Pólipo endometrial metaplásico: hallazgo histeroscópico de enfermedad premaligna en mujeres jóvenes. Reporte de tres casos / Endometrial metaplastic polyps: findings of premalignant disease on histeroscopy in young women, a report of 3 cases

ANTECEDENTES: Los pólipos endometriales son sobrecrecimientos de la mucosa endometrial, una de las causas más comunes de hemorragia uterina anormal, pueden estar asociados con lesiones premalignas y malignas del endometrio. Existen características histeroscópicas que ayudan a diferenciar una lesión benigna o maligna. El pólipo metaplásico es un hallazgo histeroscópico caracterizado por superficies laminares e hiperqueratosis, con zonas blancas e hiperrefringentes. CASOS CLÍNICOS: Tres casos clínicos de pacientes menores de 40 años, con hemorragia uterina anormal donde el hallazgo histeroscópico común fue el pólipo metaplásico, hallazgo premaligno que se confirmó mediante el análisis patológico y la positividad del marcador de inmunohistoquímica p63. Caso 1. Paciente de 28 años, nulípara, obesa, con antecedente de síndrome de ovario poliquístico, con engrosamiento endometrial e histeroscopia, con pólipo con superficie hiperqueratósica, a manera de láminas irregulares, con excrecencias y lesiones exofíticas. Caso 2. Paciente de 25 años, con endometrio irregular engrosado e histeroscopia con hallazgo de pólipos transparentes, con cambios vasculares leves y superficie con zonas hiperrefringentes blanquecinas. Caso 3. Paciente de 38 años, con antecedente de síndrome de ovario poliquístico y obesidad. En la histeroscopia el endometrio se encontró hiperplásico, irregular, con cambios vasculares y pólipos con zonas superficiales hiperrefringentes, sólidas y blancas. CONCLUSIONES: En pacientes jóvenes, con hallazgo histeroscópico de pólipo metaplásico debe considerarse y descartar la enfermedad premaligna y maligna endometrial. El estudio debe completarse con marcadores de inmunohistoquímica (p63), específicos de la metaplasia escamosa.

Abstract BACKGROUND: Endometrial polyps are overgrowths of the endometrial mucosa, one of the most common causes of abnormal uterine bleeding and may be associated with premalignant and malignant endometrial lesions. There are hysteroscopic features that help differentiate a benign or malignant lesion. Metaplastic polyp is a hysteroscopic finding characterized by lamellar surfaces and hyperkeratosis, with white and hyperreflective areas. CLINICAL CASES: Three clinical cases of patients under 40 years of age, with abnormal uterine bleeding where the common hysteroscopic finding was metaplastic polyp, a premalignant finding that was confirmed by pathological analysis and positivity of the immunohistochemistry marker p63. Case 1. 28-year-old female, nulliparous, obese, with a history of polycystic ovary syndrome, with endometrial thickening and hysteroscopy, with polyp with hyperkeratotic surface, in the form of irregular sheets, with excrescences and exophytic lesions. Case 2. 25-year-old patient, with irregular thickened endometrium and hysteroscopy with finding of transparent polyps, with mild vascular changes and surface with whitish hyperrefringent areas. Case 3. 38-year-old patient with a history of polycystic ovary syndrome and obesity. At hysteroscopy the endometrium was found to be irregularly hyperplastic, with vascular changes and polyps with hyper-refringent, solid, white superficial areas. CONCLUSIONS: In young patients, with hysteroscopic finding of metaplastic polyp should be considered and premalignant and malignant endometrial disease should be ruled out. The study should be completed with immunohistochemical markers (p63), specific for squamous metaplasia.

Metaplastic breast carcinoma with chondrosarcomatous differentiation: an unusual disease with a worse prognosis

Metaplastic breast carcinoma (MBC) has an incidence of <1% of all breast cancers and MBC with chondrosarcomatous differentiation is even more rare, <0.1% of all cases. The World Health Organization have classified MBC into pure epithelial-type and mixed epithelial and mesenchymal type. The epithelial-type MBC is sub-classified into squamous cell carcinoma, adenosquamous carcinoma and adenocarcinoma with spindle cell differentiation; mixed type MBC is sub-classified into carcinosarcoma and carcinoma with osseous and chondroid metaplasia. Metaplastic carcinomas of the breast are characterized by large tumour size and rapid  growth, and they are usually estrogen receptor, progesterone receptor, and HER2/neu negative and tend to have a worse prognosis than other triple negative breast cancers. There is a noteworthy increased risk of tumour recurrence and a worse prognosis with MBC compared with invasive lobular carcinoma and infiltrating duct carcinoma. We report a case of metaplastic carcinoma with extensive chondroid differentiation that is chondrosarcoma and chondroid metaplasia along with classic infiltrating duct carcinoma with involvement of ipsilateral axillary lymph nodes.

In vivo diagnosis of intraocular osseous metaplasia in neovascular age-related macular degeneration

A 75-year-old man presented with deterioration of right eye vision for 6 months. He had no relevant medical history. Fundus examination revealed subretinal fluid, fibrosis, and subretinal hemorrhages. Ocular coherence tomography of the right macula illustrated an underlying subretinal lesion with internal lamellae, resembling trabecular bone elsewhere in the body. Bruch's membrane was clearly intact beneath the lesion, indicating an extrachoroidal location. The lesion appeared highly reflective on B-scan ultrasonography, consistent with ossification. Although initially misdiagnosed as choroidal osteoma, this lesion represents in-vivo intraocular osseous metaplasia at the site of neovascular age-related macular degeneration. The authors believe that similar lesions may have been misdiagnosed as 揳typical� osteoma caused by failure to identify their extrachoroidal location.

Basal Cell Carcinoma with Metaplastic Bone Formation / 대한피부과학회지

No abstract available.

Cáncer de metaplásico de mama: revisión de dos casos clínicos / Metaplastic breast cancer: review of two clinical cases

RESUMEN El carcinoma metaplásico de mama es un tipo de cáncer infiltrante que asemeja un carcinoma de alto grado histológico, pero cuya incidencia es muy baja (< 1%). Desde el punto de vista anatomopatológico presenta un componente mixto epitelial y mesenquimal; siendo lo más característico su comportamiento clínico altamente agresivo junto con unas características anatomopatológicas, inmunohistoquímicas concordantes, como son el HER2/neu negativo, los receptores hormonales negativos, el tamaño tumoral grande y el alto grado histológico. Por todo ello, resulta de especial interés conocer esta entidad, con la finalidad de realizar un diagnóstico preciso y llevar a cabo un tratamiento adecuado en estas pacientes. En el presente artículo se presenta la revisión de dos casos clínicos de cáncer de mama metaplásico, diagnosticados y tratados en nuestro Hospital durante el año 2015 y 2018.

ABSTRACT The metaplastic breast cancer is a subtype of an infiltranting breast cancer and it's usually high grade. However it is a rare subtype of cancer (incidence <1%). This cancer has an epithelial and connective tissues, which has an epithelial invasor ductal breast cancer with high grade and sarcomas breast. The main characteristic of the metaplastic breast cancer is their high agressive behavior as clinical as anatomopathological, which immunohistochemical expression is like a triple negative breast cancer. Because of this we consider that their knowledge is very important with the purpose of being diagnosed in women. In this paper it is showed a revision of two cases of metaplastic breast cancer, whose diagnostic and treatment were reported in our Centre.

Metaplastic Carcinoma with Chondroid Differentiation Arising in Microglandular Adenosis

Microglandular adenosis (MGA) of the breast is a rare, benign proliferative lesion but with a significant rate of associated carcinoma. Herein, we report an unusual case of metaplastic carcinoma with chondroid differentiation associated with typical MGA. Histologically, MGA showed a direct transition to metaplastic carcinoma without an intervening atypical MGA or ductal carcinoma in situ component. The immunohistochemical profile of the metaplastic carcinoma was mostly similar to that of MGA. In both areas, all the epithelial cells were positive for S-100 protein, but negative for estrogen receptor, progesterone receptor, HER2/neu, and epidermal growth factor receptor. An increase in the Ki-67 and p53 labelling index was observed from MGA to invasive carcinoma. To the best of our knowledge, this is the first case of metaplastic carcinoma with chondroid differentiation arising in MGA in Korea. This case supports the hypothesis that a subset of MGA may be a non-obligate morphologic precursor of breast carcinoma, especially the triple-negative subtype.

Ultrasonographic and pathological features of metaplastic carcinoma with squamous cell component of breast / 中国医学影像技术

Objective To observe the ultrasonographic and pathological features of metaplastic carcinoma with squamous cell component (MCSC) of the breast.Methods The ultrasonographic and pathological features of 7 patients with breast MCSC confirmed pathologically were retrospectively analyzed.Results Seven cases were single lesion and the maximal diameters of the lesions were 2.6-5.1 cm.On two-dimensional imaging,6 lesions with cystic and solid were complex echogenic,only 1 lesion was hypoechoic.All the lesions had irregular shape (lobulated)and indistinct margin.On CDFI imaging,most of lesions had rich blood flow signals with high resistance (resistance index 0.75-0.91),4 lesions were grade l,2 lesions were grade Ⅱ and 1 lesion was grade Ⅰ blood flow signals.On gross histopathological examination,6 masses had cystic cavity,only 1 mass was pure solid.On microscopic histopathological examination,5 masses were adenosqua mous carcinoma,only 2 masses were pure squamous cell carcinoma.Estrogen receptors,progesterone receptors and human epidermal growth factor receptor were negative in 4 masses (triple-negative breast cancer).Conclusion MCSC have some distinguished ultrasonic characteristics of larger volume,cystic-solid mixed echo,posterior echo enhancement,abundant vascularity with high resistance.

Clinicopathological features, immunohistochemistry and differential diagnostic analysis of metaplastic breast carcinoma / 重庆医学

Objective To analyze the clinicopathological features,immunohistochemistry and differential diagnosis of metaplastic breast carcinoma.Methods A total of 32 cases of patients with metaplastic breast cancer in our hospital from March 2013 to March 2016 was randomly selected.The specimens were fixed with 4％ neutral formaldehyde solution,then dehydrated,embedded,sliced,stained with HE,and immunohistochemically stained with immunohistochemical staining machine,and then the results of macroscopic examination,microscopic examination and immunohistochemical examination were analyzed.Results Metaplastic breast cancer was lack of clear boundaries,and had no envelope.The tumor diameter was 1-5 cm,and its average was(3.1 ±1.2) cm.Section was tough and solid.Some had nodular shape,and their color was gray.Some had cysts appearance in the section.Among the 32 patients,20 patients underwent sentinel lymph node biopsy without cancer metastasis,and 12 patients underwent axillary lymph node dissection,including 8 cases with axillary lymph node metastasis;32 patients were presented as estrogen receptor (ER) (-),progesterone receptor(PR) (-),epidermal growth factor receptor-2 (HER-2) (-),broad spectrum CK (+),28 patients presented as epidermal growth factor receptor(EGFR)(+),20 patients presented as CK5/6 (+),and 8 patients presented as p53 (+),myoepithelial carcinoma p63 (+),respectively accounting for 100.0％,87.5 ％,62.5 ％ and 25.0％ in their total number.A total of 32 cases of patients with metaplastic breast carcinoma was divided into two types according to the metaplasia:pure epithelial type,including 4 cases of squamous cell carcinoma,2 cases of glandular squamous cell carcinoma and 13 cases of adenocarcinoma differentiated by spindle cell;epithelial/mesenchymal metaplastic carcinoma,its heterologous elements including 3 cases of sarcomatoid components,3 cases of rhabdomyosarcoma-like ingredients and 7 cases of ossification of cartilage and natural ingredients.Conclusion Metaplastic breast cancer,ER(-),PR(-),and HER-2 (-) should be identified with primary breast sarcoma,malignant follicular tumor,sarcomatosis and desmoplastic breast cancer.

Carcinoma metaplásico escamoso primario de mama: un subtipo infrecuente. A propósito de tres casos en el Hospital Universitario del Caribe / Primary breast squamous metaplastic squamous cell carcinoma of the breast: a rare subtype. Presentation of three cases in the Hospital Universitario del Caribe

De todas las neoplasias malignas de mama los carcinomas ductales son los más frecuentes. Menos del 5% son denaturaleza metaplásica y 0,04%-0,1% presentan diferenciación de células escamosas, subtipo que se considera más agresivo. Debido a los pocos casos en la literatura,no hay consenso sobre su diagnósticoy tratamiento. Presentamos tres casos con ese diagnóstico vistos entre 2014 y 2015 en nuestra institución y que corresponden a mujeres de 57, 49 y 65 años sin factores de riesgo y que presentaron cuadros clínicos similares consistentes con aparición de masa de crecimiento rápido. Dos de las pacientes se habían diagnosticado previamente con carcinoma ductal infiltrante de tipo no especial en biopsias por tru-cut con diagnóstico definitivo en la mastectomía radical que reportó en todos los casos carcinoma metaplásico escamoso confirmado por inmunohistoquímica.

Ductal carcinomas are the most common of all breast malignancies, less than 5% are of metaplastic nature, and 0.04% to 0.1% have squamous cell differentiation. These special subtypes are considered more aggressive. Due to the few cases in the literature, there is no consensus about its diagnosis and treatment. Three cases are presented with this diagnosis, seen in our institution between 2014 and 2015. They were women of 57, 49, and 65 years old with no risk factors, and who presented with similar clinical features, consisting of the appearance of a rapid growing mass. Two of the patients had been previously diagnosed with infiltrating ductal carcinoma of no special type by core needle biopsy, with a definitive diagnosis in radical mastectomy, which reported squamous metaplastic carcinoma confirmed by immunohistochemistry.

Pulmonary hemangioendothelioma with osteoclast‑like giant cells: A rare observation.

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular neoplasm, predominantly encountered in women, more often in the age group of 40 years and below. It is a tumor of borderline malignant potential with a clinical course intermediate between hemangioma and angiosarcoma. The tumor has variable prognosis, and treatment options include surgical excision in operable cases and chemotherapy in disseminated ones. The present report describes complete clinical, radiological, and histopathological features of PEH with osteoclast‑like giant cells and metaplastic ossification in a 20‑year‑old boy who presented with dyspnea and episodes of hemoptysis with review of literature.

Heterologous osseous differentiation in Malignant Phyllodes tumour – A rare case report

Breast sarcomas are rare neoplasms accounting for less than 1% of breast malignancy. Phyllodes tumors have biphasic histological features with both epithelial and stromal component. Careful characterization of the stromal component is critical since it is the pathologic features of the stromal cells that determine its malignant potential. We reported a case of 57 years old female with right breast mass who underwent wide excision and on histological examination a diagnosis of malignant phyllodes tumour with heterogonous osseous differentiation was made. The rarity of the lesion was considered for reporting and on follow up the patient was free of metastasis.

Fallopian Metaplastic Papillary Tumour: An Atypical Transdifferentiation of the Tubal Epithelium?

A metaplastic papillary tumor of the Fallopian tube is an extremely uncommon condition, with odd and confusing features that make it difficult to categorize as benign or borderline. Here, we summarize all the published cases to date and document the case of a 41-year-old woman diagnosed with this alteration after her last childbirth and ensuing tubal ligation. One of the tubes was bulky and filled with a caramel-like substance encircling a blurry spot. Light microscopy detailed a slender stalk covered by eosinophilic, columnar plump cells, showing atypical nuclei and focal budding. Mitotic figures were absent. The immunohistochemistry panel was positive for pan-cytokeratin, epithelial membrane antigen, cyclin D1, and hormone receptors. Additionally, a proliferation index of less than 5% was rated using Ki-67. The true nature of this tumor (reactive vs neoplastic) is uncertain. Nonetheless, its association with pregnancy suggests an adaptive change, likely similar to the atypical transdifferentiation proposed for Arias-Stella reaction.

Recent advances in spindle cell carcinoma of the breast / 国际外科学杂志

Spindle cell carcinoma of the breast (SpCC) is a very rare variant of breast cancer characterized as large tumor size,high histological grade and high negative expression of hormone receptors and HER2/neu protein.It has a high tendency for local recurrence and distant metastasis,while the axillary lymph node metastasis is less common occured,which leads to poor outcomes.Given the relatively low incidence,our knowledge about SpCC is limited.The main unsolved obstacles are the early dection and diagnosis,and the improvement in treatments.Herein,this article reviewed the clinicopathologic characteristic,diagnosis,treatment and prognosis of the spindle cell carcinoma of breast.

Diagnostic Dilemma in Metaplastic Chondroid Breast Carcinoma

Metaplastic breast cancer is a rare form of primary breast cancer. It contains a mixture of adenocarcinoma with metaplastic elements. It is important to differentiate with primary sarcoma of the breast which carries different treatment strategies and prognosis. A 55-year-old lady previously diagnosed to have a left breast cancer in the year 2000 and carcinoma of the endometrium in 2009, presented with a right breast lump. A trucut biopsy reported as an infiltrating ductal carcinoma with background of chondromyxoid and cartilagenous matrix, most probably metaplastic carcinoma. A wide local excision with sentinel lymph node biopsy was performed, and the final histology was consistent with metaplastic chondroid carcinoma of the breast with no evidence of metastsis. The surgery was followed by adjuvant radiotherapy and currently free from any recurrence. The diagnostic dilemma on this very rare condition is reviewed.

Metaplastic Carcinoma of Breast - Squamous Variant.

Metaplastic carcinoma of breast is a rare neoplasm. Although it is a tumor of ductal type, the predominant component may have appearance other than the glandular pattern and usually runs an aggressive course.

Carcinoma metaplásico de mama en una paciente menor de 30 años / Breast metaplasic carcinoma in patient less than 30 yeard old

Los carcinomas metaplásicos de mama son un grupo heterogéneo de neoplasias malignas poco frecuentes poco diferenciadas; que representan menos del 1% de todos los tumores de mama invasivos, en los que un segmento de células epiteliales ha sufrido metaplasia, son bifásicos, capaces de adoptar un fenotipo variable, con receptores de estrógeno, progesterona, Her2 negativos. Los carcinomas metaplásicos de mama son más frecuentes en mujeres mayores de 55 años. Su pronóstico es peor que los carcinomas convencionales se relaciona con el tamaño tumoral, tipo histológico, y grado de componente mesenquimático. El tratamiento inicial es quirúrgicoy se considera imprescindible el empleo de técnicas de inmunohistoquímica para diagnosticarlos. Presentamos el caso de una paciente joven de 28 años de edad a quiense le realizó en clínica particular, una mastectomía parcial que reportó carcinoma metaplásico, acudiendo a nuestro servicio, donde se le realiza mastectomía radical modificada tipo Madden preservadora de piel.

Metaplastic breast carcinomas are heterogeneous group of malignancies poorly differentiated and rare, representing less than 1% of all invasive breast tumors, in which a segment has undergone metaplasia epithelial cells are biphasic which can take a variable phenotype, with negative estrogen and progestagen receptors Her2 negative. Metaplastic breast carcinomas are more common in women over 55 years, however, most reports ascribed different characteristics to those of infiltrating ductal carcinoma, found larger tumors, high grade, lymphatic glandular less affected with hormone receptor negative. The prognosis is worse than conventional carcinomas is related to tumor size, histological type, type degree of mesenchymal component.The treatment is surgical is considered essential to the use of immunohistochemistry for diagnosis. We report the case of 28 year woman who was held in private clinic, a partial mastectomy reported metaplastic carcinoma, going to our service, which performs modified radical mastectomy Madden type of skin sparing.

Totally Ossified Metaplastic Spinal Meningioma

A 61-year-old woman with a very rare case of totally ossified large thoracic spinal metaplastic meningioma, showing progressing myelopathy is presented. Computed tomographic images showed a large totally ossfied intradural round mass occupying the spinal canal on T9-10 level. Magnetic resonance imaging revealed a large T9-10 intradural extramedullary mass that was hypointense to spinal cord on T1- and T2-weighted sequences, partial enhancement was apparent after Gadolinium administration. The spinal cord was severely compressed and displaced toward the right at the level of T9-10. Surgical removal of the tumor was successfully accomplished via the posterior midline approach and the histological diagnosis verified an ossified metaplastic meningioma. The clinical neurological symptoms of patient were improved postoperatively. In this article we discuss the surgical and pathological aspects of rare case of spinal totally ossified metaplastic meningioma.

Ureteric nephrogenic adenoma: A report of two cases.

Nephrogenic adenoma is a rare, benign, metaplastic lesion predominantly seen in urinary bladder, which occurs even more rarely in the ureters. We report two such cases, arising in the ureter. Both patients were young adult males. Histology of both cases was similar, showing tubules lined by columnar cells with hobnailing of nuclei. Immunohistochemically, both cases resembled their counterparts in urinary bladder. These lesions are important to recognize, since they can easily be confused with several malignancies.

Metaplastic Carcinoma with an Adenomyoepithelioma Component : A Case Report

Metaplastic carcinoma of the breast is rare. We report a case in a 53-year-old woman who presented with a rapidly-growing breast mass. The lesion had a complex echogenicity in ultrasonography and a high signal intensity in a T2-weighted image with rim enhancement in contrast-enhanced MR images. The PET/CT images showed high uptake for the lesion. The lesion was biopsied and found to be a metaplastic carcinoma with an adenomyoepithelioma component. Although metaplstic carcinoma was difficult to differentiate from other common breast cancers, it showed complex echogenicity on ultrasonography and high signal intensity on a T2 weighted image with rim enhancement on contrast-enhanced MR images.

Cutaneous Metaplastic Synovial Cyst of the First Metatarsal Head Area

A cutaneous metaplastic synovial cyst (CMSC) is a cyst lined with metaplastic synovial tissue, which includes the formation of an intracystic villous structure resembling hyperplastic synovial villi. Clinically, the lesion is a tender, subcutaneous nodule that usually occurs at the site of previous surgical trauma and is frequently misdiagnosed as a suture granuloma. The actual cause remains unclear; however, trauma is presumed to be a precipitating factor, as most reported cases have demonstrated a history of antecedent cutaneous injury. Here, we present a case of CMSC in a 51-year-old woman who presented with a cystic mass localized in the left sole. She had no history of previous trauma or surgical procedures performed in the area. Although the case explained in this report is a spontaneous case of CMSC that occurred without a history of trauma, it is believed to have been caused by constant and chronic pressure since CMSC occurred in the first metatarsal head area, a part of the sole where heavy pressure is consistently applied.