Cytological Criteria for Predicting the Luminal Phenotype of Breast Carcinoma.

BACKGROUND: Specific cytological criteria for the luminal phenotype of breast carcinoma, despite it being the most common and having a better prognosis as well as targeted therapies under study, remain to be established. Using fine-needle aspiration cytology (FNAC), we aimed to identify the luminal phenotype through the evaluation of cytological criteria recognized in routine practice. METHODS: We correlated 169 FNACs of breast carcinomas with their tissue specimens, classified into phenotypes by immunohistochemistry (applying tissue microarray technology) as luminal A, luminal B, HER2 overexpression, and triple negative. All FNAC samples were blindly reviewed according to cellularity, cell cohesion, necrosis, nucleoli, and nuclear atypia. Fisher's exact test was used to test associations between the cytological criteria and phenotypes. RESULTS: The following phenotypes were obtained - luminal A: 107 (63.3%), luminal B: 39 (23.1%), HER2 overexpression: 8 (4.7%), and triple negative: 15 (8.9%). The luminal phenotype showed mild/moderate cellularity (40.4%) (OR = 7.12, 95% CI: 1.61-31.52), inconspicuous, present nucleoli (55.5%) (OR = 8.31, 95% CI: 2.36-29.19), and mild/moderate nuclear atypia (44.5%) (OR = 8.42, 95% CI: 1.90-37.25). CONCLUSION: The criteria that might indicate the luminal phenotype of breast carcinoma in FNAC were mild/moderate cellularity, inconspicuous, present, and nonprominent nucleoli, and mild/moderate nuclear atypia.

Fine needle aspiration cytology of lobular breast carcinoma and its variants.

OBJECTIVE: To identify associations between cytological criteria in fine needle aspiration (FNA) specimens and histological subtypes of lobular breast carcinoma (classical and other types). STUDY DESIGN: FNA cytology and mastectomy specimens from 72 cases of invasive lobular breast carcinoma were consecutively retrieved from the files of the Amaral de Carvalho Hospital, Jaú-São Paulo, Brazil. All cases were reviewed regarding five cytological criteria: cellularity, cellular cohesion, presence of inflammation, nucleoli and nuclear atypia. The χ2 test or Fisher's exact tests with 95% confidence intervals (CI) were used. RESULTS: The classical type showed lower initial cytological diagnosis of malignancy compared to the other variants (p=0.017; odds ratio (OR) 0.26, 95% CI 0.89-0.80). Moderate/intense cellular cohesion (p=0.011; OR 0.18, 95% CI 0.04-0.73) and mild atypia (p=0.000; OR 16.15, 95% CI 3.20-81.48) were significantly associated with the classical type of lobular breast carcinoma, while the absence of inflammation (p=0.082; OR 0.36, 95% CI 0.12-1.15) was marginally associated with the classical type. CONCLUSIONS: In cytology, the characterization of lobular carcinoma as malignant is difficult, especially the classical type. The association between cell cohesion and the classical type of lobular breast carcinoma may be one of the factors that complicate this diagnosis.

Mononuclear inflammatory infiltrate and microcirculation injury in acute rejection: role in renal allograft survival.

This study aimed at investigating associations between monocytes/macrophages (Mo) infiltration and three important criteria associated with acute antibody-mediated rejection: C4d staining, microcirculation injury, and graft survival time. By quantitative analysis, Mo were counted in peritubular capillaries and in the interstitial compartment (peritubular/interstitial Mo), and they were also identified in glomeruli (glomerular Mo). The study included 47 patients who received renal allograft between 1991 and 2009. Capillaritis and glomerulitis were classified by the Banff scoring system, and C4d and Mo were analyzed by immunohistochemistry. In the quantitative analysis, the mean values of 50 Mo per 10 high-power fields (HPF) and 4 Mo per glomerulus were used as cut-off points for the peritubular/interstitial and glomerular compartments, respectively. Positive C4d cases were associated with the groups of biopsies with a mean value ≥50 Mo per 10 HPF (p = 0.01) and ≥4 Mo per glomerulus (p = 0.02). The group with a mean value ≥4 Mo per glomerulus also showed association with the presence of glomerulitis (p = 0.02). Peritubular/interstitial Mo did not associate with glomerulitis. Capillaritis did not show association with peritubular/interstitial or glomerular Mo. As regards graft survival, the infiltration of Mo in glomeruli interfered with allograft survival (p = 0.01). The group with a mean value of ≥4 glomerular Mo presented worse survival at the time of the 1-year follow-up. According to the literature, our data showed that infiltration of mononuclear cells was associated with C4d staining, microcirculation injury, and glomerulitis, in particular, and that glomerular macrophages could influence renal allograft survival.

Perivascular epithelioid cell tumor of the liver coexisting with a gastrointestinal stromal tumor.

Approximately 10% of patients with gastrointestinal stromal tumors (GIST) develop other neoplasms, either synchronously or metachronously. In this report we describe coexistence of a gastrointestinal stromal tumor and a hepatic perivascular epithelioid cell tumor (PEComa) in a 51-year-old woman with no evidence of tuberous sclerosis. A subcapsular hepatic nodule (0.8 cm in diameter) was found during surgery for symptomatic gastric neoplasm (15 cm in diameter) arising from the lesser curvature. Both tumors revealed histomorphological and immunohistochemical features confirming a diagnosis of a small incidental hepatic PEComa and a high risky extramural gastric GIST, respectively. The patient remained disease-free 25 mo after surgery with no evidence of tumor recurrence or new neoplasms. To our knowledge, this is the first report of PEComa in a patient with GIST. Hepatic lesions detected synchronously or metachronously in patients with GISTs may represent histogenetically distinct lesions and should be sampled to confirm or exclude metastatic GISTs.

Shorter CAG repeat in the AR gene is associated with atypical hyperplasia and breast carcinoma.

BACKGROUND: Previous reports into the role of [CAG]n repeat lengths in the androgen receptor (AR) gene indicate that these may play an important part in the development and progression of breast cancer, however, knowledge regarding benign breast lesions is limited. PATIENTS AND METHODS: PCR-based GeneScan analysis was used to investigate the [CAG]n repeat length at exon 1 of the AR gene in 59 benign breast lesions (27 fibroadenomas, 18 atypical hyperplasias, and 14 hyperplasias without atypia) and 54 ductal breast carcinomas. Seventy-two cancer-free women were used as a control group. In addition, [CAG]n repeats were evaluated for the presence of loss of heterozygosity (LOH) and microsatellite instability (MSI) in a subset of these samples (27 fibroadenomas, 14 hyperplasias without atypia and 22 breast carcinomas). RESULTS: Shorter [CAG]n repeat lengths were strongly correlated with atypical hyperplasias (p = 0.0209) and carcinomas (p < 0.0001). LOH was found in 1/12 and 4/20 informative cases of hyperplasias without atypia and breast carcinomas, respectively. Three patients with breast carcinoma who had previously presented atypical hyperplasia showed a reduction in the [CAG]n repeat length in their carcinomas. CONCLUSION: Short [CAG]n repeat length (< or = 20) polymorphisms are strongly associated with breast carcinomas and atypical hyperplasias. Although non-significant, a subgroup of patients with breast carcinoma and genotype SS showed an association with parameters of worse outcome.

Carcinoma de células claras da mama rico em glicogênio / Glicogen-rich clear cell of the breast

O carcinoma rico em glicogênio da mama é uma variante rara de carcinoma ductal infiltrativo. Clinicamente, não difere de outros tipos de carcinoma mamário. Relatamos um caso de paciente de 56 anos, com nódulo não-palpável de mama direita, cujo diagnóstico por biópsia foi de carcinoma de células claras da mama. Posteriormente, a paciente foi submetida a setorectomia com biópsia do linfonodo sentinela. Como apresentava receptores de estrógeno e progesterona positivos, optou-se por radioterapia e hormonoterapia como tratamento adjuvante. De história pregressa, há cinco anos, a paciente havia sido submetida a nefrectomia por carcinoma renal, diagnosticado à época como carcinoma de células claras, sugerindo que o tumor mamário atual fosse de natureza metastática, hipótese afastada por estudo imunoistoquímico. A revisão do tumor renal, no entanto, mostrou tratar-se de carcinoma de células cromófobas do rim, variante de prognóstico favorável e sem potencial metastático.

The glycogen-rich carcinoma of the breast is an uncommon type of ductal invasive carcinoma. Its clinical presentation does not differ from other types of invasive carcinoma of the breast. Herein, we report a case of a 56-year old woman presenting with a nonpalpable nodule in the right breast whose biopsy diagnosis was glicogen-rich clear-cell carcinoma. A lumpectomy was performed later on with sentinel lymph node biopsy. As it expressed estrogen and progesterone receptors, radiotherapy and hormoniotherapy were given as adjuvant treatment. Of interest, 5 years ago, the patient had been underwent a nephrectomy due to a renal carcinoma diagnosed as clear-cell carcinoma of the kidney raising the suspect that the breast tumor might be a metastase. This hypothesis, however, was eliminated by immunohistochemistry. Moreover, the review of the slides of the renal tumor showed a cromophobe-cell carcinoma, a variant associated with favorable prognosis and no metastatic potential.