Corinne Engohan-Aloghe

Estrogen receptor, progesterone receptor, and glucocorticoid receptor expression in normal breast tissue, breast in situ carcinoma, and invasive breast cancer

Glucocorticoids (GCs) are used in cancer treatment to induce programmed cell death in transformed cells of the hematopoietic system and to lessen side effects. Moreover, GCs have been described not only as inhibitors of some chemotherapy or radiation-induced apoptosis, but also as inhibitors of cancer progression by down-regulation or up-regulation of different gene expressions. Recently, it has been suggested that GCs can attenuate estrogen responses through induction of expression and activity of the sulfotransferase. The presence or absence of glucocorticoid receptor (GR) in normal and abnormal breast tissue is thus interesting, and the aim of this study was to analyze the expression of GR during the progression of breast tissue. We tested by immunohistochemistry the expression status of estrogen receptor (ER), progesterone receptor (PR), and GR in normal breast parenchyma (n=49), ductal intraepithelial neoplasia (DIN) 1a (n=9), DIN 1b-1c (n=15), DIN 2-3 (n=21), and invasive breast carcinoma (n=39). The evaluation of GR expression was made by using the Allred score. All the normal parenchyma, DIN 1a, DIN 1b, and DIN 1c were ER-positive (ER+) and PR-positive (PR+). Seventeen of 21 DIN 2-3 and 30 of 39 invasive carcinomas were ER+/PR+. The other samples were ER-negative (ER−) and PR-negative (PR−). Moreover, all the ER−/PR− samples were GR-negative. Interestingly, we found a significant correlation between the histologic grade and the GR-negative tumors, and a percentage of positive patients presented with nuclear immunoreaction to GR, which decreases significantly with tumor histologic grade. Understanding the role of GCs in breast carcinoma is thus essential before continuing the widespread use of GCs combined with antineoplastic drugs or agents in the clinical management of women with breast cancer.

Immediate surgical resection of residual microcalcifications after a diagnosis of pure flat epithelial atypia on core biopsy: A word of caution

The entity of pure flat epithelial atypia remains a challenge due to controversy of the surgical management of residual microcalcifications after core needle biopsies. This study aims to assess the morphological data observed in immediate surgical resection specimen of residual microcalcifications after a diagnosis of pure flat epithelial atypia on mammotome core biopsy. Sixty-two mammotome core biopsy with a diagnosis of pure flat epithelial atypia (flat epithelial atypia without associated atypical ductal hyperplasia, in situ and/or invasive carcinoma) were identified. From these 62 cases, 20 presented residual microcalcifications and underwent an immediate surgical excision after mammotome. Of the 20 patients with excised microcalcifications, 8 (40%)cases had residual pure flat epithelial atypia, 4 (20%) cases had atypical ductal hyperplasia, 4 (20%) cases had lobular in situ neoplasia, no lesions were retrieved in 4 (20%) case. None of the patients had either in situ ductal carcinoma and/or invasive carcinoma. Surgical resection of residual microcalcifications after the diagnosis of pure flat epithelial atypia on core needle biopsy remains still a debate. The present study shows no cases of in situ ductal and/or invasive carcinoma on immediate excision of residual microcalcifications after mammotome core biopsies.

Low-grade adenosquamous carcinoma of the breast—A case report with a BRCA1 germline mutation

Breast cancers occurring in women with germline BRCA1 mutations tend to fall into the category of triple-negative or basal-like phenotypes, such as metaplastic carcinoma. Low-grade adenosquamous carcinoma of the breast is a rare variant of metaplastic carcinoma. We present the case of a 49-year-old woman with a past medical history of invasive ductal breast carcinoma 13 years ago, and who was recently diagnosed as having a low-grade adenosquamous carcinoma in the same breast. Genetic analysis of blood DNA revealed a BRCA1 mutation. To our knowledge, BRCA1 mutation in association with a low-grade adenosquamous carcinoma of the breast has not yet been reported. Thus, it may be important to consider the possibility of an association, but supplemental studies are needed.

Ovarian involvement by desmoplastic small round cell tumor with leydig cell hyperplasia showing an unusual immunophenotype (Cytokeratin negative, calretinin and inhibin positive) mimicking poorly differentiated sertoli leydig cell Tumor

Desmoplastic small round cell tumor (DSRCT) is a rare aggressive tumor primarily involving serosal surfaces in adolescents and young men. Diagnosis is based on specific clinicomorphologic, immunohistochemical, and genetic features. We report here a variant of DSRCT involving the ovaries that mimics the Sertoli-Leydig cell tumor in a 21-year-old woman complaining of abdominal pain. Abdominal ultrasonography and computed tomography showed a right adnexal mass. She had a slightly raised serum CA-125 level. Frozen section examination identified the right ovarian mass as a poorly differentiated Sertoli-Leydig cell tumor. The surgically resected tumor and left ovary and omentum implants found during laparoscopy were diagnosed as DSRCT with Leydig cell hyperplasia. Immunohistochemically, the tumor cells were negative for epithelial markers but were positive for calretinin and inhibin. The patient is still undergoing chemotherapy at 8 months after initial presentation with partial response. This case showed that DSRCT with unusual immunohistochemical profiles and Leydig cells hyperplasia pose a diagnostic challenge. Molecular genetic techniques may help in these cases.

Lymph Node Involvement in Multicystic Peritoneal Mesothelioma

Multicystic peritoneal mesothelioma is an uncommon lesion most frequently encountered in women of reproductive age. Although the pathologic characteristics have been documented, the lymph node status associated with this pathology, the etiopathogenesis and prognosis of which remain unclear, is unknown. We report here the case of a 35-year-old woman with a 5.5 cm multicystic mesothelioma affecting the pelvic peritoneum of the rectum. Involvement by multicystic mesothelioma was observed within two lymph nodes simultaneously resected with the tumor. To the best of our knowledge, lymph node involvement has not been described in previous studies.

Angiolipoma of the Breast in a Male A Case Report and Review of the Literature

Objective: Angiolipoma is an unusual variant of lipoma involving subcutaneous tissues on trunk and extremities. This tumor is rarely described in the breast and particularly in breast male. Case report: We report here the case of angiolipoma of the breast in a 55-year-old man complained of tenderness in the left breast. Ultrasonography showed a homogenously, well circumscribed, hyperechoic mass in the internal quadran of breast. The surgically resected tumor showed mature fat cells separated by proliferating branched vessels and intravascular hyaline thrombi. Conclusion: The existence of angiolipoma of the breast in the male must not to be forgotten because this tumor may be confused clinically, radiologically and pathologically with a malignant tumor.

Morphologic criteria associated with trichomonas vaginalis in liquid-based Cytology

OBJECTIVE To evaluate the morphologic criteria associated with Trichomonas vaginalis on Cytyc (Marlborough, Massachusetts, U.S.A.) liquid-based cytology and to compare results between 2 types of liquid-based cytology-Cytyc and SurePath (BD Diagnostics-TriPath, Burlington, Vermont, U.S.A). STUDY DESIGN Forty thousand Cytyc liquid-based cytology cases were tested between January 2005 and 2008. Among these, 80 cases (0.2%) had aT vaginalis infection without intraepithelial lesions or other associated infectious organism. The 80 ThinPrep (Cytyc) slides were reexamined, and for each case, morphologic characteristics associated with the parasite were listed. Concerning the SurePath technique, only 1 paper has been found in the literature based on 60,104 cases with 88 cases of T vaginalis (0.17%). RESULTS Among the 80 T vaginalis patients, the most frequent features associated with the infection were the presence of cannonballs (93%), perinuclear halo (90%), reactive nuclear changes (88%) and attachment of T vaginalis to squamous cells (86%). Moreover, the presence of ghost cells was significantly more frequent in SurePath than Cytyc liquid-based cytology (p = 0.00001), and the presence of neutrophils, reactive nuclear changes, dirty background and karyorrhexis and the predominance of coccobacilli were significantly more frequent in Cytyc than SurePath liquid-based cytology (p < 0.05). CONCLUSION On the basis of these results, we conclude that SurePath and Cytyc, which are the both commonly used liquid-based cytologic techniques, are useful and have the same efficacy in the detection of T vaginalis infection (p = 0.99).

Primary ovarian carcinoid tumor with luteinized stromal cells

BackgroundPrimary ovarian carcinoid tumors are rare. Distinct histologic patterns have been described in the literature as insular, trabecular, mucinous and mixed types.Case reportWe describe a case of 71-year-old woman diagnosed with a left ovarian tumor. Frozen section examination identified the mass as a sex-cord stromal tumor. The surgically resected tumor was diagnosed as an insular carcinoid tumor with unusual luteinized stromal cells. Histologic diagnosis complied with results acquired by immunohistochemical with positivity of tumor cells for neuroendocrine markers and positivity of luteinized stromal cells for alpha-inhibin, calretinin and Melan A.ConclusionOvarian carcinoid tumor can be extremely heterogeneous. The purpose of our report was to show that the ovarian carcinoid tumor can be associated with stromal luteinization, mimicking a sex-cord stromal tumor.

Abnormal BI-RADS Breast Lesions in Gabon

To the Editor: The Breast Imaging Reporting and Data System (BI-RADS) was design to report risk of malignant tumor and give management recommendations (1). It is now widely used for mammography. In Western countries, a vast majority of mammograms are normal, classified BI-RADS 1 or 2 (1). However, in Sub-Saharan countries most mammograms are commonly abnormal (classified BI-RADS 3, 4, and 5). Indeed, African patients usually present with advanced stage of breast cancer (2), probably due to poor knowledge of the disease and low socioeconomic circumstances (3,4). In sub-Saharan African countries, diagnostic performance of radiologists using the BI-RADS classification has shown shortcomings in the evaluation, interpretation and follow-up of some lesions (5,6). In Gabon, mammography is delivered in localized region of the country and the mammographic image are mostly analyzed by one radiologist. To the best of our knowledge, we report the second study addressing the correlation between abnormal BI-RADS categories and histologic results in Libreville (Gabon). A retrospective review of 552 mammograms with BI-RADS classification assigned before biopsy, from January 2012 to March 2015 from Centre Hospitalier universitaire d’Angondj e, Centre M edical Inter Entreprises or Polyclinique El Rapha in Libreville, identified 306 (55.43%) abnormal mammograms. 101 (18.30%), 159 (28.80%), and 46 (8.33%) were classified as BI-RADS 3, 4, and 5, respectively. The frequencies of appropriate follow-up increase with the BI-RADS classification (Table 1). Only 11.88% of BI-RADS 3 received appropriate follow-up. In contrast, 40.25% (64 of 159) and 73.91% (34 of 46) of BI-RADS 4 and 5 classified patients received appropriate follow-up. These results highlight the poor awareness of breast cancer before diagnosis in subSaharan populations (3), as recommendations are only respected when there is high concern. Histologic results were available for only 5 (4.95%) BI-RADS 3, 55 (34.59%) BI-RADS 4 and 34 (73.91%) BI-RADS 5 patients. Therefore, considering the number of biopsies available, the correlation between BI-RADS classification and morphologic features as well as histology was only examined in BI-RADS 4 and 5 categories. The morphological features of the 89 biopsies obtained from BI-RADS 4 (n = 55) and BI-RADS 5 (n = 34) classified patients were further analyzed in order to differentiate benign from malignant lesions. The 89 lesions were obtained from one male and 87 females, 34 (39%) of which were postmenopausal. The mean age of the patients was 50.7 13.4 years (range 23–85). We noted that the mean breastfeeding duration was 13.5 6.0 months. The mean BMI of the patients was 28.2 6.8 Kg/m (range 15.4–45.7) with 23 (25.27%) obese patients (BMI ≥ 30 Kg/m). A mass was identified in 75 (84.26%) of the 89 biopsies. The mean diameter of the lesion was 5.2 3.3 cm. Among BI-RADS 4 and 5, spiculated and lobulated lesion margins, asymmetric density and in mass microcalcifications all (100%) found in malignant cases were predictive of malignancy (7–9). Also, 95.65% of obese patients had breast cancer. Bouguerra et al. (10)

Evaluation of accuracy of fine needle aspiration cytology in BI-RADS3 category breast lesions: Cytohistological correlation in 337 cases

C. Engohan‐Aloghe, N. Hottat, J. Cosaert, R. Boutemy, I. Fayt and J.‐C. Noël
Evaluation of accuracy of fine needle aspiration cytology in BI‐RADS3 category breast lesions: cytohistological correlation in 337 cases