Canan Kelten

Insertion/deletion polymorphism of the angiotensin I-converting enzyme gene in patients with breast cancer and effects on prognostic factors.

The aims of the present study were to investigate the distribution of the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene in breast cancer patients and the association between ACE genotypes and clinicopathologic features, as well as their effects on prognosis. We assessed the I/D polymophism of the ACE gene by using polymerase chain reaction from peripheral blood in breast cancer and healthy age-matched women. The clinicopathologic parameters of breast cancer patients were obtained from medical records. Of the 57 patients, 31 (54.4%) had DD, 24 (42.1%) had ID, and 2 (3.5%) had II genotypes. In control subjects, 33 (63.5%) had DD, 12 (23.1%) had ID, and 7 (13.4%) had II genotypes. The ID genotype was seen more commonly in breast cancer patients (p = .03). When the combination of ID and II genotypes was used as a reference group, the DD genotype was associated with negative hormone receptor status (p = .003), tumor size (p = .054), and lymph node involvement (p = .07) but not histologic high grade and c-erb B2 overexpression. These results suggest that the DD genotype may accompany poor prognostic factors and influence the tumor course.

Ectopic Pancreas of the Gastric Antrum Contiguous to a Gastrointestinal Stromal Tumor Manifesting as Upper Gastrointestinal Bleeding: Report of a Case

A 54-year-old woman was referred to us for investigation of recurrent episodes of melena. Gastroduodenal endoscopic examination revealed a hemorrhagic, polypoid tumor, about 3 cm in diameter, in the posterior wall of the gastric antrum, near the greater curvature. The lesion had a smooth surface with ulceration, and was fixed to the sublying planes. The source of the bleeding was the mucosa overlying the tumor. We performed a distal subtotal gastrectomy with Roux-en-Y anastomosis. Histopathological examination of the resected specimen revealed an ectopic pancreas and a gastrointestinal stromal tumor contiguous to the ectopic pancreatic tissue in the gastric antrum. The patient was discharged after an uneventful postoperative course and has not experienced any recurrence of symptoms since.

PRIMARY NEUROENDOCRINE CARCINOMA OF THE BREAST: A CASE REPORT

Primary neuroendocrine carcinoma of the breast is an extremely rare tumor. We present our experience of primary neuroendocrine carcinoma of the breast in a 76-year-old woman. Surgical biopsies from breast and axillary lymphadenopathy showed a neuroendocrine carcinoma. Immunohistochemical staining of tumor cells with GCDFP15, NSE and chromogranin were positive. Computed tomography scans of the chest and abdomen showed no lesion for metastasis or another primary origin. Adjuvant hormone therapy was given, since the tumor was immunohistochemically receptor positive.

Signet ring cells in fine needle aspiration cytology of breast carcinomas: review of the cytological findings in ten cases identified by histology

Objective:  To establish whether the presence of signet ring cells (SRCs) in histology sections of breast carcinoma cases was reflected by their presence in fine needle aspiration cytology (FNAC) smears, correlating to the histological type of breast carcinoma.

Secondary involvement of the breast in T-cell non-Hodgkin lymphoma, an unusual example mimicking inflammatory breast carcinoma

Non-Hodgkin lymphoma of the breast is a rare malignancy and present with almost equal frequency either as a primary or a secondary disease. Survival is poor in most cases of secondary breast lymphoma because of their advanced stage. We report a 35-year-old woman presenting with dyspnea as well as swelling, tenderness, and ruddiness in the left breast with non-cyclic pain for several months and maculopapular skin eruption in the same breast. Physical examination revealed fixed lymphadenopathies in both axillary regions. Radiologic evaluations (bilateral mammaograpy and ultrasonography) showed skin thickening in the left breast, asymmetrical densities in both breasts, and confirmed lymphadenopathies in the axillary regions. Excisional biopsies were performed to the left axillary lymph nodes and the breast skin eruptions. The histologic and immunohistochemical features were diagnosed as an ALK (−) anaplastic large cell lymphoma. A Computed Tomography examination was performed for staging the lymphoma and then chemotherapy was started. Thirty months after the diagnosis, the patient is still alive with disease. Because of the presence of systemic symptoms such as skin involvement and generalized lymphadenopathies (mediastinal, axillary or cervical), T cell lymphoma cases with breast involvement could mimic the clinical presentation of inflammatory breast carcinoma. Pathologic examination is needed for the correct diagnosis.

Expression and Amplification of Topoisomerase-2α in Type 1 and Type 2 Papillary Renal Cell Carcinomas and Its Correlation with HER2/neu Amplification

The current study was undertaken to investigate chromosomal and genetical aberrations leading to overexpression of Topoisomerase-2α (TOP2α) and to reveal the possible association of these aberrations with HER2/neu overexpression and gene amplification, and to search for the relationship between TOP2α and HER2/neu status with prognostical biomarkers in papillary renal cell carcinoma (RCC), a group of tumors with diverse molecular, chromosomal and clinical features. Archival cases of papillary RCC obtained from Departments of Pathology of Pamukkale, Ege and Dokuz Eylul Universities were studied in two groups (type 1 and type 2) each containing 20 cases. The level of TOP2α and HER2/neu expression by tumor cells were determined immunohistochemically. A multicolor FISH probe was used to define both amplification of HER2/neu and TOP2α genes, and polysomy 17. The ratio of cells expressing TOP2α in type 1 and type 2 papillary RCC were 24.29% and 6.89%, respectively. The difference was statistically significant comparing the average or median values of groups separately (p = 0.002). The expression levels of TOP2α and HER2/neu were also correlated. TOP2α and HER2/neu were co-amplified in both groups. Immunohistochemical expression was not observed in 15 of 23 cases with HER2/neu amplification. The most frequent finding detected by FISH method was polysomy of chromosome 17. We had contradictory results compared with the findings reported in the limited numbers of literature. It shows us that papillary RCC constitute a heterogenous group of tumors with various cytogenetic features and morphological classification of these tumors may not be compatible with their molecular characteristics.

Fine‐needle aspiration biopsy of an invasive ductal carcinoma with medullary features presented with abscess formation

Dear Dr. Bedrossian: We point out that breast carcinomas infrequently appear as cystic masses, which may mimic an abscess formation clinically and cytologically. A 38-year-old woman was presented with a breast mass for 2 weeks. In her physical examination, a palpable, tender breast mass was found within the upper outer quadrant of the right breast without axillary lymphadenopathy. Mammography showed a suspicious microcalcified mass with slightly irregular margins (3 cm in diameter). An ultrasound of the breast revealed a cystic lesion with rough papillary projections. Fine-needle aspiration biopsies (FNABs) from solid and cystic areas of the mass were performed. The smears showed syncytial groups of atypical cells (nuclear pleomorphism, hyperchromasia, nuclear contour irregularity but no macronucleoli) in a background composed of prominent neutrophils and sparse plasma cells (Fig. 1). Tubular formation was also observed in some groups of tumor cells. A diagnosis of malignant cytology consistent with high-grade ductal carcinoma was rendered. The patient, then, underwent breast conservative surgery with sentinel lymph node dissection and was diagnosed as invasive ductal carcinoma with medullary features. No axillary lymph node metastasis was identified. Breast carcinomas are rarely seen clinically as cystic masses. Cystic breast carcinomas comprise intracystic papillary carcinoma, solid tumors infiltrating benign cysts, or cystic degeneration of solid tumors. FNABs from these lesions may reveal varying amounts of neutrophils, which may obscure the tumor cells and mimic abscess formation easily. Therefore, smears with abundant neutrophils in the background should be considered with caution. The differential diagnosis of a breast carcinoma from an abscess is important. Both breast carcinomas and abscess may cause skin retraction, erythema of breast skin, and tenderness. A carcinoma can occur in any site of the breast, whereas breast abscess mostly is confined to subareolar region with a previous history of multiple abscesses in the same area. Breast abscess may have sparse epithelial cells with regenerative atypia on FNAB. However, ultrasound-directed FNAB from breast mass may better reveal groups of many carcinoma cells. High-grade invasive ductal carcinomas with or without medullary features, medullary carcinomas, or pure squamous cell carcinomas have been reported as cystic degenerative masses with extensive neutrophils on their smears. Akbulut et al. reported cytologic features in FNAB from 20 histologically verified medullary breast carcinomas. Only 1 of these 20 cases appeared radiologically as a partly cystic, solid mass (as in our case) and the rest as solid circumscribed masses. However, the presence of neutrophils was observed in 11 of the 20 cases, 3 of which strongly suggested abscess formation. This may show that abundant neutrophils may exist in the background of smears even if the tumors include no cystic components. Moreover, not only a prominent lymphoplasmacytic background but also a neutrophilic infiltrate may be seen in medullary carcinomas. Kleer and Michael reported cytological features of breast carcinomas with prominent lymphocytic infiltrate in 18 cases. Of these 18 cases, 9 were invasive ductal carcinomas and 9 were medullary carcinomas (6 typical and 3 atypical). A prominent neutrophilic infiltrate was observed in one of typical medullary carcinoma cases. *Correspondence to: Ender Duzcan, M.D., Department of Pathology, Pamukkale University School of Medicine, Morfoloji Binasi, Kınıkli 20070, Denizli, Turkey. E-mail: eduzcan@pau.edu.tr Received 26 August 2009; Accepted 6 October 2009 DOI 10.1002/dc.21266 Published online 15 January 2010 in Wiley InterScience (www. interscience.wiley.com).