Wei B

Comparison of immunohistochemical markers in the differential diagnosis of adrenocortical tumors: immunohistochemical analysis of adrenocortical tumors.

Most adrenocortical tumors (ACTs) can be diagnosed directly by a combination of morphologic features and clinical findings. However, sometimes it may be difficult to distinguish ACTs from other neoplasms such as pheochromocytomas and some metastatic tumors, particularly for small biopsy specimens because they may be morphologically similar. Expression of calretinin has recently been suggested as a valuable immunomarker for the differential diagnosis between ACTs and other tumors; however, its diagnostic value is still under debate. To determine the diagnostic value of calretinin in Chinese patients with adrenocortical and non-ACTs, we employed both polyclonal and monoclonal anticalretinin to characterize the expression of calretinin in adrenal tissues and compared its expression with that of inhibin α, Melan-A, cytokeratin, or CD99 by immunohistochemistry in tissue microarrays and standard tissue sections of 414 specimens. Our results revealed that calretinin was expressed by adrenocortical cells, but not by the other cells tested and the percentage of calretinin-positive ACTs reached 99% when stained with polyclonal antibodies, which was higher than that with monoclonal anticalretinin (91.3%), anti-Melan-A (90.3%), antiinhibin α (81.6%). In addition, our results also revealed that ACTs were stained by cytokeratin (AE1/AE3) with variable degrees (58.7%). Furthermore, unlike anti-Melan-A that stained all metastatic malignant melanoma, anticalretinin did not recognize other tested tumors. Therefore, immunohistologic staining with polyclonal anticalretinin is more sensitive than other antibodies tested for the diagnosis of ACTs. However, monoclonal anticalretinin appeared to be more specific. Importantly, our data suggested that the fried-egg–like staining pattern, but not the mere cytoplasmic staining, was characteristic of anticalretinin staining in adrenocortical tissues. Notably, a few anticalretinin negative-ACTs were stained by other immunomarkers that we tested. Thus, the combinational characterization of calretinin (either by polyclonal or monoclonal antibody), inhibin α, and Melan-A expression is of great significance in the differential diagnosis of ACTs.

Myofibroblastic Sarcoma vs Nodular Fasciitis A Comparative Study of Chromosomal Imbalances

We investigated the molecular cytogenetic features in myofibroblastic sarcoma (MS) to gain insight into the nature of the controversial entity. DNA copy number changes were analyzed by comparative genomic hybridization in 29 cases of MS and 5 cases of nodular fasciitis. The characteristic chromosomal imbalances in MS were gains at 1p11 --> p36.3 (19/29 [66%]), 12p12.2 --> p13.2 (13/29 [45%]), 5p13.2 --> p15.3 (9/29 [31%]), and chromosome 22 (8/29 [28%]) and loss at 15q25 --> q26.2 (7/29 [24%]). In contrast, only 1 of 5 cases of nodular fasciitis showed genetic aberrations. The average number of aberrations in nodular fasciitis (0.4) was significantly lower than that in MS (5.4). Thus, MS displayed complex DNA copy number changes and shared no range of common chromosomal abnormality with nodular fasciitis, indicating that distinct genetic pathways may be involved in the development of these entities.

Concurrent primary angiosarcoma and invasive ductal carcinoma in the same breast

A 33-year-old Chinese female was admitted to a local hospital with a 20-day history of a painful lump in her right breast. Breast ultrasonography and mammography revealed a 2-cm irregular solid lesion in the breast. Previous exposure to radioactive or chemical substances and a history of extremity oedema were denied. A diagnosis of invasive carcinoma was made based on intraoperative frozen sections, and the patient underwent a right modified radical mastectomy in June 2009. A pathological examination revealed a high-grade invasive carcinoma with negative margins and axillary lymph nodes. The patient rejected postoperative adjuvant therapy. In February 2010 (8 months following the operation), the patient returned to the same hospital with a rapidly growing nodule at the original surgical site, measuring 1.5×0.8 cm. She subsequently underwent a lumpectomy, and a histological diagnosis of haemangioma was rendered. Unfortunately, a new mass measuring 1×0.8 cm emerged along the surgical scar 6 months later. The patient underwent a new lumpectomy with wider margins. Our department received the consultation slides from the peripheral hospital. Microscopy of the third lesion revealed an ill-defined tumour infiltrating the adipose tissue and dermis. The neoplasm was composed of predominantly solid areas with spindle cell morphology showing marked cytological atypia (figure 1 …