Clinicopathologic study of intracystic papillary carcinoma of the breast / 中华病理学杂志

<p><b>OBJECTIVE</b>To elucidate the clinicopathologic features, immunophenotype and differential diagnosis of intracystic papillary carcinoma (IPC).</p><p><b>METHODS</b>The clinical and pathological characteristics of 14 cases of breast IPC were studied. Immunohistochemical study of SMA, MSA, ER, PR, p63, AE1/AE3, 34betaE12 and CK5/6 was performed using Envision method.</p><p><b>RESULTS</b>The age of IPC patients ranged from 42 to 79, with a mean age of 65.4 years. A palpable mass was the most common symptom. There were two morphological features: (1) Slender papillae lined by tall columnar epithelial cells which were present directly on the fibrovascular cores without an intervening myoepithelial cell layer (9 cases). (2) The proliferation may assume a cribriform architecture with rigid, punched-out regular spaces or a solid glandular pattern, studded with fibrovascular cores (5 cases). Low nuclear grade is typically seen. Among the 14 cases of IPC, 11 were of pure type. Ductal carcinoma in situ (DCIS) in adjacent ducts was found in one case, and invasive carcinoma was found in two cases. Immunohistochemical results showed that the tumor cells were homogenously strongly positive for ER and PR, but were negative or focally and weakly positive for CK5/6 and 34betaE12. Myoepithelial cell staining was negative within the tumor; and was diminished or scattered at the periphery of the tumor.</p><p><b>CONCLUSIONS</b>IPC is a rare entity that usually arises in older women. It is specific enough in its clinical presentation and morphologic appearance to warrant distinction from other breast lesions.</p>

Clinicopathologic study of breast cancer with features of endocrine ductal carcinoma-in-situ / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features and differential diagnosis of 18 cases of endocrine ductal carcinoma-in-situ (E-DCIS).</p><p><b>METHODS</b>Eighteen cases of breast cancer with features of E-DCIS were studied by light microscopy, histochemistry and immunohistochemistry. E-DCIS was diagnosed if the histologic patterns were compatible with those described in the literature and at least 50% of the tumor cells expressing two of the three neuroendocrine markers employed (chromogranin, synaptophysin and neuron-specific enolase).</p><p><b>RESULTS</b>E-DCIS tended to occur in older women. All the patients were over 61 years old (mean age=71 years). The presenting symptoms were either palpable breast mass or had nipple discharge. Histologically, E-DCIS demonstrated an expansile intraductal growth pattern. Intraductal papilloma was not uncommon at the peripheral area of the tumor. The tumor cells were polygonal, oval or spindle in shape and contained abundant eosinophilic to granular cytoplasm and mildly to moderately pleomorphic nuclei. Intracellular or extracellular mucin was highlighted by periodic acid-Schiff (with diastase digestion) or alcian blue stains. Some tumor cells assumed a signet-ring configuration. All the three neuroendocrine markers were expressed by more than 50% of the E-DCIS cells. The neuroendocrine differentiation was further confirmed in some cases by CD57 and CD56 immunostaining. Pagetoid spread into adjacent ductolobular units was frequently seen in E-DCIS, and the expanded lobules were often not rimmed by myoepithelial cells. These two features helped to distinguish E-DCIS from usual ductal hyperplasia.</p><p><b>CONCLUSIONS</b>E-DCIS represents a subgroup of low-grade DCIS, which carries characteristic morphologic features and immunophenotype. Conventional light microscopy usually permits a correct diagnosis. Ancillary histochemical and immunohistochemical studies can be helpful in doubtful cases.</p>