Pseudoangiomatous hyperplasia of mammary stroma

Grossly circumscribed, nonhemorrhagic breast masses consisting of mammary stromal proliferations that simulated vascular lesions were studied in nine women. Histologically, a striking pattern, which appeared to consist of complex inter-anastomosing channels lined by slender spindle cells, was present in the mammary parenchyma. The importance of this benign lesion, referred to as pseudoangiomatous hyperplasia of mammary stroma, is its distinction from angiosarcoma. The patients ranged in age from 22 to 52 years; all were premenopausal. Each presented with a palpable unilateral mass, measuring up to 7 cm in diameter. The patients were treated by excisional biopsy and remained well for up to 2.5 years after excision. One patient had two local recurrences within one year of the original excision, and a second patient had a local recurrence at 14 months. No patient had another concurrent or metachronous malignant tumor of the breast or other organ, and no abnormal hormonal status was found. Complete local excision appears to be adequate treatment. It remains to be determined whether this is a neoplastic process. However, there is no evidence that it is a precursor of angiosarcoma, and ultrastructural observations demonstrate that the spaces found in the lesion are not true vascular channels. Rather, they appear to arise by a process that involves disruption and separation of stromal collagen fibers. Since small foci of this change are common in hyperplastic breast tissue from premenopausal women, it is likely that the development of a discrete tumor with this pattern represents an exaggerated form of stromal hyperplasia.     

Pseudoangiomatous hyperplasia of mammary stroma: a case of pure type after removal of fibroadenoma

A case of pure pseudoangiomatous hyperplasia of the mammary stroma after removal of a fibroadenoma is described. The lesion, which was found in the right breast of a 40-year-old woman, was a well-circumscribed non-encapsulated, rubbery, lobulated mass measuring 40x40x35 mm. Histologically, it consisted predominantly of a proliferation of spindle cells with interanastomosing vascular-like arrangements in the interlobular or interductal stroma. Neither cytological atypia nor mitotic figures were observed. The stroma contained abundant collagen with focal hyalinization. Focally, epithelial elements showed mild ductal hyperplasia. There was no fibroadenoma. Immunohistochemically, the spindle cells were positive for vimentin, CD34, alpha-smooth muscle actin, muscle actin, CD34, calponin, and progesterone receptors. Ultrastructurally, many spindle cells had thin elongated cytoplasmic processes, which enveloped pseudovascular spaces containing a few collagenous fibrils, indicating fibroblastic cells. This lesion should be distinguished from other mammary fibrous and vascular lesions with which it may be confused.     

Pseudoangiomatous hyperplasia of mammary stroma associated with gynaecomastia.

AIMS: To evaluate the prevalence of pseudoangiomatous hyperplasia of mammary stroma in gynaecomastia and its immunohistochemical profile in this setting. METHODS: Eighty eight cases of gynaecomastia recovered from the files of the department of pathology, Botucatu School of Medicine from 1976 to 1996 were studied. In the cases associated with pseudoangiomatous hyperplasia of mammary stroma, immunoreactivity for cytokeratins (CAM 5.2), vimentin, CD34, factor VIII related antigen, and the oestrogen and progesterone receptors were studied. RESULTS: Pseudoangiomatous hyperplasia of mammary stroma was found in 21 of 88 cases of gynaecomastia (23.8%). In all cases, the cells lining the spaces were positive for vimentin, whereas CAM 5.2 and factor VIII related antigen were consistently negative. Nineteen of the 21 cases showed immunoreactivity for CD34. Ductal epithelial cells were positive for both the oestrogen receptor and the progesterone receptor, whereas stromal cells were negative. CONCLUSIONS: Pseudoangiomatous hyperplasia of mammary stroma was present in approximately one quarter of the cases of gynaecomastia. This immunohistochemical study confirms the mesenchymal origin of the stromal cells that line the pseudovascular spaces, as has been found in female cases of pseudoangiomatous hyperplasia of mammary stroma.     

Stromal regulation of neoplastic development: age-dependent normalization of neoplastic mammary cells by mammary stroma

There is mounting evidence that the stroma plays a crucial role in mammary gland carcinogenesis. Here, we report that mammary gland stroma from mature and multiparous rats prevents neoplastic development and encourages normal ductal growth of grafted epithelial cancer cells. Fifty thousand epithelial cancer cells were injected into the cleared fat pads of virgin hosts at 24, 52, 80, and 150 days of age and of hosts that had undergone two cycles of pregnancy, lactation, and involution. Six months after inoculation, tumor incidence was 75%, 100%, 50%, and 18.2% in 24-, 52-, 80-, and 150-day-old virgin rats, respectively, and 0% in the twice-parous animals. Most remarkably, these neoplastic cells appeared to form normal ducts in all hosts-Ha-ras-1 mutation served as a marker to identify the tumor origin of the outgrowths. The tumor development pattern suggests a parallel to the phenomenon of age- and reproductive state-dependent susceptibility and resistance to chemical carcinogens. As susceptibility to carcinogenesis decreases, the ability of the stroma to reprogram neoplastic epithelial cells increases. Thus, the neoplastic phenotype is context-dependent, and it therefore offers the intriguing possibility that the process of carcinogenesis is amenable to normalization or cure once the mechanisms of stroma-mediated normalization are elucidated and manipulated.     

小鼠乳腺增生组织中BMP信号通路的改变

目的:探明骨形态发生蛋白(BMP)信号分子在乳腺增生组织中的表达模式和BMP通路的激活情况。方法:8周龄的未孕雌性C57BL/C小鼠按体重随机分为2组:对照组和激素组,每组15只。激素组先以2.5mg/kg的戊酸雌二醇灌胃25 d,再腹腔注射黄体酮(4 mg/kg)5 d诱导乳腺增生;对照组予以等体积的PBS。给药结束后收集乳腺组织,观察乳腺的形态,real-time PCR检测BMP信号分子的表达水平,并用Western blot检测Smad1/5/9的磷酸化水平。结果:与对照组比较,在乳腺增生组织中,BMP信号通路配体BMP2、4、5、6、7、9、13和14,受体BMPR1A及拮抗剂Chrdl1和Twsg1的表达异常(P0.05);而BMP3、BMP12、BMPR1B、BMPR2、Chrd、Chrdl2和Noggin等分子的表达则无明显改变;Western blot结果显示乳腺增生组织的Smad1/5/9的磷酸化水平升高(P0.05)。结论:多个BMP信号分子在乳腺增生组织中异常表达,致使BMP通路异常激活。BMP信号通路可能成为治疗乳腺增生的新靶点。     

T细胞淋巴瘤伴黏液间质1例及文献复习

目的 报道1例罕见的臀部伴黏液间质的T细胞淋巴瘤并文献复习,探讨其诊断要点。方法 应用组织学、免疫组化、基因重排检测技术进行诊断与鉴别诊断。结果经多项免疫组化排除了软组织肿瘤（纤维、平滑肌、横纹肌、脂肪、滑膜肉瘤及肌纤维母细胞瘤）及恶性黑色素瘤等以后,进行了淋巴瘤标记：CD45、CD45RO、CD3、CD20、CD79α、CD68、和TCRγ基因重排检测。显示CD45、CD45RO、CD3阳性,TCRγ克隆性基因重排。结论 本例与文献报道4例资料提示：伴黏液间质的非霍奇金淋巴瘤好发于淋巴结外软组织,由弥漫性淋巴瘤样片状区与黏液间质区组成,必需应用免疫组化排除间叶源性肿瘤,加用淋巴瘤标记和基因重排检测阳性确诊。     

Langerhans cells proliferation in ectopic micronodular thymoma with lymphoid stroma: a case report

Ectopic micronodular thymoma (MNT) is a rare tumor. We described a 76-year-old woman, who was referred to our institutional for a mass in the left cervical region. The Magnetic Resonance Imaging (MRI) scan showed a 3.7 cm × 1.7 cm × 2.0 cm mass. The neoplasm was composed of epithelial tumor cells arranged in a micronodular growth pattern set in a stroma showing lymphoid hyperplasia with germinal centers. Immunohistochemical studies showed that the neoplastic epithelial cells were reactive for AE1/AE3, CK5/6, P63, and the lymphoid component to be of mixed B- and immature T-cell lineage. Langerhans cells were confirmed within epithelial nodules for the first time with langerin, S-100, CD1a expression. We report a case of cervical ectopic MNT to emphasize the langerhans cells proliferation and the histopathologic features and differential diagnosis of the rare lesion to promote a better and broader understanding of this less understood subject.     

Transitional carcinoma of the ureter with osseous metaplasia of the stroma: a case report

Transitional cell carcinoma with osseous metaplasia of the stroma is a rare variant of urothelial carcinoma which must be distinguished from sarcomatoid carcinoma. We report here a further observation of this tumor variant, in a very unusual location, the ureter, in order to underline the radiological and pathological characteristics useful for the correct diagnosis, and to point out the problems of differential diagnosis. The diagnosis was made in an 85-year-old patient, presenting with chronic right lombalgias. Imaging studies showed a calcified thickening of the right ureter, associated with a major dilatation of the right excretory cavities and a parenchymal atrophy of the right kidney. A right nephro-ureterectomy was performed. Macroscopical examination showed an ossified, ill-limited tumor, measuring 4 cm in diameter, infiltrating the right ureteral wall. At histological examination, the lesion was identified as a high grade transitional cell carcinoma with extensive osseous metaplasia of the stroma. There was no evidence for a sarcomatous component (absence of mesenchymal cell proliferation, absence of mitosis in stromal cells). An early locoregional recurrence was observed three months after surgery. Our case report underlines the radiological and histological features of a rare variant of transitional cell carcinoma, which may be diagnosed by pre-operative imaging studies and which must be distinguished from a highly aggressive sarcomatoid carcinoma.     

Carcinoma of the bladder with pseudosarcomatous stroma. Presentation of a case

Carcinoma with pseudosarcomatous stroma of the bladder. Case report. We report a case of transitional cells carcinoma of urinary bladder with pseudosarcomatous stroma in a 54 years old male. The patient was admitted in hospital owing to recidivous haematuria events for about 3 months. Three urine samples were sent for cytological studies that showed the presence of transitional neoplastic cells. Subjected to a cystoscopic examination the patient revealed a roundish peduncled bladder formation of about 3.5 cm. in size. Hence three bladder lesion biopsies were done. The histological sections obtained pointed out the existence of two cellular populations: the first one presented roundish or lengthened, pluristratified cells arranged in solid nests, with transitional morfology and high atypias; the other population had sarcomatoid features characterized by lenghtened cells with hyperchromic nuclei. The two populations were mixed up and there were sometimes carcinomatous areas that merged into sarcomatoid areas. Chondroid areas were also observed. We diagnosed a G3 transitional cells carcinoma with pseudosarcomatous stroma. The lesion, after literature review, results to be somewhat rare and not easily interpretable since it may be confused with carcinosarcoma. The rarity of this case and the problems of differential diagnosis connected with it urged us to this pubblication along with a short review of literature.     

Transplanted mammary epithelium grows in association with host stroma: aging of serially transplanted mammary gland is intrinsic to epithelial cells

Mouse mammary gland displays an irreversible decline in growth rate when propagated by serial transplantation in gland-free mammary fat pads of isogeneic mice. Because transplanted fragments of gland contain both mammary epithelial and stromal elements, the present study was undertaken to distinguish between two possibilities: (1) stromal cells in the implants proliferate in coordination with epithelium as the mammary ductal tree regenerates at each passage, or (2) transplanted epithelial tissue interacts exclusively with host stroma. Mammary xenografts from 18-week-old virgin Sprague-Dawley rats were implanted into gland-free mammary fat pads of athymic Balb/cNu/Nu mice. These rat xenografts regenerated chimeric mammary ductal outgrowths. When sectioned and stained with Hoechst dye 33258, a procedure that provides for unambiguous identification of mouse cell nuclei, rat mammary epithelium was found to be associated with mouse stromal cells; only at the site of transplantation were occasional rat stromal nuclei observed. This indicates that as mouse epithelial tissue becomes progressively aged during serial transfer in young mice, the stromal components are refreshed during each passage. The primary lesion underlying the mammary aging phenomenon must therefore be intrinsic to the epithelial cells.     

Lymphangioma of the pancreas with "ovarian-like" mesenchymal stroma: a case report with emphasis on histogenesis

Pancreatic lymphangiomas, which occur predominantly in women, are rare and account for only 1% of all lymphangiomas. The characteristic histologic features include multiple cysts lined by endothelial cells, irregularly distributed smooth muscle cells, and lymphoid aggregates in the wall of the cyst. We describe a 36-year-old woman with lymphangioma of the pancreas with "ovarian-like" mesenchymal stroma in the wall. This stroma, composed of uncommitted mesenchymal cells, has not been described previously in the wall of pancreatic lymphangiomas. Multiple small lymphatic channels that are found in this stroma recapitulate the development of lymphatic channels in the embryo. Lymphangioma of the pancreas may arise from distension of these lymphatic channels. Pancreatic lymphangioma may, therefore, be a developmental anomaly rather than a true neoplasm.     

肺结节性淋巴组织增生一例

患者女,48岁。例行体检时X线发现左下肺结节2个,大小分别为0·8及1·2 cm,边界清;患者无自觉症状。于2004年3月15日入院,胸腔镜下切除病变组织。楔形切除的灰褐色肺组织2块,大小分别为2·0 cm×1·8 cm×1·6cm、5·7 cm×2·5 cm×1·5 cm,一侧面被肺膜,尚光滑;切面前者见一结节,直径约0·6 cm,结节紧邻切缘,后者肺膜下可见一结节,大小1·5 cm×1·6 cm×0·7 cm,二者切面均呈灰粉色、实性、质中。病理检查:结节由淋巴细胞构成,均与周围肺组织界限清楚,部分结节以细支气管为中心,未见累及支气管软骨,部分紧邻肺膜;小淋巴细胞位于肺间质中,…     

Polypoid leiomyosarcoma of the gallbladder: study of a case associated with adenomyomatous hyperplasia

A case of polypoid leiomyosarcoma of the gallbladder arising in association with pre-existing adenomyomatous hyperplasia is described. The patient, a 34-year-old woman with symptoms of cholelithiasis, underwent a cholecystectomy for gallstones. The resected specimen showed, in addition to multiple stones, a large, rubbery, broad-based polypoid mass in the fundus. Histologic examination showed a malignant spindle cell proliferation with immunophenotypic features of smooth muscle differentiation. The base of the lesion showed features of adenomyomatous hyperplasia. The possible relationships of this lesion with adenomyomatous hyperplasia and other stromal lesions of the gallbladder are reviewed.