Carcinoma ductal in situ de la mama con características apocrinas: reporte de un caso / Ductal carcinoma in situ of the breast with apocrine characteristics: case report

Resumen Se presenta el caso de una femenina de 69 años con un carcinoma ductal in situ de la mama, el cual presentaba diferenciación apocrina y alto grado nuclear. La forma de presentación clínica se hizo patente en forma de microcalcificaciones detectadas en la mamografía, y corroboradas histológicamente como comedonecrosis. La diferenciación apocrina se comprobó por medio de tinciones de inmunohistoquímica. El diagnóstico se realizó en una biopsia excisional, pero dado a que uno de los márgenes se encontraba comprometido, la paciente se sometió posteriormente a una mastectomía.

Abstract We present the case of a 69 year old female diagnosed with a ductal in situ carcinoma of the breast. The tumor had apocrine differentiation and a high nuclear grade. The clinical presentation corresponded to microcalcifications detected on mammography, which were histologically patent in the form of comedo type necrosis. The aforementioned apocrine differentiation was reassured using the aid of immunohistochemistry. The biopsy was an excisional biopsy, but due to positive quirurgical margins, the patient was later reintervened for total mastectomy.

Metastização uterina de carcinoma mamário - Relato de caso / Uterine metastasis of breast carcinoma - Case report

A doença metastática que envolve o útero é rara. Geralmente os ovários são o órgão envolvido e o tumor primário é habitualmente da mama ou do trato gastrointestinal.Caso clínico: Os autores apresentam um caso de metastização uterina de carcinoma mamário. A doente tinha antecedentes de mastectomia bilateral por carcinoma invasivo NOS havia mais de 30 anos. A avaliação histológica do produto de biópsia histeroscópica, complementada com imuno-histoquímica, confirmou a origem do tumor primário como mamário e de variante lobular. A doente recusou outros procedimentos invasivos, mas concordou com seguimento clínico e ecográfico. Conclusão: Geralmente a doença metastática da mama para o trato genital feminino deve-se majoritariamente a carcinoma lobular invasivo. Apresentamos um caso de metastização uterina de carcinoma lobular invasivo, mais de 30 anos após o tumor primário, o qual foi classificado como carcinoma invasivo NOS e confirmado em revisão de lâminas. É de salientara importância de uma correta informação clínica ao patologista do antecedente oncológico, de forma a poder ser feito um correto diagnóstico diferencial.

Metastatic disease involving the uterus is rare. Typically it is the ovaries that are involved and the primary tumor is usually the breast or the gastrointestinal tract. Case report: We describe a case of metastatic breast carcinoma involving the uterus in a patient who had had a bilateral mastectomy due to invasive carcinoma NOS more than thirty years ago. Histological assessment of the hysteroscopy biopsy specimen including immunohistochemistry staining confirmed the breast carcinoma as the primary lesion, however it was classified as lobular carcinoma. The patient refused surgery or other invasive procedures, having complied nevertheless to follow up with clinical and ultrasound evaluation. Conclusion: Metastatic breast disease to the feminine genital tract is more frequently due to lobular invasive carcinoma. We present a case of uterine metastization of invasive lobular carcinoma more than thirty years since the primary tumor, which was classified as invasive carcinoma NOS and confirmed by histological revision. It is of great importance to give the pathologist the correct information about the patient, namely of any oncologic background, so differential diagnosis can be made.

A Case of Apocrine Carcinoma on the Pubis / 대한피부과학회지

Apocrine carcinoma is a rare malignant epithelial tumor of apocrine sweat glands. It manifests as a painless, slow-growing, firm or cystic red nodule with focal ulcerations. These tumors are capable of hematogenous dissemination to visceral organs and lymphatic spread. Their occurrence has been reported mainly in the axilla and breast area. We present a case of apocrine carcinoma arising from the pubis, where it rarely occurs. An 83-year-old man displayed a 3.5x3.0 cm-sized irregular-shaped mass with a crust. Histopathologic examination revealed a complex glandular appearance of cribriform and cord-like pattern tumor nests throughout the dermis. The tumor was positive in immunohistochemical staining for EMA, PAS diastase, and GCDFP-15.

Depigmented Scrotal Extramammary Paget's Disease in a Patient with Rectal Cancer: A Case of Coincidental Double Primary Adenocarcinomas

Extramammary Paget's disease (EMPD) typically presents as an eczematous, eroded or crusted plaque. Only a few cases with depigmentation have been reported. We herein report a patient with a depigmented scrotal patch as the sole finding of EMPD. Since he had concurrent rectal cancer, we stained the tissue with gross cystic disease fluid protein-15 (GCDFP-15) and cytokeratin 20 (CK20) in order to differentiate primary/secondary EMPD. This case represents coincidental primary EMPD and rectal cancer, of which the initial features of EMPD were unusual.

The Utility of HMFG-1 and GCDFP-15 to Discriminate the Differentiation of Eccrine and Apocrine Neoplasms / 대한피부과학회지

The discrimination of eccrine and apocrine neoplasms is still in dispute among researchers. To discriminate the differentiation of eccrine and apocrine neoplasms, immunohistochemical stainings with HMFG-1 and GCDFP-15 were performed on 12 specimens of eccrine and apocrine neoplasms, 3 of normal palmar tissues, and 3 of normal axillary tissues. The 12 cases of eccrine and apocrine neoplasms included 3 cases of syringoma, 2 cases of eccrine poroma, 2 cases of hidradenoma, 2 cases of apocrine hidrocystoma, 2 cases of syringocystadenoma papilliferum, and 1 case of spiradenoma. The 3 specimens of palmar tissue were used as the positive control of eccrine unit, and the 3 specimens of axillary tissue as that of apocrine unit. The results are as follows; HMFG-1 was positive in the cytoplasm and luminal surface of normal apocrine units, and also positive in those of eccrine units. Still more, HMFG-1 was documented as positive even in the eccrine poroma which is originated from eccrine unit. GCDFP-1 was positive in both normal eccrine and apocrine units, and glandular structure was stained stronger than ductal structure. In all of eccrine and apocrine neoplasms, syringoma, eccrine poroma, and spiradenoma which were known to differentiate to ductal structure were negative in GCDFP-15, but hidradenoma, apocrine hidrocystoma, and syringocystadenoma papilliferum which were known to differentiate to glandular structure were positive, partially. All these findings suggest that GCDFP-15 might be a useful marker for glandular differentiation rather than ductal differentiation, and both HMFG-1 and GCDFP-15 might not be useful to discriminate eccrine and apocrine neoplasms. Further intensive studies about normal eccrine and apocrine unit should be performed to determine if HMFG-1 could be used as a significant marker of apocrine unit, and it is necessary to develop new methods for the discrimination of eccrine and apocrine neoplasms.

A Case of Apocrine Gland Carcinoma / 대한피부과학회지

Apocrine gland carcinoma is a rare form of sweat gland neoplasm with a distinctive cytologic appearance. Their occurrence has been reported mainly in the axilla and breast area. The authors describe a 51-year-old man with an apocrine gland carcinoma in the right axilla area. Physical exam revealed a 2.0 X 2.5 cm sized strawberry-like mass and histologic sections showed multiple cribriform pattern tumor nodules throughout the dermis. The periodic acid-Schiffs(PAS) diastase stain revealed positively staining granules in the cytoplasm of the neoplastic cells and stains for lysozyme and GCDFP-15(Gross Cystic Disease Fluid Protein-15) were also positive.

Invasive Extramammary Paget Disease: A Report of 2 Cases with Immunohistochemical and Ultrastructural Findings

We present 2 cases of invasive extramammary Paget disease occuring in the vulva area of a 60 year old female, and in the scrotal and penile area of a 63 year old male patient. The histologically typical Paget cells were not only seen in the surface epithelium but were also involved in the outer root sheath of the hair follicles. Stromal infiltration of tumor cells into the upper dermis were present in both cases, however, no underlying primary sweat gland carcinoma was present. Metastatic foci of inguinal lymph nodes showed apocrine-type epithelium with abundant eosinophilic granular cytoplasm, which were positive for anti-CEA and GCDFP-15, as well as eccrine-type epithelium containing mucinous secretory materials in the lumen and the cytoplasm. Ultrastructural findings showed interdigitating plasma membranes with prominent desmosomes between the Paget cells, intracytoplasmic tonofibrils, intracellular tubules, lipid vacuoles, and enlarged mitochondria. Histological, immunohistochemical, and ultrastructural findings suggested that Paget cells showed both eccrine and apocrine differentiation.