Malignant adenomyoepithelioma of the breast: a non-tubular and matrix-producing variant.

Two women, aged 82 and 58 years old, cases 1 and 2, respectively, with the non-tubular and matrix-producing variant of malignant adenomyoepithelioma (MAM) of the breast are described. The tumors were 20 and 35 mm in diameter, respectively, and had cut surfaces with a tan-white-colored appearance and vague lobulation. Although both tumors showed marked central necrosis and a high level of mitoses, the tumor cells had relatively monomorphous nuclei and exhibited only mild atypia. The invasive component was predominantly trabecular and lobular, and the intraductal component demonstrated a focal-comedo pattern. The cytoplasm of the tumor cells was rather scanty, vacuolar or pale with ill-defined borders. The tumor in case 2 contained intermingled spindle-shaped cells. The stroma of both tumors resembled that of pleomorphic adenoma, containing a myxoid and chondroid matrix and, in case 2, cartilage and mature bone. Immunohistochemical and ultrastructural analyses of both tumors revealed dual cytological differentiation, predominantly of myoepithelial cells with secretory epithelial cells intermingled haphazardly. Although these tumors resembled metaplastic carcinomas, particularly matrix-producing carcinomas, they showed marked myoepithelial differentiation without overt tubular differentiation, a pattern quite different from matrix-producing carcinomas and from the adenomyoepitheliomas reported so far. MAM of the breast, non-tubular and matrix-producing variant, resembles epithelioid myoepithelial carcinoma of the salivary gland and has not been reported previously in the English literature.

Cineangiographic evaluation of diastolic properties of the left ventricle in man.

Diastolic properties of the left ventricle were evaluated cineangiographically in 110 patients with various heart diseases (19 normal cases, 13 mitral stenosis, 19 left ventricular volume overload, 18 coronary artery diseases without myocardial infarction, 27 myocardial infarction, 6 hypertrophic cardiomyopathy, 5 congestive cardiomyopathy and 3 chronic constrictive pericarditis). Early diastolic ventricular filling was assessed by diastolic maximal circumferential relaxation velocity (maxVcf), diastolic maximal dV/dt, volume change during early 1/3 of ventricular filling (V1/3), rapid filling time and isovolumic relaxation time; myocardial stiffness constant K was calculated at end-diastole. Increase in myocardial stiffness constant was not necessarily associated with abnormal indices measured during the early diastolic period but well correlate with isovolumic relaxation time. During the isovolumic relaxation period, the affected left ventricular segments where myocardial infarction or myocardial hypertrophy existed, showed reduced and delayed relaxation resulting in a total increase in the isovolumic relaxation period. Calcium antagonist was effective in improving the delayed relaxation in patients with left ventricular hypertrophy, suggesting a role of calcium on delayed myocardial relaxation in the hypertrophied heart.