Mucinous tubular and spindle cell carcinoma of the kidney with prominent papillary component,a non-classic morphologic variant. A histologic,immunohistochemical, electron microscopic and fluorescence in situ hybridization study

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare type of kidney tumor with relatively indolent behavior. Non-classic morphological variants have not been well studied and rarely been reported. We report a challenging case MTSCC with a peculiar morphology in a 42-year-old man, arising in a background of end-stage renal disease (ESRD). Predominant areas with extensive papillary architecture, psammoma bodies and stromal macrophageal aggregates, reminiscent of a papillary renal cell carcinoma (papillary RCC), were intermixed with foci that transitioned into a MTSCC-like morphology exhibiting elongated tubules and a low grade spindle cell component in a background of mucinous stroma. Immunohistochemistry demonstrated diffuse positivity for P504s/AMACR and vimentin in tumor cells. Focal positivity for RCC, CD10 and CK7 was also noted. Kidney-specific cadherin, cytokeratin 34betaE12 and TFE3 stains were negative in the tumor. The major differential diagnostic considerations were papillary RCC, clear cell papillary RCC, and Xp11.2 translocation carcinoma. Negative FISH studies for trisomy 7 and 17 in both papillary and spindled components supported the diagnosis of MTSCC. The ultrastructural profile was not entirely indicative of the cellular origin of the tumor. Cytogenetic analysis should be performed in atypical cases of MTSCC for precise diagnosis.     

Mucinous tubular and spindle cell carcinoma of the kidney with neuroendocrine differentiation: report of two cases

We encountered 2 cases of mucinous tubular and spindle cell carcinoma (MTSCC) during a short time. In a 61-year-old man who had macroscopic hematuria for 1 month, the 14.5 x 14.0 x 12.0-cm resected tumor involved the right middle aspect of the renal parenchyma and compressed the renal pelvis. In an asymptomatic 47-year-old man, a renal tumor was found during an annual physical examination. The 3.5 x 3.0 x 2.0-cm tumor was located at the upper pole of the right kidney. The histologic findings in both cases were similar Tumors consisted of tightly packed, small, elongated tubules separated by pale mucinous stroma. The tumor cells were cuboidal to spindled with eosinophilic cytoplasm and low nuclear grade. Mitoses were few or nonexistent and without abnormal figures. Both tumors were immunoreactive for cytokeratin (CK) cocktail (AE1/AE3), high-molecular-weight CK (34betaE12), low-molecular-weight CK (35betaH11), CK7, epithelial membrane antigen, E-cadherin, and vimentin. The tumor cells also were reactive for neuron-specific enolase, chromogranin, and synaptophysin. The ultrastructure of the tumor cells contained abundant mitochondria, junctional complex, and dense-core neurosecretory granules. We present 2 additional cases of MTSCC showing typical morphologic features with neuroendocrine differentiation.     

肾脏黏液性管状和梭形细胞癌的临床及病理学特点

目的 探讨肾脏黏液性管状和梭形细胞癌的临床病理学特点.方法 分析7例肾脏黏液性管状和梭形细胞癌的临床特点、组织形态及免疫表型特点[CD10、CK7、CK18、CK19、Villin、上皮细胞膜抗原(EMA)、P504S和波形蛋白],并复习相关文献.结果 7例黏液性管状和梭形细胞癌中,男性3例,女性4例,平均年龄48.2岁(39～61岁).均为体检时发现肿瘤,肿瘤最大径平均5.5 cm(4.0～9.0 cm),术后随访18～51个月,得到随访资料的5例均无复发及转移.肿瘤大体切面均为实性、灰白色,无包膜,但与周围肾组织分界清晰.镜下观察肿瘤细胞主要由两种形态构成:均一的由立方细胞构成的紧密排列的小管状结构和梭形细胞成分.两种成分比例或多或少,交错分布,其中5例伴有黏液样基质,3例见到明显的透明细胞区域,1例可见灶状肉瘤样区域,1例见乳头状结构及泡沫细胞.免疫组织化学染色显示,7例肿瘤CK7均呈阳性表达,EMA、CK18和P504S在染色的5例中全部呈阳性表达,CK19在染色的5例中有4例表达,而CD10、Villin和波形蛋白表达差异较大.结论 肾脏黏液性管状和梭形细胞癌是一种低度恶性的多形性肿瘤,组织形态学谱系较宽,不典型的病例可以主要由两种成分之一构成,并缺少黏液,有些病例可见到透明细胞、乳头状结构,少数可见肉瘤样形态及坏死.免疫表型上对于从近曲小管到集合管的标志物均有表达.

Abstract：

Objective To investigate the clinical and pathological features of the mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney. Methods Seven cases of MTSCC were analyzed by gross examination and light microscopy. Immunostaining was performed to detect the expression of CD10, CK7, CK18, CK19, Villin, EMA, P504S and vimentin. The literature on this tumor was reviewed to discuss the histological features of MTSCC and its clinical behavior. Results Three of 7 cases were male and the other 4 were female. The mean age of the patients was 48.2 years old, with a range from 39 to 61 years. All the patients presented no symptom and their tumors were found by health examination. Tumors averaged 5.5 cm in greatest dimension (range from 4.0 cm to 9.0 cm). The tumors were well-circumscribed without capsules, and the cut surfaces were solid and soft with white-tan color. By light microscopy, tumors were composed of tightly packed, small, elongated tubules with transitions to spindle cell components. Five cases had mucinous stroma. Clear cell clusters, focal sarcomatoid differentiation, papillations and foamy macrophages were seen in several cases. Immunohistochemically, all 7 cases showed positive for CK7, five of 5 cases positive for EMA, CK18 and P504S, four of 5 cases positive for CK19, but heterogeneous for CD10, villin and vimentin expression. No evidence of local recurrence or distant metastases was identified in the 5 patients with follow-up information. Conclusions The mucinous tubular and spindle cell carcinoma is a low-grade and polymorphic neoplasm. The morphology of these tumors may not be uniform with a wide histological spectrum. The tumors can be tubular predominant or spindle cells predominant with scant to abundant mucinous stroma, which coupled with the presence of other unusual features such as clear cells, papillations, foamy macrophages, necrosis and sarcomatoid differentiation. Immunohistochemically, MTSCC can express the markers from the proximal convoluted tubules to collecting tubules.     

Metastatic renal mucinous tubular and spindle cell carcinoma. Atypical behavior of a rare, morphologically bland tumor

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare, distinctive renal neoplasm characterized by an admixture of cuboidal cells in tubules and sheets of spindle cells, typically with low-grade nuclei and a myxoid or mucinous background. It is characteristically of low malignant potential, and only rare metastatic cases have been reported. We describe a case in which the patient presented with extensive regional and distant metastases, but both primary and metastatic tumor showed the typical histomorphology of bland cuboidal or spindle cells lacking pleomorphism, mitoses, and necrosis. Almost all previous cases of metastatic MTSCCs have shown nuclear atypia or sarcomatoid morphology of the primary tumor; and metastatic renal MTSCC in which the primary neoplasm does not display atypical features is exceptional, serving to highlight that these rare tumors can behave aggressively even with "indolent" histological appearances.     

肾脏黏液性管状和梭形细胞癌的临床病理特征

目的 探讨肾脏黏液性管状和梭形细胞癌(MTSCC)的临床病理特征、组织发生和预后.方法 收集5例肾MTSCC进行组织病理学、组织化学、免疫组织化学(EnVision)及电镜观察,随访3～52个月,并复习相关文献.结果 5例患者女性4例,男性1例.3例因腰酸、腰部不适而就诊,2例系体检偶然发现.大体观察:肿瘤与周围组织分界清楚,切面实性,灰白灰黄或灰红色,1例高级别MTSCC切面可见明显坏死.镜下观察:低级别MTSCC主要由小管状结构、梭形细胞及黏液样基质构成,细胞形态较温和,核分裂象稀少.1例高级别MTSCC细胞呈梭形或多边形,未见小管状及黏液样基质,细胞明显异形,核分裂象易见.免疫组织化学染色显示,波形蛋白(5/5)、CKpan(5/5)、CK7(5/5)、CK19(5/5)、34βE12(1/5)、上皮细胞膜抗原(EMA,5/5)、E-cadherin(3/5)、CD10(1/5)、P504S(5/5)、CAM5.2(5/5)有阳性表达;Ki-67阳性指数4例小于或等于5%,1例高级别者达15%.超微结构显示管腔内可见短的微绒毛,局部核膜有内陷.4例随访3～52个月,未见肿瘤复发和转移.结论 肾MTSCC好发于女性,是一种罕见的肾肿瘤,临床多为低级别MTSCC,预后良好;对高级别MTSCC患者因其预后较差,手术后须密切随访观察.

Abstract：

Objective To investigate the clinicopathological features, histogenesis and prognosis of mucinous tubular and spindle cell carcinoma (MTSCC). Methods Five MTSCCs were studied with histochemical, immunohistochemical staining, electron microscopy, and review of the related literatures. Results Four cases of MTSCC were females and one was male. Three patients presented with flank discomfort and two were incidentally found with health examination. In gross examination, the tumors were circumscribed. The cut surface was solid, gray-white, yellow or red. Necrosis was present in one case of high-grade MTSCC. Microscopically, low-grade MTSCC was mainly consisted of tubular, spindle cell and mucinous stroma with relatively bland morphology, and mitoses were rare. While in the high-grade area of one case, the cells were spindle or polymorphic with severe atypia and high mitotic activity, without mucinous stroma and tubular structure. Mucin was positive for Alcian blue. The neoplastic cells were positive for vimentin (5/5), CKpan (5/5), CK7 (5/5), CK19 (5/5), 34βE12 (1/5), EMA (5/5), E-cadherin (3/5),CD10 (1/5), P504S (5/5), and CAM5.2 (5/5). The Ki-67 index was low (≤5%) in the low-grade component, while it was high (15%) in the high-grade component. Ultrastructural study showed short microvilli along glandular lumens. The nuclear membrane was focally invaginated. Four cases were followed up for 3 to 52 months, and recurrence and metastasis were not found.Conclusions MTSCC occurs predominantly in females and it is a rare kidney neoplasm. Most of MTSCCs are low-grade and the prognosis is relatively good. However, the patients of high-grade MTSCC should be closely followed up.     

Mucin poor mucinous tubular and spindle cell carcinoma of the kidney, with nonclassic morphologic variant of spindle cell predominance and psammomatous calcification

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare type of kidney tumor that has only been recently described. The classic MTSCCs are polymorphic renal neoplasms characterized by small, elongated tubules lined by cuboidal cells and/or cords of spindled cells separated by pale mucinous stroma. Nonclassic morphologic variants and features of MTSC have not been well studied and rarely been reported. We report a challenging case of mucin-poor MTSCC with marked spindle cell predominance and focal psammomatous calcification in a 39-year-old man and describe its histologic and immunohistochemical features. Pathologists must be aware of the histologic spectrum of MTSCCs to ensure their accurate diagnosis.     

Clinicopathological characteristics of kidney mucinous tubular and spindle cell carcinoma

Kidney mucinous tubular and spindle cell carcinoma (MTSpCC) is a rare renal low-grade pleomorphic epithelial neoplasm featured by tubular and spindle cells with a relatively indolent behavior. This study was designed to clinicopathologically characterize two cases of kidney MTSpCC. Similar to other tumors, the data showed the diagnosis of MTSpCC relies on histological examination. Tumor cells stained strongly for CK19, CK20, and CK7 within the epithelioid component. Whereas evaluating MTSpCC clinically showed no specific symptoms, analyzing MTSpCC microscopically showed multiple elongated tubular branches of tumor cells that are closely arranged in cord-like manner under lightly stained myxoid stroma. MTSpCC also has the spindle cell area; the single tumor cell is small and nucleus round or oval. Immunohistochemical analysis of cytokeratins, electron microscopy, or genetic tests all improves the diagnosis.     

Fine‐needle aspiration diagnosis of high grade adenoid cystic carcinoma metastatic to the pancreas

Pancreatic tumors are mostly primary tumors, with only rare metastatic tumors described in the literature. Here we report an unusual case of fine‐needle aspiration (FNA) diagnosis of high grade adenoid cystic carcinoma of the parotid gland metastatic to the pancreas. The aspirate smears were moderately cellular and revealed numerous basaloid neoplastic cells. The cytomorphologic differential diagnosis included primary pancreatic tumor with small cell morphology as well as metastatic tumors. By immunocytochemistry, the tumor cells were positive for cytokeratins (AE1/AE3, CAM5.2, and CK7), and CD117 (C‐KIT), and negative for CD45, WT1, synaptophysin, chromogranin, CD56, TTF‐1, and CK20. The cytomorphologic features and immunoprofile in our case were consistent with high‐grade carcinoma metastases from patient's known salivary gland primary. To the best of our knowledge, this case is the first reported encounter of FNA diagnosis of pancreatic metastasis with small cell morphology from a salivary gland neoplasm as primary site. Diagn. Cytopathol. 2015;43:117–120. © 2014 Wiley Periodicals, Inc.     

Mucinous tubular and spindle cell carcinoma of kidney without sarcomatoid change showing metastases to liver and retroperitoneal lymph node

Mucinous tubular and spindle cell carcinoma (MTSCC) is an uncommon, newly recognized tumor that in its classic histological form shows tightly packed, elongated tubules with transition into spindle cell areas and pale mucinous stroma. The current data suggest that the great majority of MTSCCs have a favorable prognosis; however, the follow-up data are limited and the full biologic potential of this tumor remains to be established. There are a few examples of MTSCCs metastatic to lymph nodes and rare cases with sarcomatoid differentiation associated with distant metastases. We report on a case of MTSCC of kidney with concurrent nodal and liver metastases. The metastatic nodules were well circumscribed and showed morphological and immunophenotypic features similar to those of the primary tumor. Extensive sampling revealed no evidence of sarcomatoid morphology. To our knowledge, this is the first case of MTSCC without sarcomatoid differentiation showing parenchymal metastasis.     

A renal cell carcinoma with components of both chromophobe and papillary carcinoma

We report a case of a morphologically unusual renal cell carcinoma with features of both chromophobe and papillary carcinoma. Immunohistochemical analysis of high molecular weight cytokeratins (HMWCK), cytokeratin 7 (CK7), cytokeratin 19 (CK19), c-Kit, and α-methylacyl-CoA racemase (AMACR) demonstrated differential profiles for the two components of the tumor, consistent with the respective patterns commonly observed for pure chromophobe and papillary renal cell carcinomas. Specifically, the chromophobe tumor cells expressed CK7 and c-Kit weakly, while HMWCK, CK19, and AMACR were not detectable. In contrast, the papillary tumor cells expressed uniformly HMWCK, CK7, and c-Kit and focally CK19 and AMACR. Fluorescence in situ hybridization analysis of nuclei isolated from paraffin-embedded tumor tissue detected monosomy 1, disomy 7, and monosomy 17, a common and characteristic finding in chromophobe carcinomas, in a majority of, but not all tumor cells, whereas a population characterized by disomy 1, trisomy 7, and trisomy 17, a frequent finding in papillary carcinoma, was not identifiable. Electron microscopic analysis revealed numerous characteristic small cytoplasmic vesicles in the chromophobe areas, which were absent in the papillary component. This case illustrates the rare coexistence of two distinct and admixed histologic types of renal cell carcinoma.     

High-grade mucinous tubular and spindle cell carcinoma: comparative genomic hybridization study

Mucinous tubular and spindle cell carcinoma (MTSCC) has recently been integrated into the World Health Organization classification. Although MTSCC is generally a low-grade carcinoma, MTSCC with high-grade morphology has been recently reported. We present the first case of high-grade MTSCC with comparative genomic hybridization findings. A 60-year-old Japanese man presented with weight loss and general fatigue. He underwent radical nephrectomy because of the clinical diagnosis of renal cancer. Histologic examination of renal tumor showed findings of high-grade MTSCC. Comparative genomic hybridization analysis showed gain of chromosomes 1q, 7, 16, 19q, and Y and loss of chromosomes 1p, 6p, 8p, 11q (del(11)(q23)), and 13. G-band karyotype showed gain of chromosomes 2, 3, 5, 7, 12, 16, and 20 and loss of chromosome 15. Results of our molecular genetic analysis support the idea that high-grade MTSCC is a real counterpart of low-grade MTSCC. There is no evidence to designate such tumors as unclassified renal cell carcinoma.     

Renal mucinous tubular and spindle cell carcinoma: report of four cases and literature review

Mucinous tubular and spindle cell carcinoma of the kidney (MTSCC-K) is an unusual renal tumor. It is important to increase the recognition of the clinicopathological features of MTSCC-K and improve its clinical and differential diagnosis. This report described four cases of MTSCC-K with clinical, imaging, and pathological examination and showed that the tumor boundaries of MTSCC-K were clear, and tumor cells arranged into tubules and cord-like beams, between which was lightly stained myxoid stroma. The tumor cells were smaller and cube- or oval-shaped, with single small eosinophilic nucleoli, low-grade nuclei, and little nuclear fission. The myxoid stroma was scattered around lymphocytes and plasma cells. Immunohistochemical markers including CK7, CD117, EMA (epithelial membrane antigen), vimentin, and CK8/18, showed positive expression in tumor cells, but the tumor cells were negative for CD10 and villin. The proliferation index of Ki-67 was 5-10%. Since MTSCC-K is a rare low-grade malignancy, with unique histological and immunohistochemical characteristics, it is important for clinicians and pathologists to have a defined awareness of this tumor type in order to decrease the rate of misdiagnosis.     

Fine-needle aspiration cytology of malignant peripheral nerve sheath tumors

The histopathologic features of malignant peripheral nerve sheath tumors (MPNSTs) have been well described. There have been limited studies on the cytologic features of MPNST. In this present study, we have retrospectively reviewed eight histopathology confirmed cases of MPNST over a 5-year period. Detailed cytomorphological analysis of these cases was carried out individually by two observers. On cytology, these cases were diagnosed as benign spindle-cell tumor (two), spindle-cell tumor possibly benign (one), spindle-cell tumor possibly malignant (one), malignant spindle-cell tumor (two), spindle-cell tumor, and neural origin (two). The cardinal cytomorphologic features were loosely cohesive clusters and fascicular arrangement of spindle cells with rounded ends. The kinking of nuclei was not a conspicuous finding. Fibrillary background was noted in two of the cases. Nuclear pleomorphism was ranged from mild to moderate degree. One case exhibited extensive intranuclear pseudoinclusions. Mitotic figures (including atypical forms) were present in almost all the cases. Possibly a constellation of cytologic features such as clusters of short and long fascicles of cells admixed with dissociated spindle cells of round-ended nuclei and prominent nucleoli on myxoid or fibrillary background and frequent mitosis may be helpful in diagnosis of MPNSTs. The cytomorphologic features along with clinical correlation are necessary to increase the diagnostic accuracy of MPNST on aspiration cytology.     

Mucinous tubular and spindle cell carcinoma with aggressive histomorphology--a sarcomatoid variant

Mucinous tubular and spindle cell carcinoma (MTSCC) is a recently described renal epithelial tumor. The bland cytomorphology of the spindled component and low-grade behavior help in its differentiation from sarcomatoid renal carcinoma. Sarcomatoid change has been reported in most histologic variants of renal cell carcinoma apart from MTSCC. Herein we report a case of an MTSCC in a 72-year-old female patient with high-grade spindled areas resembling fibrosarcomatous and undifferentiated pleomorphic sarcoma patterns with metaplastic bone. This index case also demonstrates a high proliferation index and extensive necrosis representing the first documented case of sarcomatoid change in MTSCC.     

Biphasic squamoid alveolar renal carcinoma with positive CD57 expression: A clinicopathologic study of three cases

Biphasic squamoid alveolar renal cell carcinoma (BSARCC) is a rare and recently characterized form of papillary renal cell carcinoma (PRCC). Herein, we describe three cases of BSARCC that were CD57+. Among a total of 90 cases of PRCC, three cases were found to be consistent with a diagnosis of BSARCC. In addition to reviewing these cases, we reviewed the relevant literature pertaining to this form of cancer and assessed the immunohistochemical staining for CD57 on the available tumor samples. The three BSARCC cases in the present study were composed of two primary populations of cells. Tumors stained positive for CK, PAX8, CK7, CK19, AMACR, EMA, and vimentin. Larger cells expressed detectable levels of cyclin D1, and expression of CD57 was limited to the larger cells. All three patients were alive and free of disease during the most recent follow‐up. Our results suggest that the CD57 positivity of at least a subset of cases should necessitate their differentiation from cases of metanephric adenoma.     

Solid papillary renal cell carcinoma: clinicopathologic,morphologic, and immunohistochemical analysis of 10 cases and review of the literature

Solid papillary renal cell carcinoma is rarely reported in the literature, and its tumor characteristics are not entirely compatible with the concept of 2 histological subtypes of papillary renal cell carcinoma (PRCC). Tumor is composed mostly of small compressed tubules and short abortive papillae giving solid appearance of monomorphic epithelial cells with scanty cytoplasm and small nuclei, sometimes mimicking spindle cells, without or with sparse true papillae. It shows immunohistochemical (+ CK7, + EMA, + AMACR) and genetic hallmarks (polysomy/trisomy 7/17, loss of Y) of conventional PRCC. About 53 cases have been described in the literature, with male predominance and age ranging from 17 to 82 years. By available follow-up data, solid PRCC has a favorable clinical course. We describe 10 cases compatible with the diagnosis of solid PRCC. All patients were males age range was from 34 to 70 years, and all but one were pT1 according to TNM 2009. On follow-up, 9 patients were without evidence of disease, and 1 had recurrent tumor. Size of the tumor ranged from 1.4 to 5.5 cm (mean, 3.32 cm). Tumors were well-circumscribed whitish to yellow masses with granular surface. Although solid architecture was a prominent morphologic feature, detailed analysis revealed that the tumors were composed of compressed short abortive papillae and compressed tubules admixed with true solid areas. Well-formed papillae were exceptionally present. All 10 cases were strongly and diffusely positive for CK7 and negative for WT-1. In conclusion, solid PRCC is a rare tumor with an incidence of less than 1% of all renal tumors. In majority of the cases, tumors were composed of tightly compressed tubular structures and short abortive papillae that render a solid morphologic appearance. Immunohistochemical and molecular features do not differ from conventional PRCC. Metanephric adenoma; epithelioid nephroblastoma; and, rarely, mucinous tubular and spindle cell carcinoma and oncocytic variant of PRCC should be considered in the differential diagnosis.     

乳腺纤维瘤病样梭形细胞癌临床病理分析

目的 探讨乳腺纤维瘤病样梭形细胞癌（fibromatosis-like spindle cell carcinoma,FLSCC）临床病理特征。方法 对3例FLSCC病例进行光镜观察和免疫组化染色[CK、CK（34βE12）、vimentin、SMA、ER、PR、Ki-67、c-erbB-2]。结果 3例均为女性,年龄分别为47、53、56岁,均可触及乳腺肿块。肿瘤境界清楚,但镜下边缘呈浸润性。肿瘤主要是梭形细胞、多边形细胞、少量的管状腺体及鳞上皮巢混合,间质纤维明显增生伴胶原化,细胞成束状排列或散在分布,似纤维瘤病样改变。梭形细胞分化良好,异型性不明显,部分区域细胞较丰富,其间聚集的上皮簇或片状多边形细胞核有轻度异型,可见少数核分裂象。多边形细胞与梭形细胞有移行。病变中亦可见淋巴细胞、浆细胞聚集浸润。上皮细胞、多边形细胞及部分梭形细胞CK（34βE12）、CK（AE1／AE3）阳性,CK阴性的梭形细胞表达vimentin、SMA。3例均行肿块切除,其中1例,术后4个月复发,再行乳腺根治术。结论 乳腺（纤维瘤病样）梭形细胞癌是一种少见的、低度恶性肿瘤,诊断需依赖免疫组化标记并与乳腺其它梭形细胞肿瘤相鉴别。     

Fine‐needle aspiration of neural lesions

The cytomorphologic features of 13 neural lesions sampled by fine‐needle aspiration (FNA) are reviewed. The frequencies at which various architectural features including Verocay bodies, filamentous background, and vascular arcades were present was recorded, along with the frequencies of cytologic findings including the presence of spindle cells, wavy nuclei, intranuclear inclusions, fishhook nuclei, nuclear pleomorphism, filamentous cytoplasm, and mitotic figures. Verocay bodies were a rare finding, present in only 1 of 11 cases. Vascular arcades were similarly infrequent (1/11 cases). Spindle‐shaped cells along with wavy nuclei were the most frequent findings, with fishhook‐shaped nuclei and a filamentous background of high frequency (9/11 cases). Our study indicates that some of the characteristic features recorded in the literature are rarely seen in needle aspiration smears, but features such as spindle‐shaped cells, wavy and fishhook‐shaped nuclei, and a filamentous background are relatively frequent findings. Diagn. Cytopathol. 1999;20:1–5. © 1999 Wiley‐Liss, Inc.     

伴有神经内分泌分化的乳腺梭形细胞癌

目的探讨乳腺伴有神经内分泌分化的梭形细胞癌的病理形态学和免疫表型特点及鉴别诊断。方法复习2500例乳腺癌切片,找出以梭形细胞占主要优势（〉80％）的癌5例,其中2例梭形细胞型导管内癌和3例梭形细胞型浸润癌。采用HE、阿辛蓝（AB）／PAS和网织染色,以及用癌胚抗原（CEA）、上皮膜抗原（EMA）、细胞角蛋白（CK7、3413E12、AE1／AE3）、神经元特异性烯醇化酶（NSE）、突触素、嗜铬蛋白（cg）A、Lue-7、波形蛋白,S-100、平滑肌肌动蛋白（SMA）、calponin、雌激素受体（ER）、孕激素受体（PR）、c—erbB-2、E-钙黏素、Ki-67、p53抗体进行免疫组织化学观察。其中4例有随访信息。结果患者平均年龄在68岁。镜下：5例癌细胞形态主要为长梭形的上皮样细胞,3例有少数胞质内空泡状细胞,4例可见散在AB阳性细胞。免疫组织化学5例均表达AE1／AE3、EMA、CEA、E-钙黏素和突触素,CK7有4例表达,NSE阳性3例,CgA和Lue7阳性2例,ER阳性4例,PR阳性2例,1例表达c-erbB-2,1例有灶状波形蛋白阳性。免疫组织化学结果显示2例梭形细胞型导管内癌和1例梭形细胞型浸润性癌是梭形细胞型的神经内分泌癌,另外2例梭形细胞型浸润性癌是伴有神经内分泌分化的化生性癌。随访3例存活（24～58个月）,1例27个月内死亡。结论上皮样梭形细胞和细胞内黏液的出现是乳腺伴有神经内分泌分化癌的一个形态学特点。梭形细胞神经内分泌型导管内癌需要和普通导管增生及导管内乳头状瘤鉴别。梭形细胞型的神经内分泌癌和伴神经内分泌分化的梭形细胞浸润性癌需要与梭形细胞肌上皮肿瘤、恶性黑色素瘤及某些软组织肿瘤鉴别。