Mucinous Cystadenocarcinoma in Breast: Complicated with Lymph Node, Thoracic Wall Metastasis, and Contralateral Triple Negative Breast Cancer: A Case Report

Background: Mucinous cystadenocarcinoma of the breast is a very rare and special type adenocarcinoma of the mammary tract. We report a rare case of mucinous cystadenocarcinoma of the breast with an unfavourable prognosis which was confirmed after surgical resection pathologically. Case summary: At low power appearance, the tumor formed mucus-filled spaces of varying sizes, and with mucus-rich tumor cells lining the walls. The tumor cells were arranged in papillary structures. At high magnification, the tumor cells shown moderate to severe atypia, which were most of simple columnar cells with nuclei in the base and cytoplasm rich in mucin. In some areas, tumor cells proliferated, stratified, and clustered that protruded into the cyst cavity, or formed papillary structures with thin fibrovascular core. Immunohistochemical staining showed cytoplasm CK7 strong positive of tumor cells and cytoplasm negative of CK20, PAX-8 and CDX2, which could exclude metastatic tumors from ovary and intestine. And the tumor cells also demonstrated the basal-like characters such as negative for ER, PR, HER-2 (triple-negative), CK5/6 focal positive, EGFR positive. Besides, a triple negative breast cancer with basal-like features, lymph node, thoracic wall metastasis of mucinous cystadenocarcinoma was found. Conclusion: Mucinous cystadenocarcinoma of the breast usually have a favorable prognosis, but in this case, it happened lymph node, thoracic wall metastasis, therefore, it needs extra attention of clinical workers.

Primary leiomyosarcoma of femur: A rare entitycase report and review of literature

Background: We report this case to highlight clinical and pathological features of this rare entity. Methods: It is about a 48 year-old woman with an osteolytic lesion of the lower extremity of the left femur. Result: A biopsy of the lesion showed densely cellular malignant mesenchymal proliferation. It was made by bundles of smooth muscle cells with nuclei of moderate to severe atypia. The immunohistochemical study showed an intense and diffuse cytoplasmic positivity of tumor cells with the smooth anti-muscle. Desmin was focal positive. After neoadjuvant chemotherapie, a knee block resection was made. Macroscopically, it was a 10 cm sized tumor located in the distal part of tumor. Histologically tumor showed post chemotherapy effects estimated at 20%. The bone and muscle surgical limits were unscathed. Conclusion: Primary leiomyosarcoma of bone is a rare and a diagnostically challenging tumor entity.

Primary acquired melanosis/melanoma: utility of conjunctival map biopsy

AimTo assess the role of map biopsy in patients with conjunctival primary acquired melanosis (PAM)/melanoma.MethodsRetrospective case series of 400 conjunctival biopsy samples of 51 unique patients in a tertiary referral centre.ResultsEach patient underwent one diagnostic biopsy and several additional map biopsies (range 2–7) providing a total of 400 samples for the analysis (55 diagnostic biopsies, 345 map biopsies). The median age was 63 years old (range 20–88) with women representing 67% of the cases. Histopathological findings were graded as negative for melanosis/normal (grade 0), melanosis without atypia (grade 1), melanosis with mild atypia (grade 2), melanosis with severe atypia (grade 3) or invasive melanoma (grade 4). Clinicopathologic concordance was observed in the majority of the map biopsies (313, 91%) (positive: clinical+/path+ (57,17%), negative: clinical−/path− (256, 74%)). Three discordant samples (clinical−/path+) represented PAM sine pigmento. The histopathological spectrum of atypia was absent (40, 73%) or limited (11, 20%) in the majority of cases with tendency to cluster as low-grade or high-grade atypia. Map biopsy led to the identification of six patients (11%) with severe atypia, requiring topical mitomycin (MMC). Similarly, in 29 cases, periodic observation without topical MMC was recommended. One case of invasive melanoma transformation occurred in the MMC-treated group.ConclusionsMap biopsy enhances overall assessment of the anatomic and pathologic extent, impacting use of adjuvant topical chemotherapy. In absence of map biopsy, it would be impossible to diagnose PAM sine pigmento. Additional corroborative work is needed to validate our observations.

Anxiety and depression in COPD patients and correlation with sputum and BAL cytology

Background and aims: Anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD). The degree of lung function may not explain anxiety and depression. The aim of our study was to assess the psycholog- ical aspects of COPD, to test the BODE index (a composite score of body mass, obstruction, dyspnea and exercise capac- ity), and to evaluate the association between atypical cyto- logic findings of sputum, bronchoalveolar lavage (BAL) and the pyschological components of the disease. Methods: COPD was classsified according to the GOLD stages based on forced expiratory volume in 1 second (FEV1) in 60 stable patients. The BODE index was calculated for grading COPD. The Hospital anxiety and depression (HAD) scale was used to appraise the anxiety and depression symptoms. Cytologic examination of sputum and BAL samples were per- formed in each patient. The cytologic findings were classified as normal, mild, moderate or severe atypia. Results: The overall prevalance of anxiety and depression symptoms was 41.7% and 46.7% respectively. The prevalance of these symptoms increased with increasing BODE stages and correlated well with the severity of atypical BAL cytology results (p < 0.001). Dyspnea and reduced exercise capacity were the predominant mechanisms leading to anxiety and depression symptoms associated with COPD. Conclusions: We conclude that the BODE index is superior to GOLD stratification for explaining anxiety and depression symptoms in COPD. BAL cytologic findings, which reflect the distal parenchymal lung structure, correlated significantly with the presence of the anxiety and depression symptoms.

Dysplastic (or Atypical) Nevi Showing Moderate or Severe Atypia With Clear Margins on the Shave Removal Specimens Are Most Likely Completely Excised

Background: Dysplastic nevi (DN) are graded by their degree of atypia into 3 categories of mild, moderate, and severe. In many practices, DN with moderate or severe atypia are generally excised regardless of the status of the shave specimen margins. Objective: With a new approach toward the margins on the shave removal specimens (SRS), the goal herein is to assess whether the shave removal procedure can sufficiently remove DN with moderate or severe atypia. Methods: A total of 426 SRS diagnosed with DN showing moderate or severe atypia between January and December 2015 along with their post–shave excision specimens were reviewed. Based on the author’s experience, clear or negative margins on the SRS were defined as neoplastic melanocytes confined within >0.2 mm of the lateral and deep specimen margins. The biopsy specimens were accompanied by Melan-A highlighting the subtle neoplastic cells. Results: With a negative predictive value (NPV) of 98.4% (confidence interval: 97.2% to 100%, P < .001), DN showing moderate or severe atypia with clear margins are most likely removed by the shave procedure. Conclusion: Routine excision of DN showing moderate or severe atypia with clear margins on SRS is not necessary. Regular surveillance is sufficient.

Atypia and Surface Structure of Superficial Neoplasms of the Colon Less Than 10 mm in Diameter

Histological specimens of 30 distinct adenomas and 30 distinct carcinomas were studied by image analysis to quantify nuclear size and shape. These data were used to derive a discriminant equation, which permitted the lesions to be classified into two groups based on nuclear atypia. Next, 50 superficial type tumors of the colon (34 IIa lesions, 9 IIc + IIa lesions, and 7 IIc lesions) <10 mm in longest diameter were similarly analyzed. These lesions were classified into a high atypia index group (HAI group, 14 lesions) and a low atypia index group (LAI group, 36 lesions) by the above discriminatory equation. Differences between these two groups in surface structure, marginal zone properties, and macroscopic type, assessed using a dissecting microscope, were studied. A hyperplastic shape of the tubular orifice was seen at the marginal zone in 10 lesions (27.7%) in the LAI group and 11 lesions (78.5%) in the HAI group. This difference was significant. Surface structure and macroscopic type were not correlated with the degree of atypia. The tubular density in lesions showing a hyperplastic pitted pattern at their border was 77.40, significantly higher than that for lesions without such a pattern (73.12). The contribution of various variables to surface structure, marginal zone properties, and macroscopic type was studied by discriminant analysis. A high correlation was found between marginal zone properties and tubular density. Since lesions with high nuclear atypia tend to have high tubular density, marginal zone properties were secondarily correlated with the level of nuclear atypia. Observation of the marginal zone properties of lesions was thus suggested to be helpful in the diagnosis of lesions with severe atypia.