Hongfen Lu

Secretory breast carcinoma: a clinicopathological and immunophenotypic study of 15 cases with a review of the literature

Secretory breast carcinoma is a rare breast cancer with indolent clinical behavior. Recent research showed that secretory breast carcinoma belongs to the phenotypic spectrum of basal-like breast carcinomas. In this study, a clinicopathological and immunophenotypic analysis of secretory breast carcinomas from 15 Chinese patients was conducted. This patient group consisted of 2 males and 13 females, with ages ranging from 10 to 67 years old (median, 36 years old). All patients presented with a painless and firm mass. Tumor size ranged from 10 to 55u2009mm. Most tumors were located in the outer upper quadrant of the breast. Two patients (2 of 13, 15%) displayed positive axillary lymph nodes. At the microscopic level, the presence of intracellular and extracellular secretory material was the most remarkable feature. Most cases showed mild dysplasia cytologically. All cases were negative for estrogen receptor, progesterone receptor and HER2. The expression rate of the basal-like marker (CK5/6 or epidermal growth factor receptor) was 87% (13 of 15). The basal-like phenotype was identified in 13 cases (87%). Follow-up time ranged from 10 to 55 months (median, 19 months). None of the cases had evidence of recurrence and metastasis. Our study reveals that secretory breast carcinoma is a distinct subset of invasive breast carcinoma, with expression of basal-like markers. It should be noted that secretory breast carcinoma is different from conventional basal-like breast carcinomas. Future studies are required to further understand the prognostic significance of the basal-like markers expression in secretory breast carcinomas.

Diagnostic significance of CK19, RET, galectin-3 and HBME-1 expression for papillary thyroid carcinoma

Aims To evaluate CK19, RET, galectin-3 and HBME-1 expression in papillary thyroid carcinoma (PTC) and to evaluate their diagnostic significance. Methods 155 PTC specimens and 83 other diseased-thyroid specimens were collected. Immunohistochemistry for CK19, RET, galectin-3 and HBME-1 was performed. Results The 155 PTC cases were classified into eight variants according to the WHO classification, including 74 cases of classic PTC, 40 cases of papillary microcarcinoma, and rare variants. CK19, RET, galectin-3 and HBME-1 expression was 87.1% (135/155), 71.0% (110/155), 91.6% (142/155), and 95.5% (148/155), respectively, for the PTC group; expression of all these markers was much higher than that in the control group (p<0.05). However, the expression of these markers did not differ among the variants (p>0.05). The expression of these markers, particularly CK19 and RET, was diffuse and strong in the papillary structure of PTC, but weak and focal in the papilla of tissue with benign disease. The expression of CK19 in follicular PTC was significantly higher than in follicular thyroid carcinoma (FTC) (p<0.05). Conclusions CK19, RET, galectin-3 and HBME-1 expression in PTC was higher than that in benign disease cases, but these were not specific markers for PTC. In summary, combining markers can increase the reliability and differential diagnosis of PTC. It is also worth noting that CK19 was very useful not only for the differentiation of benign and malignant papillary structure but also for the differential diagnosis of follicular PTC and FTC.

Centrally necrotizing carcinoma of the breast: clinicopathological analysis of 33 cases indicating its basal-like phenotype and poor prognosis

Yu L, Yang W, Cai X, Shi D, Fan Y & Lu Hu2028(2010) Histopathologyu200257, 193–201

Clinicopathologic and molecular features of sporadic microsatellite- and chromosomal-stable colorectal cancers

Background and aimsChromosomal instability (CIN) and microsatellite instability (MSI) are two major causes of colorectal cancers. Recently, a percentage of colorectal cancers were found to be neither CIN nor MSI. This study was performed to explore whether microsatellite- and chromosomal-stable (MACS) colorectal cancers comprise a substantially distinct subtype.Materials and methodsSixty-nine sporadic colorectal cancers were classified into three subsets according to ploidy and microsatellite instability status: CIN+, MSI+, and MACS. Clinicopathologic, genetic, and epigenetic differences among these three groups were investigated by immunohistochemical analysis of p53, APC, hMLH1, and BAX and methylation study of p14ARF, hMLH1, p16INK4a, MGMT, and MINT1 with methylation-specific polymerase chain reaction.ResultsThe 69 cases included 49 CIN+, 7 MSI+, and 13 MACS. MACS were found to differ from CIN+ and MSI+ in three aspects. The clinicopathologic features of MACS were similar to MSI+ but distinguished from CIN+. Comparatively, MACS preferred proximal location and poor differentiation (pu2009<u20090.05). An immunohistochemical study demonstrated that MACS had a lower rate of loss of hMLH1 or BAX protein than MSI+ and less loss of APC protein than CIN+. In an epigenetic aspect, both MACS and MSI+ had a high rate of CpG island methylator phenotype (46.2 and 42.9%). However, they differed in the presence of hMLH1 methylation (7.7 vs 57.1%, pu2009<u20090.05). Otherwise, compared with CIN+, MACS had a more frequent CpG island methylator phenotype and MINT1 methylation (pu2009<u20090.05) and relatively more common p16INK4a methylation with marginal significance (pu2009=u20090.056).ConclusionMACS sporadic colorectal cancers may compose a unique phenotype with distinct clinicopathologic and molecular characteristics.

Genetic alterations and protein expression of HER2 and chromosome 17 polysomy in breast cancer

HER2/neu alteration detection in breast cancer is important for decision making of the HER2-targeted therapy. We retrospectively analyzed the HER2/neu status by fluorescence in situ hybridization and HER2 protein expression by immunohistochemistry in a cohort of 481 patients with invasive breast cancer. Fluorescence in situ hybridization showed that 57.4% of cases exhibited HER2 amplification but 41.4% did not, and 1.2% exhibited an equivocal status. Immunohistochemistry showed that 10.4%, 16.8%, 38.3%, and 34.5% of cases had scores of 0, 1+, 2+, and 3+, respectively. The HER2 status showed a moderate agreement with HER2 expression with a score of 0, 1+, and 3+ (κ = 0.576, P < .05), and the concordance rate was 90%, 61.7%, and 83.1%, respectively. The HER2 amplification occurred more likely in cases with higher immunohistochemistry scores (P < .001), and polysomy 17 was observed in 28.3% of cases, but more frequently in the HER2 amplification subgroup (33.3%) than in the HER2 nonamplification subgroup (20.1%) (P < .05). There was no significant correlation between the frequency of polysomy 17 and immunohistochemistry scores (P > .05). In the immunohistochemistry 2+ group, 56.5% cases showed HER2/neu amplification, and polysomy 17 occurred more likely in the HER2 amplification subgroup (34.6%) than in the HER2 nonamplification group (13.0%) (P < .001). We concluded that the HER2 status was correlated with HER2 protein expression levels, and it is necessary to determine the HER2 status for cases with immunohistochemistry 2+. The frequency of polysomy 17 was correlated with the HER2 copy number and partially contributed to HER2/neu amplification but not HER2 protein expression.

The spectrum of primary mucosal CD30-positive T-cell lymphoproliferative disorders of the head and neck.

OBJECTIVEnTo retrospectively investigate the clinicopathologic spectrum of primary mucosal CD30-positive T-cell lymphoproliferative disorders (PTCLDs) of the head and neck.nnnSTUDY DESIGNnArchives of PTCLDs primarily arising in head and neck mucosa were reviewed. Immunostaining of CD20, CD3, CD4, CD8, CD30, CD56, anaplastic lymphoma kinase (ALK), epithelial membrane antigen (EMA), cytotoxic molecules (TIA-1, granzyme B, or perforin), and Ki67; in situ hybridization for Epstein-Barr virus; and T-cell receptor gene rearrangement analysis were performed.nnnRESULTSnFourteen cases of primary mucosal anaplastic large cell lymphoma (M-ALCL) were identified, and no lymphomatoid papulosis (LyP) cases were found. All cases demonstrated atypical mononuclear neoplastic cells with diverse histology and cytomorphology. The typical immunophenotype of neoplastic cells was CD3-positive, CD4-positive, CD8-negative, CD30-positive, ALK-negative, and cytotoxic molecules-positive. Infiltration of inflammatory cells was common. All cases presented an indolent course, regardless of therapy.nnnCONCLUSIONSnPTCLDs of the head and neck provisionally included M-ALCL alone.

Myoid Harmatoma of the Breast: Clinicopathologic Analysis of a Rare Tumor Indicating Occasional Recurrence Potential

To the Editor: Myoid hamartoma (MH) is an extremely rare subtype of breast hamartoma characterized by the presence of myoid cell bundles in the stroma. Only approximately 30 cases have been reported to date. So its biological behavior, clinicopathologic features and histological origin are not well characterized. Moreover, its potential recurrence is usually overlooked. To the best of our knowledge, no case of MH with local recurrence has been reported previously. Herein, we described clinicopathologic features of five MHs, containing two recurrent lesions. Our aim is to elucidate pathologic features of MH, and to lay stress on its recurrence potential to evoke attentions of pathologists and surgeons. Five cases of MH were collected in the Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai. For each case, sections of 5 lm were cut from paraffin blocks for HE and immunohistochemistry using Envision method. The primary antibodies included vimentin, desmin, h-caldesmon, calponin, SMA, MSA. One case was studied ultrastructurally. The age of five patients ranged from 29 to 44 years (mean, 39 years). Physical examinations all revealed nontender, palpable lumps. The radiological information of two patients was available. On Mammography, two lesions appeared as ovoid to rounded, well circumscribed masses of mixed heterogenous density. A thin smooth capsule with peripheral radiolucent zone was seen in one lesion. In MRI, the lesion displayed an ovoid, well-defined mass with heterogenous enhancement, a focal dark thin rim. Internal fat intensity was demonstrated. All patients underwent lumpectomy. Three patients were well after the initial surgery. However, two cases developed local recurrence. One case relapsed 10 months following the initial surgery. Another recurred twice, with an interval of 36 and 41 months, respectively. Moreover, when recurred for the second time there were two separate

Expression of ALK protein, mRNA and fusion transcripts in anaplastic large cell lymphoma

Systemic anaplastic large cell lymphoma (ALCL) can be divided into two subgroups, anaplastic lymphoma kinase (ALK)-positive and ALK-negative, based on the expression of ALK protein. Expression of this protein is due to genetic alterations of ALK at 2p23. Overall, observations on ALK protein, ALK mRNA, ALK-associated genetic alterations and their relationships, to one another are not often reported in the literature. In this study, we investigated the expression of ALK protein, mRNA and fusion transcripts involving ALK and their relationships in ALCL and analyzed formalin-fixed, paraffin-embedded tissues. Forty-five human cases were analyzed with immunohistochemistry for the ALK protein and RT-PCR for ALK mRNA and seven kinds of ALK involved fusion transcripts. Our results showed that the expression of ALK protein, ALK mRNA and ALK fusion transcripts were significantly related to one another (P<0.01). Consistent with the expression of ALK protein, patients presenting with ALK mRNA or ALK involved fusion transcripts were significantly younger than those lacking ALK gene alteration (P<0.01). This study demonstrates expression of both ALK protein and ALK mRNA are positively correlated with expression of ALK-associated fusion transcripts. Combined detection of ALK protein, ALK mRNA and ALK fusion transcripts can complement each other to aid in the diagnosis of ALCL.

Concurrent occurrence of nodular lymphocyte predominant Hodgkin lymphoma and Kaposi sarcoma in lymph nodes: a first case report

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma, which principally affects lymph nodes and is characterised by a nodular, or a nodular and diffuse lymphoid proliferation composed of scattered large neoplastic B cells, namely, L&H cells, in a background of reactive small lymphocytes and accessory cells.1 Kaposi sarcoma (KS) is a locally aggressive endothelial neoplasm that usually involves the skin. Occasionally, KS may involve lymph nodes and other organs, with or without cutaneous lesions.2 We describe herewith an unusual case showing simultaneous presence of NLPHL and KS components as a collision tumour in two lymph nodes of an immunocompetent patient.nnThe patient, a 31-year-old man, presented with enlarged right inguinal and left supraclavicular lymph nodes without hepatosplenomegaly, skin lesions or systemic symptoms. A CT scan revealed enlarged lymph nodes in his left cervical, bilateral inguinal and pelvic, and retroperitoneal regions. No immune abnormalities were found by the laboratory examination, nor was HIV or Epstein–Barr virus (EBV) infection detected. One lymph node each from the supraclavicular and inguinal region was biopsied. After diagnosis, the patient received six cycles of chemotherapy with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) regimen and a locoregional radiotherapy (3600cGY/20FX). The patient …