Clinicopathologic features of collagenous spherulosis of the breast / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the morphological features, immunohistochemical phenotype, diagnosis and differential diagnosis of collagenous spherulosis of the breast.</p><p><b>METHODS</b>Clinicopathologic observation, immunohistochemistry using EnVision method and histochemical staining were applied in 33 cases of collagenous spherulosis of the breast.</p><p><b>RESULTS</b>Collagenous spherulosis of the breast was a benign lesion, consisting of proliferative myoepithelial and ductal epithelial cells. These cells were arranged in a cribriform pattern with esinophilic, round, oval or star-shaped fibrillary spherules in the lumen.SMA, calponin and p63 by immunohistochemistry identified the proliferative myoepithelium, while E-cadherin identified the proliferative ductal epithelial cells. The esinophilic spherules were stained with collagen type IV, AB-PAS and reticulin. Collagenous spherulosis was often found in sclerosing adenosis.</p><p><b>CONCLUSIONS</b>Collagenous spherulosis of the breast is often associated with other diseases. It has special morphological presentation and is easily confused with malignant tumors such as adenoid cystic carcinoma or cribriform carcinoma in situ, and needs to be differentiated from these disease entities.</p>

Morphology, immunohistochemistry and hTERC gene in-situ hybridization in Barrett's esophagus / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features and differential diagnosis of proximal gastric mucosa and mucosa of Barrett's esophagus (BE) in biopsy specimens.</p><p><b>METHOD</b>Thirty-eight cases of Barrett's esophagus (diagnosed using WHO criteria) and 44 cases of proximal gastric mucosa were studied by immunohistochemistry (for CK7, CK20, CK4, CK8, S-100 protein, MUC6, COX2 and bcl-2) and fluorescence in-situ hybridization (FISH) (for hTERC gene). The pathologic features were analyzed.</p><p><b>RESULTS</b>The differences in expression of CK7, CK20, MUC6, COX2 and bcl-2 between BE and proximal gastric mucosa with intestinal metaplasia were not statistically significant (P > 0.05). There was however a statistically significant difference in expression of S-100 protein (P < 0.05). The expression of CK7/CK4 and CK7/CK8 in BE showed positive correlation (P < 0.05). However, such correlation was not demonstrated in proximal gastric mucosa (P > 0.05). The results of hTERC gene expression by FISH showed a statistically significant difference between the two groups: 57.9% (22/38) in BE and 13.6% (6/44) in proximal gastric mucosa (P < 0.05).</p><p><b>CONCLUSIONS</b>The significance of CK7 and CK20 expression is uncertain in the differential diagnosis between BE and proximal gastric mucosa. On the other hand, positivity for CK7/CK4/CK8 may support the diagnosis of BE and play a role in distinguishing between the two groups. S-100 protein expression and detection of hTERC gene amplification also contribute to the diagnosis of BE.</p>

Morphologic evaluation of papillary carcinoma of the breast featuring expansile invasion / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the pathology, diagnosis and differential diagnosis of papillary carcinoma of the breast featuring expansile invasion.</p><p><b>METHODS</b>Morphologic analysis and immunohistochemical study using MaxVision method were carried out in 25 cases of papillary carcinoma of the breast featuring expansile type of invasion.</p><p><b>RESULTS</b>All the 25 cases were female, and ranged from 26 to 84 years old in age with median of 69. The diameters of the neoplasms were from 1 cm to 5 cm, among which those of two cases were 4 cm and 5 cm respectively and the others were less than 2.5 cm. The tumor appeared solid and well-demarcated on gross examination. Histologically, the tumor was non-encapsulated. In some cases, the tumor tissue was separated by fibrous septa or intervening native breast tissue. The tumor was composed of arborizing papillae with fibrovascular cores, associated glandular fusion and cribriform pattern. The fibrovascular cores were covered by cuboidal to columnar cells. In 3 of the cases studied, focal transition with micropapillary ductal carcinoma-in-situ was demonstrated. The tumor cells showed mild or moderate degree of nuclear pleomorphism and contained amphophilic to eosinophilic cytoplasm. Mitotic figures were not frequently seen. One case displayed squamous metaplasia and 4 cases showed apocrine metaplasia. Dimorphic features were identified in 2 cases. The stromal tissue within the tumor was often scanty and sometimes sclerotic, associated with various degrees of inflammatory infiltrate and hemosiderin deposition. Immunohistochemical study for smooth muscle actin, p63, CD10 and CK5/6 showed negative staining in all of the 25 cases studied, including the 2 cases with dimorphic features. Seven cases had breast cancer marker study performed. Six cases were positive for estrogen receptor and progesterone receptor. HER2 oncoprotein was not over-expressed in 6 cases. Nine patients underwent axillary dissection and 2 of them showed axillary nodal metastasis.</p><p><b>CONCLUSIONS</b>Diagnosis of papillary carcinoma of the breast is one of the most difficult areas in breast pathology. Demonstration of expansile type of invasion, when coupled with complex papillary fusion, cribriform pattern and absence of myoepithelial cells on immunohistochemistry, is helpful in arriving at a correct diagnosis.</p>

Invasive lobular carcinoma of basal-like subtype of breast: a clinicopathologic analysis / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathologic features, clinical progress and prognosis of the basal-like subtype of invasive lobular carcinoma (ILC) of the breast.</p><p><b>METHODS</b>Four cases of ILC were analyzed by detailed histopathologic observation and immunohistochemical staining for E-cadherin, p120 catenin, ER, PR, HER2, CK5/6, EGFR, p63, p53, Ki-67 using MaxVision method. The follow-up and clinical data were analyzed.</p><p><b>RESULTS</b>Morphologically, one case was mixed ILC and three cases were pleomorphic ILC. The tumor cells were negative for E-cadherin except one case with focal membrane positivity, and all showed p120 catenin cytoplasmic positivity except one case with focal membrane positivity. All cases were negative for ER, PR and HER2 (triple negative), and positive for EGFR and CK5/6. Two cases were positive for p63. The cases were partly and weakly positive for p53, and the Ki-67 positive rate was between 30% and 75%. Follow-up data showed that two cases developed chest wall metastases, and in one case, there was progression to liver and abdominal metastases.</p><p><b>CONCLUSIONS</b>ILC of the breast are ER, PR and HER2 "triple negative", CK5/6 and EGFR positive, indicative of basal-like characteristics. Basal-like subtype of ILC are peculiarly prone to metastasis and poor response to chemotherapy, suggesting that it is associated with poor prognosis.</p>

Pathologic diagnosis and differential diagnosis of low-grade adenosquamous carcinoma of breast and syringomatous adenoma of nipple / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the pathologic and immunohistochemical features, diagnosis and differential diagnosis of low-grade adenosquamous carcinoma of the breast and syringomatous adenoma of the nipple.</p><p><b>METHODS</b>Six cases of low-grade adenosquamous carcinoma of the breast and four cases of syringomatous adenoma of the nipple were examined histologically and immunohistochemically (MaxVision method), and the literature was reviewed.</p><p><b>RESULTS</b>The two types of tumors were similar in morphology, but located in different regions with low-grade adenosquamous carcinoma being present in the deep parenchyma and syringomatous adenoma in nipple. Both types of tumors were composed mainly of well-differentiated glands with angulated, comma shaped or polliwog appearance in a disordered infiltrative pattern. The tumor cells also formed solid tubules, strips or nests, with frequent areas of squamoid differentiation. Mitosis was rare. The interstitial tissue showed abundant spindle cells or sclerotic fibrosis with mixed inflammatory cells infiltration. One case of low-grade adenosquamous carcinoma showed a concomitant malignant adenomyoepithelioma, and another case showed concomitant spindle cell metaplastic carcinoma. One case of syringomatous adenoma involved the deep parenchyma. Immunohistochemistry of low-grade adenosquamous carcinoma showed that CK5/6 and p63 were positive in the outer layer of the glands and the squamoid epithelium, and CD10 was also positive in the outer layer of the glands. ER and HER2 were negative, and PR was also negative except for one case in which the spindle cells were positive for CK5/6, AE1/AE3 and PR focally. Immunostaining of syringomatous adenoma demonstrated that p63 and CK5/6 were positive in the outer layer of the glands and the squamoid epithelium. Calponin, SMA, ER, PR and HER2 were all negative.</p><p><b>CONCLUSIONS</b>Low-grade adenosquamous carcinoma of the breast and syringomatous adenoma of the nipple are similar in morphology and immunohistochemical phenotype, while the biological features are opposite due to different locations. The differential diagnoses include tubular carcinoma, adenosquamous carcinoma, radial sclerosing lesions and others.</p>

Expression of E-cadherin, p120catenin and 34βE12 in invasive lobular carcinoma of breast and their roles in diagnosis / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate expressions of E-cadherin (E-cad), p120catenin (p120), 34βE12 in invasive lobular carcinomas of the breast and their roles of diagnoses.</p><p><b>METHODS</b>The 81 cases of ILC, including 67 cases of pure type and 14 cases of ductal-lobular mixed type, which had been diagnosed in our department were collected and immunohistochemistry of E-cad, p120 and 34βE12 were performed. All the cases were diagnosed again according to morphology and immunophenotypes (MaxVision method), and difference of diagnoses and expressions of the three indexes were analysed.</p><p><b>RESULTS</b>Sixty four of 81 cases were permantly diagnosed of ILC. In the 61 cases of pure type, 54 cases displayed E-cad negative and p120 cytoplastic positive, 1 case displayed E-cad negative and p120 atypical positive, 3 cases displayed E-cad membrane positive and p120 cytoplastic positive, and 3 cases displayed both atypical positive. Fifty two of 61 cases displayed 34βE12 positive. The 3 cases of mixed type displayed p120 cytoplastic positive, and 2 cases displayed E-cad negative and 1 case displayed atypical positive. All the 3 cases displayed 34βE12 positive.</p><p><b>CONCLUSIONS</b>The diagnosis of ILC is one of the most difficult problems in breast pathology, and combination of E-cad and p120 immunostaining is an effective method for assistance. It needs further studies for invasive ductal carcinomas with morphological features of lobular carcinomas.</p>

Pathological study of radial sclerosing lesions / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the pathological diagnostic features and the differential diagnosis of radial sclerosing lesions of the breast.</p><p><b>METHODS</b>Morphological observation and immunohistochemistry were applied to forty-four cases of radial sclerosing lesions of the breast.</p><p><b>RESULTS</b>All forty-four patients were females, the mean age was 40.3 years (range 17 to 54 years). In the 31 consultation cases, 13 were misdiagnosed as carcinoma. The lesions had a radiating outline, and a central scar area where squeezed or pressed irregular shaped tubules were frequently seen. Dilated tubules and proliferated ducts or lobules were seen radically arranged at the periphery accompanied sometimes with the apocrine glands or columnar cell metaplasia and hyperplasia. Aside, there were 14 cases displaying necroses and 8 cases showing atypical ductal hyperplasia. Immunostaining showed myoepithelial cells around the pseudo-infiltrating tubules, and the florid proliferating epithelial cells were positive for CK5/6.</p><p><b>CONCLUSIONS</b>Radial sclerosing lesions of the breast possess characteristic histological features, and may be misdiagnosed as carcinoma. The lesions should be differentiated from ductal carcinoma in situ, lobular neoplasia, tubular carcinoma and invasive ductal carcinoma.</p>

Nipple adenoma: report of 18 cases with review of literatures / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological and immunohistochemical features, diagnosis and differential diagnosis of nipple adenoma of the breast.</p><p><b>METHODS</b>Morphological observation and immunohistochemistry were applied to 18 cases of nipple adenoma with a review of the related literatures.</p><p><b>RESULTS</b>The neoplasms were localized at nipples or under the areola of breast, adherent to the epidermis, mainly composed of dilated ducts in a tubular appearance associated with fibrotic matrix. The glandular epithelium showed various type of proliferation, forming thick layers or complex structures such as papillae, micropapillae, tufts, fronds, arcades or bridges accompanying with solid or cribriform cell nests. The tumor cells were crowding, lack of an uniform morphology and polarity with intact myoepithelial cells around the ducts. By immunostaining, the glandular epithelium was diffusely positive for 34betaE12, patchily positive for CK5/6, and negative for p53 and c-erbB-2. The myoepithelium, positive for p63, smooth muscle actin and Calponin, was well preserved and outlining the ducts.</p><p><b>CONCLUSIONS</b>Nipple adenoma is an infrequent type of benign breast neoplasm, presenting as sclerosing papilloma, papillomatosis or florid sclerosing adenosis. It is easily confused with atypical ductal hyperplasia/low grade ductal carcinoma in situ, invasive ductal carcinoma or low grade adenosquamous carcinoma. A correct diagnosis is based on the peculiar location and morphology of the tumor, and immunohistochemistry is helpful in some cases.</p>

Clinicopathologic features and proliferative status of colorectal serrated lesions: a study of 104 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features and proliferative status of colorectal hyperplastic polyp (HP), sessile serrated adenoma (SSA) and traditional serrated adenoma (TSA).</p><p><b>METHODS</b>One hundred and four cases colorectal serrated lesions were collected from 2628 cases of colorectal polyps during the period from November, 2002 to December, 2007. The clinicopathologic features and expression of proliferation marker Ki-67 were studied.</p><p><b>RESULTS</b>On the basis of morphologic examination, 60 cases were classified as HP, 20 cases as TSA, 11 cases as SSA, 7 cases as mixed HP/SSA/TSA, and 6 cases as mixed serrated polyp/adenoma and tubular adenoma. Immunohistochemical study for Ki-67 showed that 40 cases (78%) of the 51 cases of HP were either mostly negative or rarely (<25% cells) positive. Most of the positive cells were located at crypt bases. Among the 15 cases of TSA, 11 of them revealed positive cryptal cells (25% to 50% or>50% positivity). Most of the positive cells were located in mid portion of crypts. The number and distribution of Ki-67 positive cells in SSA were similar to those in TSA but were significantly different from those in tubular adenoma and adenocarcinoma (chi2=34.601, P=0.000; chi2=63.077, P=0.000, respectively).</p><p><b>CONCLUSIONS</b>HP, SSA and TSA have their morphologic characteristics, with some overlapping features noted. The distinction between SSA and HP can be difficult. Diagnosis of SSA relies mostly on architectural rather than cytologic features. The distinction between TSA and SSA depends mainly on the presence of dysplasia. Ectopic crypt formation is almost exclusively seen in TSA. The distribution and percentage of Ki-67-positive cells are also helpful in subtyping of various colorectal serrated lesions. In general, the proliferative index is lower in serrated adenoma (TSA or SSA) than in tubular adenoma.</p>

Clinicopathological and immunohistochemical features of colorectal sessile serrated adenoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics and expression status of Ki67, p53, CEA, CDX, CK7 in colorectal sessile serrated adenoma (SSA).</p><p><b>METHODS</b>The clinicopathological data of 11 cases of SSA, 51 cases of hyperplastic polyp (HP) and one case with mixed HP/SSA were reviewed and analyzed retrospectively. The expression of Ki67, p53, CEA, CDX and CK7 were detected by immunohistochemistry.</p><p><b>RESULTS</b>The major histological features in SSA were architectural abnormality in crypts, dilatation of serrated crypt bases like an inverted "T" or "L" shape adjacent to muscularis mucosa. Atypical cells containing round to oval nuclei and nucleoli were also observed. The immunohistochemical staining showed that the expression of p53 increased gradually from HP to TA: 11.8% in HP, 20.0% in SSA, 41.2% in VTA and 75.0% in TA, with a significant difference among the groups (chi(2) = 17.996, P = 0.000). However, no significant difference in the expression of CDX and CK7 was observed between HP and SSA. Of the 10 SSA cases, positive expression of Ki67 was found in cells located in the base or middle part of crypt in 6 cases, positive cells index was 26% - 50% in 5 cases, and > 50% in 3. Compared with the expression of Ki67 in the HP, VTA and VA, SSA showed a significant difference in both the positive cell number and in the positive regions. (positive number: chi(2) = 34.601, P = 0.000; positive regions: chi(2) = 63.077, P = 0.000).</p><p><b>CONCLUSION</b>Morphological diagnosis of SSA was mainly based on crypt architectural and cellular abnormalities, and the crypt architectural abnormality may be more important than cellular features. Detection of p53 and Ki67 expression may be helpful in differential diagnosis and understanding the nature of SSA.</p>

Clinicopathological features of the mucocele-like lesions in the breast / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinical and pathological features of mucocele-like lesions in the breast.</p><p><b>METHODS</b>Nine cases of mucocele-like lesions in the breast were reported for the morphological and immunohistochemical features, the differential diagnosis, and a literature review.</p><p><b>RESULTS</b>All nine cases were from female patients, aged 23 to 43 years (mean 34 years), clinically presented with palpable breast masses. Grossly, the lesions were multi-cystic with colloidal appearances. Histologically, the lesions consisted of multiple cysts filled with colloid, these cysts were lined with tubular, cuboidal or columnar epithelium. There were superimposed papillary epithelial hyperplasia in three cases and atypical ductal hyperplasia in one. Extravasated mucinous lakes were seen in the stroma, but without cellular component.</p><p><b>CONCLUSION</b>Mucocele-like lesions of the breast is a group of mostly benign disease, and the differential diagnosis should include mucinous carcinoma.</p>

Morphological features of basal-like subtype invasive carcinoma of breast / 中华病理学杂志

<p><b>OBJECTIVE</b>To summarize the morphological features of basal-like subtype of invasive breast carcinoma (BLSIBC), and to look for diagnostic clues for its recognition.</p><p><b>METHODS</b>Immunohistochemistry was performed in 109 cases of invasive ductal carcinoma, with CK5/6, CK14, CK8/ 18, 34betaE12, calponin, p63, CD10, ER, PR and c-erbB-2 monoclonal antibodies. Five subtypes were classified according to immunophenotypes: luminal A subtype (ER+/HER2-), luminal B subtype (ER+/ HER2+), normal breast-like subtype (ER/HER2-), HER2-overexpressing subtype and BLSIBC which was identified with at least one kind of basal-like cytokeratins or markers of myoepithelium and ER/HER2. The microscopic features of basal-like subtype were also analyzed.</p><p><b>RESULTS</b>The number of luminal A case was 48 (44.0%), luminal B 15 (13.8%), HER2 over-expressing 15 (13.6%), normal breast-like 10 (9.1%), basal-like subtype 19 (17.4%). Besides, the other two cases expressed c-erbB-2 or/and ER plus markers for myoepithelium, thus were excluded from all the five mentioned subtypes. Of the 19 basal-like subtype, CK5/6 was expressed in 16 cases, CK8/18 in 17 cases, CK14 in 11 cases, 34betaE12 in 18 cases, p63 in 5 cases, CD10 in 6 cases, and calponin in 1 case. The diameter of the BLSIBC cases was 1.2-7 cm (averagely 3.9 cm) , and in 6 cases, the tumor diameter was >5 cm. Only one case displayed extensive in situ component, 9 cases were grade 2, and 9 cases were grade 3. Compared to non basal subtype, there were significantly more high grade cases (P <0.01). The morphological features of basal-like subtype were summarized as the followings: pushing margin (13 cases), lymphocytic tissue hyperplasia (18 cases), nest or sheet arrangement (18 cases), nucleus grade 3 and scattered giant or bizarre nuclei (17 cases), syncytial growth (7 cases), and comedo-like necrosis (17 cases). The frequency of these features were significantly more common than non basal subtype (P <0.01).</p><p><b>CONCLUSION</b>The morphologic diagnostic features of BLSIBC are pushing margins, lymphocyte infiltration, comedo-like necrosis, gigantic cell and syncytial growth.</p>

Changes of biological characteristics of colon carcinoma cell line - LoVo induced by Kai1/CD82 transfection / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the influence of Kai1/CD82 transfection on the growth, adherence, separation and invasion potential of LoVo colon carcinoma cell line.</p><p><b>METHODS</b>Kai1/CD82 cDNA was transfected into LoVo cells, and a stable expressing clone was established. In vitro methodology was used to obtain the growth curve and also to detect the adherence, separation and invasion potential of the transfected LoVo cells, in comparison with those of control cells without transfection.</p><p><b>RESULTS</b>Compared with the control, no change was observed in the growth pattern of transfected LoVo cells. The numbers of adherent cells in the two groups were 0.08, 0.63, 0.83, 0.91 (x 10(5)) for the transfected cells and 0.04, 0.48, 0.71, 0.82 (x 10(5)) for the control cells respectively after 10, 20, 30, 40 minutes culture with shaking. The difference at 20, 30 and 40 minutes was statistically significant (P < 0.05). The separation rates of each group were 13%, 20%, 53% for the transfected cells and 11%, 28%, 60% for the control cells, respectively after 5, 10, 15 minutes culture with shaking. The difference at 10 and 15 minutes was statistically significant (P < 0.05). The aggregation rate of the transfected cells was higher than that of the control cells after culture with mild shaking for 5 hours (64.8% vs. 58.6%, P < 0.05). After co-incubation with endothelium cells ECV304, the number of invading cells decreased more in the transfected cells than that in the control cells (6.33/field and 17.67/field, P < 0.05).</p><p><b>CONCLUSION</b>Transfection expression of Kail/CD82 into LoVo cell line results in an increase of cell adherence and aggregation, but a diminished capability of separation and invasion, suggesting that the expression of Kai1/CD82 gene may inhibit the metastatic potential of colon carcinoma.</p>