Neural invasion in gastric carcinoma.

AIMS--To determine whether neural invasion in advanced gastric cancer is of clinicopathological significance. METHODS--The study population comprised 121 cases of primary advanced gastric carcinoma. Two paraffin wax embedded blocks taken from the central tissue slice in each primary tumour were used. For definitive recognition of neural invasion, immunostaining for S-100 protein was applied to one slide; the other slide was stained with haematoxylin and eosin. RESULTS--Neural invasion was recognised in 34 of 121 (28%) primary gastric carcinomas. There were significant differences in tumour size, depth of tumour invasion, stage, and curability between patients with and without neural invasion. The five year survival rates of patients with and without neural invasion were 10 and 50%, respectively. Multivariate analysis, however, demonstrated that neural invasion was not an independent prognostic factor. CONCLUSIONS--Neural invasion could be an additional useful factor for providing information about the malignant potential of gastric carcinoma. This may be analogous to vessel permeation which is thought to be important, but is not an independent prognostic factor.     

Morphometric studies for objective diagnosis of intraductal carcinoma of the breast.

In order to obtain objective histologic criteria for distinguishing intraductal carcinomas of the breast from benign intraductal hyperplasia, a morphometric study was carried out on 15 cases of breast carcinoma (5 cases of comedo carcinoma, 5 cribriform carcinoma and 5 papillotubular carcinoma) and 10 benign control lesions (5 papilloma and 5 fibrocystic disease). Morphometric analysis was performed for each group with regard to 1) mean nuclear area, 2) mean nucleolar size, 3) mitotic index, and 4) nuclear count within predefined area (nuclear density) in histologic specimens. The results obtained were as follows: 1) Mean nuclear area for comedo carcinoma was distinctively large. This, together with its coefficiency variance, may be a good indicator for identifying this type of carcinoma. 2) Mean nucleolar size was significantly larger in each carcinoma group than in their benign counterparts. Nucleolar size was therefore considered to be the most reliable parameter for discriminating malignant cells from benign hyperplasia. 3) Mitotic index was relatively high in comedo and papillotubular carcinomas. 4) No difference was seen in nuclear density between the malignant and benign groups. In addition to the major criteria, combined application of these morphometric indicators might also be helpful for practical histologic assessment.     

乳腺癌切除标本内导管内增生性病变的免疫表型观察

目的探讨乳腺癌切除标本内导管内增生性病变的形态和免疫表型特点及其与浸润癌的关系。方法筛选出浸润性导管癌切除标本内有较多癌旁组织的病例36例和同期乳腺良性病变28例(对照组),选用CK5、CK34βE12、S100蛋白、SMA、CK8、Ecad、cerbB2等7种抗体做免疫组化染色。结果乳癌组36例中28例伴导管内增生性病变,单纯或复合出现的病变包括:普通性导管增生7例,柱状细胞病变12例,不典型导管增生4例,导管原位癌24例,伴两种以上病变者10例,4种病变同时存在者2例。对照组中计普通性导管增生23例,柱状细胞病变9例。免疫组化提示CK5在旺炽型UDH中腺系上皮细胞有大量表达,不典型导管增生、导管原位癌及浸润性导管癌中其表达明显降低直至完全失表达;CK34βE12表达类似于CK5,但较CK5为强,二者并不完全重合;S100蛋白表达于肌上皮细胞和增生的腺系上皮细胞,其在UDH的腺系上皮中的表达近似于CK34βE12,却不表达SMA;在24例高级DCIS中,11例肌上皮对S100蛋白的反应性先消失,但对SMA仍呈强反应;Ecad在导管原位癌、浸润性导管癌中出现再表达和(或)阳性等级升高;cerbB2在高级DCIS和IDC中呈清晰的膜表达。结论77.87%浸润性导管癌伴有不同的导管内增生性病变,这些病变不仅形态学表现不同,且免疫表型有异,可据此协助诊断与鉴别诊断。仅据对活检诊断的导管内增生性病变患者长期随访而得出的后来发生浸润性乳腺癌危险度的结论,与当初诊断的病变并无直接相关,而更可能与当初残留或后来发生的导管内增生性病变有关。     

Ductal carcinoma of the breast. An analysis of proportions of intraductal and invasive components

One hundred and ninety patients with mammary ductal carcinoma were studied to evaluate the correlation of proportions of intraductal and invasive tumor growth to histologic and immunohistochemical features. Initially, attempts were made to divide the cases into 6 groups according to the proportion of extraductal invasive areas within the whole tumor. It has been found that ductal carcinoma could be divided, on this criterion, into 2 groups. One comprised tumors in which invasive areas made up less than 20% of the tumor, the other included those with invasive areas exceeding 20%. In the former, intraductal and invasive components exhibited a lower grade of nuclear and tumor component and a higher incidence of cells with CEA immune positivity. The latter manifested higher grades in both intraductal and invasive components and a lower incidence of CEA positive cells. Many of the latter tumors had a solid or comedo-like growing pattern of the intraductal component. There was a significant difference in the prognosis between the two categories. We conclude that like intraductal carcinomas, invasive ductal carcinomas with a predominant intraductal component should be considered a lower grade malignancy.     

192例浸润性乳腺癌导管内扩散及预后因素分析

目的：探讨浸润性乳腺癌导管内扩散的形态特征及其与组织学分级、c-erbB-2过表达及脉管累犯的关系。方法：对192例浸润性乳腺癌的导管内扩散情况及其与组织学分级、c-erbB-2过表达及脉管累犯的关系进行统计分析。结果：192年浸润性乳腺癌中,导管内扩散阳性88例（45．8％）,其中脉管累犯阳性组中,导管内扩散阳性率为56．6％,明显高于脉管累犯阴性组（34．4％）,且差异有显著性（P＜0．005）。导管内扩散阳性组中,c-erbB-2阳性率为72．7％,高于导管内扩散阴性组（54．8％）,且差异有显著性（P＜0．025）。导管内扩散与组织学分级呈正相关（P＜0．05）。结论：导管内扩散与组织学分级、c-erbB-2过表达及脉管累犯呈现正相关,浸润性乳腺癌中伴导管内扩散者更具有侵袭性和转移性。     

乳腺导管内二态性乳头状癌的形态及免疫表型特征

目的探讨乳腺导管内二态性乳头状癌的形态及免疫表型特征。方法收集具有二态性形态学特征的乳腺导管原位癌7例,观察其组织形态学特点,并采用EnVision免疫组化法检测CK5/6、CK34βE12、CK8、CD10、p63、SMA、ER、E-cad、Syn、CgA、GCDFP-15和AR的表达。结果二态性导管内乳头状癌4例,具有二态性特征的筛状型导管原位癌3例;其中4例伴有导管内非典型增生。二态性乳头状癌有两种形态不同的肿瘤细胞:一种是普通性肿瘤细胞,多为柱状细胞,胞质不透明,核为低或中间级别。此类细胞分布于乳头或筛状结构的浅层;第二种细胞是二态性肿瘤细胞,多呈多角形或立方形,胞质透明或淡染,核级别及形态与普通性肿瘤细胞相同。此种细胞位于柱状肿瘤细胞内侧,排列呈条带状、筛状、实性巢状或单个细胞播散分布,其胞质及细胞分布位置类似增生的肌上皮细胞。两种肿瘤细胞均显示CK8、ER阳性,基底高分子量角蛋白(CK5/6、CK34βE12)、肌上皮(CD10、p63、SMA)、Syn和CgA阴性;E-cad阳性5例,另2例部分细胞呈胞膜胞质型微弱阳性而大部分细胞不表达;1例GCDFP-15及AR阳性。结论二态性导管内乳头状癌的两种肿瘤细胞均呈腺系上皮分化,两种肿瘤细胞的形态及胞质染色不同,但核的异型性及其形态相同,免疫组化结果也相同。二态性肿瘤细胞在HE切片内与肌上皮细胞很相似,易被误认为肌上皮,从而导致诊断不足或误诊,宜予高度重视。     

神经周浸润在乳腺癌中的意义

目的：对乳腺浸润性导这癌神经周浸润与肿瘤的大小、肿瘤的组织学分级、肿瘤的ＴＮＭ分期、淋巴结转移、５年存活率、肿瘤标志物ＣＥＡ等之间关系进行探讨。方法：６５例乳腺浸润性导管癌组织常规取材制片,ＨＥ、Ｇｏｄｅｎ－Ｓｗｅｅｔ网染,ｌａｍｉｎｉｎ、ＣＥＡ、ｖｉｍｅｎｔｉｎＳ－Ｐ法免疫标记染色法光镜观察。结果：神经周浸润与肿瘤大小、的组织学分级、肿瘤的ＴＮＭ分期、淋巴结转移率均成正相关;与淋巴管浸润关系密切     

Malignant phyllode tumor of the breast with features of intraductal carcinoma]

Malignant phyllode tumor is a rare biphasic breast tumor consisting of a malignant mesenchymal component and an epithelial component that is usually benign. We report an unusual case of a malignant phyllode tumor of the breast with neoplastic features of both the epithelial and stromal components. The patient was a 39-year-old woman with family history for breast carcinoma. Grossly, the excised tumor was a 9 x 7 x 5.5 cm gray lobulated mass with infiltrative margins and necrotic-hemorrhagic areas. Histologically the tumor consisted mainly of neoplastic mesenchyme with non invasive comedo, cribriform and micropapillary features of the ducts. Three months after the excision of the neoplastic mass, the patient developed an infiltrating ductal carcinoma of the opposite breast. Hereditary and bilateral tumors are commonly associated with germline mutations. Tissue from both neoplasms however did not express either BRCA1 or BRCA2 mutations.     

Secretory breast carcinoma with extensive intraductal component: case report

Secretory breast carcinoma is a rare entity. It was first reported in pediatric patients in 1966, and was named juvenile breast carcinoma. Incidences of pediatric and adult patients are similar. Prognosis is favorable in both groups, but distant metastases have been reported. The authors describe a case of secretory breast carcinoma with extensive intraductal component.     

乳腺导管内增生性病变及浸润性癌中树突状细胞的检测

目的　检测乳腺导管内增生性病变和微小浸润性癌及浸润性导管癌中树突状细胞(dendriticcells,DC)和T细胞的 分布状况和浸润密度,探讨乳腺癌发生、发展中机体免疫状态的变化规律。方法　应用免疫组化S P法和两步法对16例正常 副乳腺、58例导管内增生性病变、4例微浸润导管癌及67例浸润性导管癌乳腺标本进行S 100蛋白+DC、HLA DR+DC、CD1a +DC(DC三参数)及CD45RO+T细胞的浸润密度检测。结果　浸润癌中DC三参数浸润密度均高于其它病变组织(P< 0.05)。导管原位癌、微浸润癌及浸润癌组织中CD45RO+T细胞浸润密度均高于其它病变组织(P<0.05)。DC三参数间及 其与CD45RO+T细胞间均呈正相关(P<0.001)。结论　DC浸润密度随增生性病变加重而逐渐增高,发展为浸润癌时则明 显增高。     

Issues relating to lymphovascular invasion in breast carcinoma

Lymphovascular invasion (LVI) by tumor cells is histologically evident in approximately 15% of invasive mammary duct carcinomas and is present in approximately 10% of cases with pathologically negative lymph nodes. LVI is indicative of unfavorable prognosis in the breast cancer-as manifested by increased local failure and reduced overall survival. It is for this reason that LVI is routinely included in the evaluation and reporting of all breast cancers. There are a variety of interpretative difficulties in the histopathologic assessment of LVI, and the clinical implications of any misinterpretation can be profound. This brief review seeks to highlight the difficulties in the evaluation of LVI in breast cancer.     

Cystic hypersecretory carcinoma: rare and poorly recognized variant of intraductal carcinoma of the breast. Report of five cases

AIMS: To report five cases of a rare variant of intraductal carcinoma of the breast, so-called cystic hypersecretory carcinoma. The clinical and pathological characteristics of the lesion are described, along with a review of the literature. METHODS AND RESULTS: The patients were females aged between 53 and 78 years (average 66.8 years). The size of the lesions ranged between 70 and 80 mm in largest dimension. In two cases, the development of high-grade invasive ductal carcinoma was observed; in one additional case there was recurrence of high-grade in-situ carcinoma after 3 years. This emphasizes the importance of correct diagnosis of this potentially aggressive lesion. Strong over-expression of HER-2/neu protein was observed in three cases, including the two with an invasive component. Protein p53 was variably positive in all cases. Steroid receptor immunohistochemistry yielded variable results with only one case being positive for both oestrogen and progesterone receptors. Interestingly, in most cases (4/5) staining for androgen receptors was observed. CONCLUSIONS: Cystic hypersecretory ductal carcinoma of the breast is a rare distinctive variant of ductal carcinoma in situ. It has the potential for invasive growth and the development of metastases.     

Invasive ductal carcinoma with a predominant intraductal component arising in a fibroadenoma of the breast

A rare case of invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma of the breast in a 42 year old Japanese female was investigated by light microscopy. The patient, who had a well-defined, rubbery breast tumor measuring 2.0 X 3.0 cm, had undergone a tumorectomy 21 months after she noticed the tumor. Histologically, the fundamental architecture of the tumor showed an intracanalicular-type of fibroadenoma, but extensive proliferation of atypical cells was noticed in the lumen of the ducts. Tumor cells in the canaliculi had characteristics of ductal carcinoma, such as solid, comedo and cribriform patterns. As most of the ducts were occupied by carcinoma cells with several foci of microinvasion in the stroma of the fibroadenoma, it was diagnosed as invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma. This coexistence of in situ proliferation and invasive lesions of carcinoma within a fibroadenoma suggest the origin of the carcinoma to have been in the epithelial component of the fibroadenoma. In addition, this study clarifies the fact that carcinoma cells may proliferate and spread along the lumen of pre-existing ducts of the fibroadenoma and speculates that the duct system of the fibroadenoma has complete continuity.     

Cytological criteria for the diagnosis of intraductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma of the breast

The advent of mammography screening presents a diagnostic challenge to the cytopathologist as an increasing proportion of breast lesions requiring investigation will be nonpalpable and up to 40% will be accounted for by atypical intraductal hyperplasia and ductal carcinoma in situ, as opposed to previously, when these lesions represented less than 10% of palpable tumors. We studied 133 fine-needle aspirates from breast tumors and found that nuclear morphology, myoepithelial cells, signs of invasion, and degree of cellular dissociation are among the most potent factors discriminating between benign epithelial proliferations, atypical intraductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma.     

Electron microscopy of intraductal papilloma of the breast. Ultrastructural comparison of papillary carcinoma with normal mammary large duct

Intaductal papillomas, papillary carcinomas, and normal mammary large ducts were studied by electron microscopy. The intraductal papillomas were divided into two subtypes: fibrous and glandular. Comparative ultrastructural analysis of these two subtypes revealed definitive differences in the nucleus, chromatin, and presence of myoepithelial cells. An irregularly shaped nucleus, aggregated heterochromatin, and prominent myoepithelial cells were the conspicuous features of the fibrous type which appeared to be almost absent in the glandular type. Moreover, the fibrous type possessed intact basal laminae, various differentiations of the cell surface, desmosomes, terminal bar, intrastromal projections of crab-finger-like appearance of the myoepithelial cells, and a two cell layer arrangement of epithelial cells. In these features, the ultrastructural appearance of the fibrous type closely resembled that of the cells of the normal mammary large duct. The glandular type, on the other hand, more or less lacked myoepithelial cells, well-developed organelles and showed a euchromatin pattern in the nucleus. This type resembled the papillary carcinoma in its histological characters. An absence of basal laminae (infiltrating carcinoma only) and the presence of intracytoplasmic lumina were characteristic of papillary carcinomas, and these two features were not found in the intraductal papillomas.     

Prognostic impact of marginal adipose tissue invasion in ductal carcinoma of the breast

This study aimed to investigate whether adipose tissue invasion (ATI) of cancer cells at the tumor margin influenced lymph node status and prognosis in patients with invasive ductal carcinoma of the breast. Data for 245 patients with breast cancer with marginal ATI were clinicopathologically compared with data for 65 patients without ATI. We also examined the value of the combination of ATI and peritumoral lymphatic vessel invasion (LVI). The frequency of axillary lymph node metastases was 40.7% in patients with ATI (99/243) and 11.3% in patients without ATI (7/62; P<.0001), and ATI was an independent factor influencing nodal metastasis. Patients with ATI had a poorer prognosis than patients without ATI (10-year disease-free survival, 76% and 94%, respectively; P=.0323). In addition, patients without ATI or LVI had neither lymph node metastasis (n=52) nor recurrent disease (n=53). ATI is one of the biologic indicators of tumor aggressiveness.