet cells, enterochromaffin cells, superficial gastric-type epithelial islands and antral-type glands. Extensive areas contained non-sulphated acid mucin and neutral mucin. The areas of normal gallbladder epithelium were small.     

Urothelial metaplasia of the bladder mucosa. Nephroid-colonic- and signet-ring cell metaplasia

Three different types of metaplasia of the urinary bladder are described: nephroid metaplasia, colonic metaplasia and signet-ring cell metaplasia. The latter metaplasia was without any histological signs of malignancy and the patient is still alive without recurrence, 12 years after the diagnosis was made. We believe it is the first published case of benign signet-ring cell metaplasia. The patients with nephroid metaplasia were controlled from 3-18 months without recurrence. Two of the patients with colonic metaplasia were followed from 16 to 132 months; both developed recurrences. In patients with metaplasia of the urothelium, follow-up cystoscopy is recommended because of the recurrent nature of the condition and the malignant potential of metaplastic urothelium.