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Zhou Q, Li H, Cheng Y, Ma X, Tang S, Tang C. Pax-8: Molecular biology, pathophysiology, and potential pathogenesis. Biofactors 2024; 50:408-421. [PMID: 37988248 DOI: 10.1002/biof.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/21/2023] [Indexed: 11/23/2023]
Abstract
Transcription factors, as the convergence points of multiple signaling pathways in eukaryotic cells, are closely involved in disease development. Pax-8, an important transcription factor belonging to the Pax family, exerts a crucial influence on the regulation of gene expression required for both physiological conditions and pathological processes. Pax-8 contributes to the pathogenesis of many human diseases, ranging from cardiovascular disease to many cancers, and therefore, it can be imagined that Pax-8 holds great therapeutic potential. In this review, we summarize the structure, distribution, function, and regulatory mechanisms of Pax-8 to provide a new research direction for Pax-8.
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Affiliation(s)
- Qinyi Zhou
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- Department of Cardiology, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Heng Li
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yaqiong Cheng
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xiaofeng Ma
- Department of Cardiology, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Shilin Tang
- Department of Critical Care Medicine, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Chaoke Tang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Joshi S, Murali-Nanavati S, Shylasree TS, Hawaldar R, Tripathi S, Sahay A, Noronha J, Jain U, Thomas A, Kowtal P, Vanmali V, Nair NS, Parmar V, Badwe RA, Sarin R. Synchronous and Metachronous Breast and Ovarian Cancers: Experience from a Single Tertiary Care Cancer Centre in India. Indian J Surg Oncol 2023; 14:809-821. [PMID: 38187845 PMCID: PMC10767083 DOI: 10.1007/s13193-023-01749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/12/2023] [Indexed: 01/09/2024] Open
Abstract
Women with either breast cancer (BC) or ovarian cancer (OC) have a 1.5-2 times higher risk of developing the other. Discerning discrete primaries versus metastases from either can be challenging. Clinico-pathological and outcome details of patients diagnosed with both BC and OC from December 1994 to August 2018 were retrospectively evaluated at a single tertiary cancer centre. We report the pattern of presentation and recurrences with case-based illustrations. Out of 139 patients, presentation was BC-first in 66.2%, OC-first in 24.5% and synchronous cancers (SC) in 9.3% of women. The median age at diagnosis in BC-first, OC-first and SC was 42 years, 48 years and 49 years, respectively. The most common histological subtype was invasive breast carcinoma-no special type (74.8%) in BC and serous cystadenocarcinoma (81.3%) in OC. BC presented at an early stage in 67.6% while OC presented at an advanced stage in 48.2% of patients. Germline mutation results were available in 82% with 61.4% of the cohort exhibiting a mutation- BRCA1 mutation being the most common. The median time to development of second cancer was 77.4 months and 39.4 months in BC-first and OC-first, respectively. At a median follow-up of 9.47 years, disease-free survival was 32.6%, 32.4% and 30.8% in BC-first, OC-first and SC, respectively (p < 0.001). In hereditary breast and ovarian cancer, BC-first patients have a better prognosis while synchronous malignancies have worse oncological outcomes. Deaths are mainly due to OC progression. Appropriate surveillance and prophylactic intervention in young patients with breast cancer may improve overall outcomes.
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Affiliation(s)
- Shalaka Joshi
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
| | - Sridevi Murali-Nanavati
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
- Department of Breast Surgical Oncology, Nanavati Max Super Speciality Hospital, Mumbai, India 400056
| | - T. S. Shylasree
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
| | - Rohini Hawaldar
- Clinical Research Secretariat, Tata Memorial Centre, Dr E Borges Road, Parel, Mumbai India 40012
| | - Sagar Tripathi
- Department of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
| | - Ayushi Sahay
- Department of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
| | - Jarin Noronha
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
| | - Urvashi Jain
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Anand Thomas
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
| | - Pradnya Kowtal
- Clinical Cancer Genetics Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), and Homi Bhabha National Institute, Navi Mumbai, India
| | - Vaibhav Vanmali
- Clinical Research Secretariat, Tata Memorial Centre, Dr E Borges Road, Parel, Mumbai India 40012
| | - Nita S. Nair
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
| | - Vani Parmar
- Breast Surgery, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai India
| | - Rajendra A. Badwe
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai India 40012
| | - Rajiv Sarin
- Clinical Cancer Genetics Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), and Homi Bhabha National Institute, Navi Mumbai, India
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Kim J, Kim NY, Pyo JS, Min KW, Kang DW. Diagnostic roles of PAX8 immunohistochemistry in ovarian tumors. Pathol Res Pract 2023; 250:154822. [PMID: 37742476 DOI: 10.1016/j.prp.2023.154822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE This study aimed to elucidate the diagnostic roles of PAX8 immunohistochemistry in various ovarian tumors. METHODS We searched through the PubMed database and selected the eligible studies to perform the meta-analysis. The PAX8 immunohistochemical expression rates of various ovarian tumors, including primary and metastatic carcinomas, were analyzed. In addition, the subgroup analysis based on tumor behaviors was performed. RESULTS The PAX8 expression rates were 0.056 (95% confidence interval [CI] 0.008-0.307), 0.400 (95% CI 0.228-0.600), 0.741 (95% CI 0.578-0.857), and 0.738 (95% CI 0.666-0.799) in normal ovary and benign, borderline, and malignant ovarian tumors, respectively. The PAX8 expression rates of serous and transitional cell carcinomas were 0.937 (95% CI 0.882-0.967) and 0.918 (95% CI 0.841-0.959). In addition, the PAX8 expression rate of mucinous carcinomas was 0.393 (95% CI 0.285-0.512). However, metastatic carcinomas showed a significantly lower PAX8 expression rate than primary ovarian cancers (P < 0.001 in the meta-regression test). In cytologic specimens, PAX8 expression rates of serous and endometrioid carcinomas were 0.905 (95% CI 0.832-0.948) and 0.714 (95% CI 0.327-0.928), respectively. CONCLUSION PAX8 expression rate was significantly higher in serous ovarian tumors than in mucinous ovarian tumors. In addition, PAX8 expression rates were significantly higher in primary ovarian cancers than in metastatic carcinomas.
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Affiliation(s)
- Jooyoung Kim
- Department of Obstetrics and Gynecology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Nae Yu Kim
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Jung-Soo Pyo
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Kyeung-Whan Min
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Dong-Wook Kang
- Department of Pathology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea; Department of Pathology, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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4
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Pozzati F, Sassu CM, Marini G, Mascilini F, Biscione A, Giannarelli D, Garganese G, Fragomeni SM, Scambia G, Testa AC, Moro F. Subjective assessment and IOTA ADNEX model in evaluation of adnexal masses in patients with history of breast cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:594-602. [PMID: 37204769 DOI: 10.1002/uog.26253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To evaluate the performance of subjective assessment and the Assessment of Different NEoplasias in the adneXa (ADNEX) model in discriminating between benign and malignant adnexal tumors and between metastatic and primary adnexal tumors in patients with a personal history of breast cancer. METHODS This was a retrospective single-center study including patients with a history of breast cancer who underwent surgery for an adnexal mass between 2013 and 2020. All patients had been examined with transvaginal or transrectal ultrasound using a standardized examination technique and all ultrasound reports had been stored and were retrieved for the purposes of this study. The specific diagnosis suggested by the original ultrasound examiner in the retrieved report was analyzed. For each mass, the ADNEX model risks were calculated prospectively and the highest relative risk was used to categorize each into one of five categories (benign, borderline, primary Stage I, primary Stages II-IV or metastatic ovarian cancer) for analysis of the ADNEX model in predicting the specific tumor type. The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal tumors and between primary and metastatic adnexal tumors was evaluated, using final histology as the reference standard. RESULTS Included in the study were 202 women with a history of breast cancer who underwent surgery for an adnexal mass. At histology, 93/202 (46.0%) masses were benign, 76/202 (37.6%) were primary malignancies (four borderline and 72 invasive tumors) and 33/202 (16.3%) were metastases. The original ultrasound examiner classified correctly 79/93 (84.9%) benign adnexal masses, 72/76 (94.7%) primary adnexal malignancies and 30/33 (90.9%) metastatic tumors. Subjective ultrasound evaluation had a sensitivity of 93.6%, specificity of 84.9% and accuracy of 89.6%, while the ADNEX model had higher sensitivity (98.2%) but lower specificity (78.5%), with similar accuracy (89.1%), in discriminating between benign and malignant ovarian masses. Subjective evaluation had a sensitivity of 51.5%, specificity of 88.8% and accuracy of 82.7% in distinguishing metastatic and primary tumors (including benign, borderline and invasive tumors), and the ADNEX model had a sensitivity of 63.6%, specificity of 84.6% and similar accuracy (81.2%). CONCLUSIONS The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal masses in this series of patients with history of breast cancer was relatively similar. Both subjective assessment and the ADNEX model demonstrated good accuracy and specificity in discriminating between metastatic and primary tumors, but the sensitivity was low. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Pozzati
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - C M Sassu
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Marini
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Mascilini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - A Biscione
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Giannarelli
- Facility of Epidemiology and Biostatistics, G-STEP Generator, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Garganese
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S M Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Huang CK, Liu JH, Chou JS, Chang CH. Challenges and Considerations in Identifying the Origin of Peritoneal Carcinomatosis: A Case Report. Cureus 2023; 15:e37469. [PMID: 37187658 PMCID: PMC10181891 DOI: 10.7759/cureus.37469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Invasive lobular cancer (ILC) of the breast is the second most common type of invasive breast cancer. Clinical determination of the growth pattern of ILC of the breast is difficult. Furthermore, the ILC of the breast has a unique metastatic pattern that involves gastrointestinal and peritoneal sites. Our patient was initially misdiagnosed with left ovarian cancer based on the findings of positron emission tomography and computed tomography. Herein, we report a case of ILC of the breast presenting as peritoneal carcinomatosis. The ESMO Clinical Practice Guidelines for cancers of unknown primary sites were used in the diagnosis of the carcinoma of unknown primary origin. Image-guided biopsy and immunohistochemical staining are also useful in the diagnosis of these cancer types.
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Affiliation(s)
- Chih-Kai Huang
- Department of Breast Surgery, Cheng Hsin General Hospital, Taipei, TWN
| | - Jin-Hwang Liu
- Department of Hemato-oncology, Cheng Hsin General Hospital, Taipei, TWN
| | - Jiann-Shang Chou
- Department of Pathology, Cheng Hsin General Hospital, Taipei, TWN
| | - Chuan-Hsun Chang
- Department of Breast Surgery, Cheng Hsin General Hospital, Taipei, TWN
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One biopsy, two tumors: A case report of collision tumor consisting in breast and endometrioid carcinoma detected on bioptic sample of peritoneal carcinomatosis. Pathol Res Pract 2023; 243:154378. [PMID: 36812738 DOI: 10.1016/j.prp.2023.154378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/18/2023]
Abstract
Collision tumors are rare and very few cases were described in which collision was revealed in a metastatic lesion. Herein we report a case of woman with a peritoneal carcinomatosis underwent to bioptic procedure in correspondence of a nodule of Douglas peritoneum with clinical suspect of ovarian/uterine origin. Histologic examination revealed two different colliding epithelial neoplasms: an endometrioid carcinoma and a ductal breast carcinoma, the latter not suspected at the time of biopsy. Morphology and immunohistochemistry, in particular GATA3 and PAX8, defined clearly the two different colliding carcinomas.
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7
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Gilks CB, Selinger CI, Davidson B, Köbel M, Ledermann JA, Lim D, Malpica A, Mikami Y, Singh N, Srinivasan R, Vang R, Lax SF, McCluggage WG. Data Set for the Reporting of Ovarian, Fallopian Tube and Primary Peritoneal Carcinoma: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S119-S142. [PMID: 36305537 DOI: 10.1097/pgp.0000000000000908] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The move toward consistent and comprehensive surgical pathology reports for cancer resection specimens has been a key development in supporting evidence-based patient management and consistent cancer staging. The International Collaboration on Cancer Reporting (ICCR) previously developed a data set for reporting of the ovarian, fallopian tube and primary peritoneal carcinomas which was published in 2015. In this paper, we provide an update on this data set, as a second edition, that reflects changes in the 2020 World Health Organization (WHO) Classification of Female Genital Tumours as well as some other minor modifications. The data set has been developed by a panel of internationally recognized expert pathologists and a clinician and consists of "core" and "noncore" elements to be included in surgical pathology reports, with detailed commentary to guide users, including references. This data set replaces the widely used first edition, and will facilitate consistent and accurate case reporting, data collection for quality assurance and research, and allow for comparison of epidemiological and pathologic parameters between different populations.
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8
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Rabban JT, Chen LM, Devine WP. Homologous Recombination Deficiency and Ovarian Cancer Treatment Decisions: Practical Implications for Pathologists for Tumor Typing and Reporting. Surg Pathol Clin 2022; 15:219-234. [PMID: 35715159 DOI: 10.1016/j.path.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Clinical testing for homologous repair (HR) deficiency (HRD) in ovarian cancers has emerged as a means to tailor the use of poly(ADP-ribose)polymerase (PARP) inhibitor therapy to the patients most likely to respond. The currently available HRD tests evaluate tumor tissue for genomic evidence of impairment of the HR pathway of DNA damage repair, which, if present, renders the tumor vulnerable to PARP inhibitors in conjunction with platinum chemotherapy. Germline or somatic mutation of BRCA1/2 is a major contributor HRD. Thus, tubo-ovarian/peritoneal high-grade serous carcinoma (HGSC) is enriched by HRD. After highlighting the general concepts underlying HRD testing and PARP inhibitor therapy, this review discusses practical roles for pathologists to maximize the opportunities for eligible patients with ovarian cancer to benefit from HRD testing, chiefly by applying contemporary diagnostic criteria for ovarian cancer tumor typing and navigating through potential pitfalls of tumor types that may mimic HGSC but are unlikely to harbor HRD.
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Affiliation(s)
- Joseph T Rabban
- Surgical Pathology Division, Pathology Department, University of California San Francisco, 1825 4th Street, M-2359, San Francisco, CA 94158, USA.
| | - Lee-May Chen
- Gynecologic Oncology Division, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - W Patrick Devine
- Molecular Pathology Division, Pathology Department, University of California San Francisco, San Francisco, CA, USA
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Bennett JA, Oliva E. The complex and often confusing history, histology and histogenesis of mesonephric, STK11 adnexal tumour and mesonephric-like neoplasms of the upper female genital tract (including broad ligament). Histopathology 2022; 81:280-296. [PMID: 35395118 DOI: 10.1111/his.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
Mesonephric lesions in the female genital tract are uncommon, with those arising from the upper tract being much less frequent than those developing in the lower tract (mesonephric hyperplasia and carcinoma). The most common upper tract lesions include rete cyst/cystadenoma and female adnexal tumour of Wolffian origin (FATWO). The integration of morphological, immunohistochemical and molecular studies on FATWOs has enabled recognition of a novel entity, the STK11 adnexal tumour, which is often associated with Peutz-Jeghers syndrome (~50%) and frequently has a salivary gland morphology but an unknown origin. Similarly, 'mesonephric-like' adenocarcinoma, an entity with striking similarities to mesonephric carcinoma but currently favoured to be of Müllerian derivation based on its association with other Müllerian tumours and molecular findings, has also been recently described, and may histologically mimic both FATWOs and STK11 adnexal tumours. In this review, we provide a historical overview of upper female genital tract mesonephric proliferations and discuss mesonephric lesions, STK11 adnexal tumour, mesonephric-like adenocarcinoma, and mimickers, the most common being endometrioid carcinoma.
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Affiliation(s)
- J A Bennett
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - E Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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Shen T, Zhao J, Zhao M, Taggart MW, Ramalingam P, Gong Y, Wu Y, Liu H, Zhang J, Resetkova E, Wang WL, Ding Q, Huo L, Yoon E. Unusual Staining of Immunohistochemical Markers PAX8 and CDX2 in Breast Carcinoma: A Potential Diagnostic Pitfall. Hum Pathol 2022; 125:35-47. [DOI: 10.1016/j.humpath.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
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11
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Puzyrenko A, Cortina CS, Jorns JM. New Challenges in the Differential Diagnosis of High-Grade Triple-Negative Breast Cancer and Serous Carcinoma. Int J Surg Pathol 2022; 30:728-733. [PMID: 35234527 DOI: 10.1177/10668969221084268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While screening has improved early detection of primary breast cancers, it may also identify metastasis to the breast in rare instances. High-grade carcinomas identified on breast screening may have non-specific morphology and immunoprofiles, making distinction from metastasis problematic. High-grade carcinomas frequently lose expression of specific tumor markers. New evidence specifically challenges GATA3/PAX8 exclusivity in the differential diagnosis of high-grade triple-negative breast cancer and high-grade serous carcinoma of müllerian origin. This case series provides a careful and detailed review of immunohistochemistry interpretation, with focus on PAX8, and the potential pitfalls in making a definitive pathological diagnosis, which is essential in determining oncological treatment options.
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Affiliation(s)
| | | | - Julie M Jorns
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
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12
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Chuang AY, Watkins JC, Young RH, Lerwill MF. Lobular Carcinoma of the Breast Metastatic to the Ovary: A Clinicopathologic Study of 38 Cases. Am J Surg Pathol 2022; 46:179-189. [PMID: 34931622 DOI: 10.1097/pas.0000000000001812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We evaluated the clinicopathologic features of 38 cases of metastatic lobular (n=33) or predominantly lobular (n=5) carcinoma involving the ovary. The patients were from 39 to 91 years of age (mean: 53 y). In 2 cases, the breast primary and ovarian metastasis were diagnosed synchronously, and in 5, the breast primary was only discovered after the metastatic carcinoma in the ovary was found. In the majority of cases (79%), both ovaries were involved; the mean ovarian tumor size was 5.9 cm. The ovarian tumors demonstrated a range of architectural patterns including macronodular (71%), diffuse/solid growth (87%), single-cell infiltration (87%), cords (74%), and small nests/clusters (50%). Nine cases demonstrated focal signet ring cell morphology. The associated stromal reaction ranged from none to marked, with almost half of cases demonstrating a marked stromal response, largely prominent sclerosis. A variety of neoplasms, most typically sex cord-stromal tumors, lymphoma/leukemia, and desmoplastic small round cell tumor, may enter the differential. In addition to the obvious help afforded in most cases by the clinical history, a combination of judicious sampling, particularly to unearth the delicate cords or single-cell growth of lobular carcinoma, appropriate consideration of the cytologic features of the neoplastic cells, and immunohistochemistry can resolve the diverse issues in differential diagnosis that may arise.
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Affiliation(s)
- Ai-Ying Chuang
- Department of Pathology, Koo Foundation Sun Yat-Sen Cancer Center
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert H Young
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Melinda F Lerwill
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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13
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Ma Q, Yuan Y, Wang Y, Shao C, Feng W. Misdiagnosis of High-grade Serous Ovarian Cancer With BRCA Mutation as Endometriotic Cyst Due to Its Unique Gross Morphology: A Case Report and Literature Review. Int J Gynecol Pathol 2021; 40:165-168. [PMID: 31985581 DOI: 10.1097/pgp.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is believed that high-grade serous ovarian cancer (HGSOC) is a solid or multilocular-solid cancer. Here, we report the case of a 40-yr-old woman with a left ovarian unilocular cyst. Ultrasonography and computed tomographic examination confirmed that the cyst was thin-walled and homogenous in thickness without mural nodules. It was considered to be an endometriotic cyst. Left ovarian cyst excision specimens proved it to be HGSOC after pathologic examination. Therefore, the patient underwent radical surgery for HGSOC. Pathologic examination of radical resection specimens confirmed that the HGSOC was still in FIGO stage IA and no fallopian tube lesion was found. Considering that the patient had a history of breast cancer in both the breasts at a young age, it was hypothesized that the breast cancer susceptibility gene (BRCA) gene may have a germline mutation. Next-generation sequencing confirmed the BRCA1 (c.3770_3771delAG) germline mutation in this patient. Previous studies have reported the special morphological characteristics and growth pattern of HGSOC with BRCA mutation in the advanced stage. Our case demonstrates that HGSOC with the BRCA mutation can also be a unilocular cyst with a thin wall and uniform thickness without a mural nodule, and in the early stage, may have unique gross morphology.
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PAX8 Expression in Breast Cancer. Appl Immunohistochem Mol Morphol 2020; 29:293-298. [PMID: 33208672 DOI: 10.1097/pai.0000000000000883] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022]
Abstract
PAX8 expression is frequently detected in renal, thyroidal, and Müllerian carcinomas, and PAX8 immunohistochemistry is often used to confirm the origin of these tumors. Tumors metastatic to the breast may masquerade as primary breast lesions. PAX8 is strongly expressed in tumors of Müllerian origin and largely negative in breast primaries, but an immunohistochemical expression of PAX8 in breast cancer has not been systematically evaluated in a large series. We analyzed 266 cases of invasive carcinoma of the breast on tissue microarrays and whole tissue sections with a PAX8 monoclonal antibody. Both the extent (focal or diffuse) and intensity (weak, moderate, or strong) of nuclear staining were assessed in the tumor cells. In total, 16 cases (6.02%) were positive for PAX8 (12 with weak and 4 with moderate staining). Expression was diffuse in 7 cases and focal in 9 cases. All 16 PAX8-positive tumors were histologic grade III invasive ductal carcinomas, 13 of these were triple-negative, 2 were HER2-positive, only and 1 was progesterone receptor-positive only. Strong PAX8 nuclear expression was not seen in any of the cases. PAX8 was negative in breast tumors with neuroendocrine features. Our study demonstrated a low rate of PAX8 expression in breast cancer. When present, PAX8 expression was only seen in high-grade invasive ductal carcinomas, mostly triple-negative. The presence of PAX8 immunoreactivity alone cannot exclude mammary origin, especially when only weak to moderate staining is observed, so the correlation with available clinical and pathologic data helps to ensure an accurate diagnosis.
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Ferrari F, Ficarelli S, Forte S, Valenti G, Ardighieri L, Sartori E, Odicino F. Extra-abdominal ovarian cancer presenting with breast metastases at diagnosis: Case report and literature review. Eur J Obstet Gynecol Reprod Biol 2020; 255:211-221. [PMID: 33152565 DOI: 10.1016/j.ejogrb.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/17/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Malignant ovarian tumours are diagnosed at an advanced stage in the majority of cases. However, only a small percentage present as extra-abdominal, non-lymph-node solid metastases, as in the breast, and they are usually cases of relapse. The discovery of mono- or bilateral breast lesions with peritoneal carcinosis and/or abdomino-pelvic lesions can be cumbersome in the differential diagnosis of primary tumours. This article aims to summarize current evidence on the detection of breast metastases at diagnosis of ovarian cancer. STUDY DESIGN A systematic review of the literature in Scopus, PubMed/MEDLINE, ScienceDirect and the Cochrane Library, including case reports and case series, was undertaken. Data regarding study features; population characteristics; clinical, radiological and histological assessment of the disease; treatment and follow-up were collected. In addition, a case report of a patient managed at the authors' centre is provided. RESULTS According to the search strategy, 16 articles (18 patients) were included in this review. Serous ovarian, fallopian tube or primary peritoneal cancer was detected in 61% of cases, while another type or a non-specified type of epithelial ovarian cancer was detected in 27.7% of cases; there was one case with granulosa cell tumour of the ovary and one case with mucinous ovarian tumour of low malignant potential. Breast metastases were mainly monolateral (66.6%), with other extra-abdominal sites of disease in the majority of the cases. A minority of patients (16.6%) received treatment for primary breast cancer with a subsequent diagnosis of ovarian cancer. Concomitant breast and abdominal surgery can be an option. PAX8, WT1 and CA125 immunohistochemical staining can aid in differential diagnosis. CONCLUSION Breast metastases of malignant ovarian tumours must be promptly recognized to ensure proper treatment. Specific immunohistochemical analysis can be a decisive assessment in uncertain cases.
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Affiliation(s)
- Federico Ferrari
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Brescia, Brescia, Italy.
| | - Silvia Ficarelli
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Sara Forte
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Gaetano Valenti
- Unit of Gynaecology and Obstetrics, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | - Enrico Sartori
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
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16
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Aberrant Immunostaining of Breast Carcinoma by MRQ-50 PAX8 Antibody. Appl Immunohistochem Mol Morphol 2020; 28:e37-e38. [DOI: 10.1097/pai.0000000000000682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Chapel DB, Schulte JJ, Husain AN, Krausz T. Application of immunohistochemistry in diagnosis and management of malignant mesothelioma. Transl Lung Cancer Res 2020; 9:S3-S27. [PMID: 32206567 PMCID: PMC7082260 DOI: 10.21037/tlcr.2019.11.29] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Immunohistochemistry plays an indispensable role in accurate diagnosis of malignant mesothelioma, particularly in morphologically challenging cases and in biopsy and cytology specimens, where tumor architecture is difficult or impossible to evaluate. Application of a targeted panel of mesothelial- and epithelial-specific markers permits correct identification of tumor lineage in the vast majority of cases. An immunopanel including two mesothelial markers (calretinin, CK5/6, WT-1, or D2-40) and two epithelial markers (MOC-31 and claudin-4) offers good sensitivity and specificity, with adjustments as appropriate for the differential diagnosis. Once mesothelial lineage is established, malignancy-specific studies can help verify a diagnosis of malignant mesothelioma. BAP1 loss, CDKN2A homozygous deletion, and MTAP loss are highly specific markers of malignancy in a mesothelial lesion, and they attain acceptable diagnostic sensitivity when applied as a diagnostic panel. Novel markers of malignancy, such as 5-hmC loss and increased EZH2 expression, are promising, but have not yet achieved widespread clinical adoption. Some diagnostic markers also have prognostic significance, and PD-L1 immunohistochemistry may predict tumor response to immunotherapy. Application and interpretation of these immnuomarkers should always be guided by clinical history, radiographic findings, and above all histomorphology.
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Affiliation(s)
- David B Chapel
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Jefree J Schulte
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | - Aliya N Husain
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | - Thomas Krausz
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
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Unexpected PAX8 Immunoreactivity in Metastatic High-grade Breast Cancer. Appl Immunohistochem Mol Morphol 2019; 27:637-643. [DOI: 10.1097/pai.0000000000000707] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Comparison of PAX8 Expression in Breast Carcinoma Using MRQ50 and BC12 Monoclonal Antibodies. Appl Immunohistochem Mol Morphol 2019; 28:558-561. [DOI: 10.1097/pai.0000000000000796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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20
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Beca F, Schmitt FC. Ancillary Tests in Breast Cytology: A Practical Guide. Acta Cytol 2019; 63:302-313. [PMID: 31141801 DOI: 10.1159/000499697] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/19/2019] [Indexed: 12/12/2022]
Abstract
Utilization of fine-needle aspiration biopsy (FNAB) cytology for the diagnosis of diseases of the breast has been met with both excitement and uncertainty during the last couple of decades. Presently, FNAB for the diagnosis of primary and metastatic breast lesions is on the rise again. This is probably due to its fast turnaround time, cost efficiency, and minimal invasiveness, characteristics of this sampling modality which are particularly crucial for patients requiring frequent repeat biopsy in the setting of metastatic lesions. In this article, we will briefly review the main modern applications of FNAB of the breast when coupled with contemporary ancillary techniques. Such contemporary ancillary techniques range from classic immunocytochemistry (ICC) to the most modern molecular techniques, particularly next-generation sequencing. Coupled with contemporary ICC and molecular methods, FNAB of the breast can be used for several applications. The applications reviewed in this article include the primary diagnosis of a breast lesion, the identification of the breast as a primary source of a metastatic lesion, the evaluation of breast prognostic/predictive markers, and the tracking of tumor evolution. In our opinion, FNAB of the breast is an ideal sampling method, sharing many of the advantages of truly liquid and of tissue biopsies. Ultimately, we aim at demystifying the complexity of many of the challenges traditionally associated with the application of ancillary techniques to FNAB of the breast and provide insights into some of the most cutting-edge and clinically useful application scenarios.
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Affiliation(s)
- Francisco Beca
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Fernando C Schmitt
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP)/I3S, Porto, Portugal,
- Department of Pathology, Medical Faculty, University of Porto, Porto, Portugal,
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22
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Cordero Hernandez Y, Boskamp T, Casadonte R, Hauberg‐Lotte L, Oetjen J, Lachmund D, Peter A, Trede D, Kriegsmann K, Kriegsmann M, Kriegsmann J, Maass P. Targeted Feature Extraction in MALDI Mass Spectrometry Imaging to Discriminate Proteomic Profiles of Breast and Ovarian Cancer. Proteomics Clin Appl 2018; 13:e1700168. [DOI: 10.1002/prca.201700168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 11/29/2018] [Indexed: 01/10/2023]
Affiliation(s)
| | - Tobias Boskamp
- Center for Industrial MathematicsUniversity of Bremen Bremen 28359 Germany
- Department for Cell BiologyUniversity of Bremen Bremen 28359 Germany
| | | | - Lena Hauberg‐Lotte
- Center for Industrial MathematicsUniversity of Bremen Bremen 28359 Germany
| | - Janina Oetjen
- Center for Industrial MathematicsUniversity of Bremen Bremen 28359 Germany
| | - Delf Lachmund
- Center for Industrial MathematicsUniversity of Bremen Bremen 28359 Germany
| | - Annette Peter
- Department for Cell BiologyUniversity of Bremen Bremen 28359 Germany
| | - Dennis Trede
- SCiLS, Bruker Daltonik GmbH Bremen 28359 Germany
| | - Katharina Kriegsmann
- Department of Hematology Oncology and RheumatologyUniversity of Heidelberg Heidelberg 69120 Germany
| | - Mark Kriegsmann
- Institute of PathologyUniversity of Heidelberg Heidelberg 69120 Germany
| | - Jörg Kriegsmann
- Proteopath GmbH Trier 54296 Germany
- Center for Histology Cytology and Molecular Diagnostic Trier 54296 Germany
| | - Peter Maass
- Center for Industrial MathematicsUniversity of Bremen Bremen 28359 Germany
- SCiLS, Bruker Daltonik GmbH Bremen 28359 Germany
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23
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Tian W, Zhou Y, Wu M, Yao Y, Deng Y. Ovarian metastasis from breast cancer: a comprehensive review. Clin Transl Oncol 2018; 21:819-827. [DOI: 10.1007/s12094-018-02007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
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24
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25
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Liu RC, Dutta R, Sebaratnam DF. Cutaneous metastasis in a patient with multiple malignancies. Clin Exp Dermatol 2018; 44:194-196. [PMID: 29869420 DOI: 10.1111/ced.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- R C Liu
- Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia
| | - R Dutta
- Kossard Dermatopathologists, Sydney, NSW, Australia
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Ren S, Klump W. Gynecologic Serous Carcinoma: An Immunohistochemical Analysis of Malignant Body Fluid Specimens. Arch Pathol Lab Med 2018; 143:677-682. [PMID: 29688031 DOI: 10.5858/arpa.2017-0260-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Evaluation of fluid specimens involved by serous carcinoma might potentially include PAX8, GATA3, Uroplakin II, SOX2, and SALL4 antibodies. Those markers are commonly employed for diagnosing carcinomas of various types, including urothelial malignancies and germ cell tumors. There have been no comprehensive immunohistochemical studies, to our knowledge, for those markers on fluid specimens involved by serous carcinoma. OBJECTIVE.— To evaluate immunohistochemical markers PAX8, GATA3, SOX2, uroplakin II, and SALL4 in the diagnosis of high-grade serous carcinoma in fluid specimens. DESIGN.— We examined 113 fluids (96 ascites specimens and 17 pleural fluid specimens) that were positive for carcinoma. Most (94 cases; 83.2%) consisted of high-grade serous carcinoma of Müllerian origin. Nineteen cases of non-high-grade serous carcinoma (including one case of low-grade serous carcinoma) of gynecologic origin were also included as anecdotal data. RESULTS.— In 113 fluid specimens with positive results for carcinoma, including nonserous types, 99 (87.6%) had positive results for PAX8, 19 (16.8%) for GATA3; 19 (16.8%) for SOX2, 23 (20.4%) for uroplakin II, and 8 (7.1%) for SALL4. Of 94 fluids (83.2%) involved with high-grade serous carcinoma, 84 (89.4%) had positive results for PAX8, 18 (19.1%) for GATA3, 17 (18.1%) for SOX2, 22 (23.4%) for uroplakin II, and 8 (8.5%) for SALL4. Some of these specimens showed reactivity for more than one immunohistochemical marker. CONCLUSIONS.— Most fluids involving high-grade serous carcinoma showed positive results for PAX8, and some cases expressed GATA3, SOX2, uroplakin II, and SALL4. Serous carcinoma in fluids may be positive for immunohistochemical markers not thought of traditionally as associated with gynecologic malignancy, an important consideration in avoiding misdiagnosis.
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Affiliation(s)
| | - William Klump
- From the Department of Pathology and Laboratory Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
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27
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Reinert T, Nogueira-Rodrigues A, Kestelman FP, Ashton-Prolla P, Graudenz MS, Bines J. The Challenge of Evaluating Adnexal Masses in Patients With Breast Cancer. Clin Breast Cancer 2018; 18:e587-e594. [PMID: 29680194 DOI: 10.1016/j.clbc.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
This narrative literature review addresses the problem of an adnexal mass discovered during the course of breast cancer (BC) care, which may represent a benign condition, a metastatic process, or a primary ovarian cancer (OC), clinical scenarios associated with distinct physiopathology and prognosis. Furthermore, the coexistence of BC and OC in the same patient may be owing to a hereditary disorder, deserving specific management strategies and counseling. The initial detection and evaluation of an adnexal mass in a patient with BC requires a high index of suspicion, and the initial workup should include a thorough medical history and physical examination, measurement of tumor markers, complete blood count, and imaging tests. Transvaginal ultrasonography remains the standard tool, and findings suggestive of malignancy include bilateral tumors, thick septations, predominance of a solid component, Doppler flow to the solid component, and ascites. From the pathology point of view, features that are suggestive of metastatic disease include bilaterality, mild ovarian enlargement, vascular emboli, no omental deposits, and the absence of transition from benign to malignant epithelium. Although there is a considerable overlap in OC and BC immunohistochemical profiles, BC usually stain positive for GCDFP-15 and negative for vimentine, PAX8, and WT1, and OC often stain positive for CK7, PAX8, WT1, and to mesothelin. Genetic counselling should always be indicated in this clinical scenario. In conclusion, diagnostic spectrum of an ovarian mass in a patient with BC is broad, and a systematic multi-professional strategy is necessary to conduct these challenging cases.
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Affiliation(s)
- Tomás Reinert
- Hospital do Câncer Mãe de Deus, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Angélica Nogueira-Rodrigues
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil; Brazilian Group of Gynecologic Oncology (EVA), Belo Horizonte, Brazil; DOM Oncologia, Minas Gerais, Brazil
| | | | - Patricia Ashton-Prolla
- Departamento de Genética e Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Márcia Silveira Graudenz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Departamento de Patologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Instituto de Patologia, Porto Alegre, Brazil
| | - José Bines
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
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Zhou ZN, Canon C, Matrai C, Chapman-Davis E. Cauda equina syndrome secondary to leptomeningeal metastases from recurrent primary peritoneal carcinoma. Ecancermedicalscience 2018. [PMID: 29515655 PMCID: PMC5834310 DOI: 10.3332/ecancer.2018.814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The patient is a 42-year-old woman with metastatic primary peritoneal carcinoma and known brain metastases, who subsequently developed cauda equina syndrome after presenting with ataxia, lower extremity weakness, and bowel and bladder incontinence secondary to leptomeningeal metastasis after treatment with neoadjuvant chemotherapy, surgical debulking, and adjuvant chemotherapy. Metastases to the central nervous system (CNS) and leptomeninges are rare events in epithelial ovarian and primary peritoneal carcinomas as these tumours do not have a predilection for the CNS. Cauda equina syndrome is often characterised by gait disturbances, bowel and bladder dysfunction, saddle anaesthesia, and lower extremity muscle weakness. In patients with known metastatic gynaecologic carcinomas presenting with nonspecific neurologic symptoms, cauda equina syndrome should remain high in the differential diagnosis.
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Affiliation(s)
- Zhen Ni Zhou
- Department of Obstetrics and Gynecology, Weill Cornell Medical College--New York Presbyterian Hospital, New York, NY 10065, USA
| | - Chelsea Canon
- Department of Obstetrics and Gynecology, Weill Cornell Medical College--New York Presbyterian Hospital, New York, NY 10065, USA
| | - Cathleen Matrai
- Department of Pathology, Weill Cornell Medical College--New York Presbyterian Hospital, New York, NY 10065, USA
| | - Eloise Chapman-Davis
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Weill Cornell Medical College--New York Presbyterian Hospital, New York, NY 10065, USA
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29
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Jia Y, Wang F, Zhang R, Liang T, Zhang W, Ji X, Du Q, Chang Z. Identification of suh gene and evidence for involvement of notch signaling pathway on gonadal differentiation of Yellow River carp (Cyprinus carpio). FISH PHYSIOLOGY AND BIOCHEMISTRY 2018; 44:375-386. [PMID: 29164452 DOI: 10.1007/s10695-017-0441-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 11/03/2017] [Indexed: 06/07/2023]
Abstract
The suh gene is crucial in Notch pathway and regulates mammalian gonad development. In this study, the sequences of suh1 and suh2 genes in Yellow River carp (Cyprinus carpio) were verified. The partial 5'-flanking regions of suh1 and suh2 were analyzed and several potential transcription factor-binding sites were identified. Phylogenetic, gene structure, and chromosome synteny analyses revealed that carp suh1 and suh2 were orthologs and homologous to vertebrate suh. Investigation of the expression profiles of suh1 and suh2 with qPCR showed that these genes were abundant in the brain and gonad of carp, with suh1 exhibiting sexual dimorphism expression pattern in gonad. To study the relationship between gonad differentiation and Notch signaling, primordial gonads were exposed to DAPT, an inhibitor of Notch signaling, in vitro and in vivo. The results revealed a significant downregulation of suh1 and other Notch genes in vitro. In addition, expression of male-biased genes, such as amh, dmrt1, etc., was downregulated, whereas that of female-biased genes, such as foxl2, gdf9, etc., was upregulated. When the primordial gonads were subjected to long-term DAPT exposure, an increased proportion of ovary and delay in testis development were observed. These results suggest that suh gene may have a conservative function between teleosts and mammals. Furthermore, Notch signaling was found to be involved in gonad differentiation in Yellow River carp, and DAPT was noted to inhibit and enhance the expression of male- and female-biased genes, respectively, and induce the increase in number of females.
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Affiliation(s)
- Yongfang Jia
- College of Life Science, Henan Normal University, 46# East of Construction Road, Xinxiang, Henan, 453007, People's Republic of China
| | - Fang Wang
- College of Life Science, Henan Normal University, 46# East of Construction Road, Xinxiang, Henan, 453007, People's Republic of China
| | - Ruihua Zhang
- College of Life Science, Henan Normal University, 46# East of Construction Road, Xinxiang, Henan, 453007, People's Republic of China
| | - Tingting Liang
- College of Life Science, Henan Normal University, 46# East of Construction Road, Xinxiang, Henan, 453007, People's Republic of China
| | - WanWan Zhang
- College of Life Science, Henan Normal University, 46# East of Construction Road, Xinxiang, Henan, 453007, People's Republic of China
| | - Xiaolin Ji
- College of Life Science, Henan Normal University, 46# East of Construction Road, Xinxiang, Henan, 453007, People's Republic of China
| | - Qiyan Du
- College of Life Science, Henan Normal University, 46# East of Construction Road, Xinxiang, Henan, 453007, People's Republic of China
| | - Zhongjie Chang
- College of Life Science, Henan Normal University, 46# East of Construction Road, Xinxiang, Henan, 453007, People's Republic of China.
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Sun P, Chen J, Lu J, Luo R, Li M, He J. Characteristics of breast metastases from non-breast solid tumors in 22 patients from a southern Chinese population. Oncol Lett 2018; 15:3685-3693. [PMID: 29467888 PMCID: PMC5795931 DOI: 10.3892/ol.2018.7741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/07/2017] [Indexed: 11/06/2022] Open
Abstract
Breast metastases from solid non-breast tumor types are rare; however, they should be always considered in the differential diagnosis of a breast lesion owing to the associated poor patient prognosis and the requirement of different therapeutic strategies compared with those used to treat primary breast cancer. The aim of the current study was to summarize the characteristics of metastases to the breast in a southern Chinese population. The medical records and pathological sections of 22 patients with pathologically confirmed extra-mammary metastases to the breast that presented to Sun Yat-sen University Cancer Center between January 2000 and December 2015 were retrospectively reviewed. The median age of onset for breast metastasis was 43 years (range, 10-62 years) and 19 (86.4%) patients had a known history of a primary tumor. The mean interval from diagnosis of the primary tumor to breast metastasis was 16.5 months (range, 6-56 months). A unilateral (45.5% left, 36.4% right), upper outer quadrant (15/22, 68.2%) lesion of the breast was most frequently initially detected by self-checking (63.6%). The most common origin of the primary tumor was the lung (22.7%). Nasopharyngeal carcinoma accounted for a high proportion of the metastases (18.2%). The median duration of survival from the time of diagnosis of a breast metastasis was 14 months (range, 2-74 months). A total of 10 patients (45.5%) succumbed to the disease. The results also indicated that overall survival in patients that underwent surgery was improved compared with patients who did not undergo surgery. The results of the present study demonstrated that clinical history, imaging findings, pathology from the primary tumor and immunostaining were required in combination to establish an accurate diagnosis. Further investigation into the improvement of the prognosis of patients with metastases to the breast following surgery is required.
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Affiliation(s)
- Peng Sun
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Jiewei Chen
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Jiabin Lu
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Rongzhen Luo
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Mei Li
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Jiehua He
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
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Panse G, Bossuyt V, Ko CJ. Metastatic serous carcinoma presenting as inflammatory carcinoma over the breast-Report of two cases and literature review. J Cutan Pathol 2017; 45:234-239. [PMID: 29194708 DOI: 10.1111/cup.13091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022]
Abstract
Non-mammary metastases involving breast are rare and most commonly involve the breast parenchyma. Infrequently, metastasis from an extramammary primary site presents as inflammatory carcinoma over the breast. Diagnosis of such lesions can be challenging, especially in patients with coexisting primary breast carcinoma. Few such cases have been described in literature; however, none of the previously reported cases had a prior history of primary breast carcinoma. We present 2 patients with history of breast carcinoma and serous carcinoma of ovarian/peritoneal origin that presented with inflammatory carcinoma over the breast. Biopsies from breast tissue showed atypical cells in the dermis forming cords and papillary structures. Histopathologic differential diagnosis included infiltrating ductal carcinoma of breast origin and metastatic serous carcinoma. Immunohistochemical studies showed that the tumor cells were positive for markers of ovarian origin such as PAX-8 and CA-125 and negative for breast markers such as GATA-3, thus supporting the diagnosis. In summary, we describe the unusual presentation of metastatic serous carcinoma as inflammatory carcinoma over breast and discuss the diagnostic challenges in patients with coexisting primary breast and ovarian malignancies. We also review the morphologic features of tumors of breast and ovarian origin and the immunohistochemical stains to differentiate these 2 entities.
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Affiliation(s)
- Gauri Panse
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Veerle Bossuyt
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Christine J Ko
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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Nogales FF, Prat J, Schuldt M, Cruz-Viruel N, Kaur B, D'Angelo E, Matias-Guiu X, Vidal A, McCluggage WG, Oosterhuis JW. Germ cell tumour growth patterns originating from clear cell carcinomas of the ovary and endometrium: a comparative immunohistochemical study favouring their origin from somatic stem cells. Histopathology 2017; 72:634-647. [PMID: 29106744 DOI: 10.1111/his.13426] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/19/2017] [Accepted: 10/27/2017] [Indexed: 01/08/2023]
Abstract
AIMS To report a series of 11 ovarian and one endometrial neoplasm in elderly patients with mixed clear cell tumour and germ cell tumour (GCT) components, to compare their immunohistochemical profiles and demonstrate a putative stem cell population. METHODS AND RESULTS The clear cell tumours included 11 clear cell carcinomas (CCC) and one borderline clear cell tumour, while the GCT always included glandular yolk sac tumour (YST). In four cases, there were also foci of teratoma with immature neuroepithelial and endodermal tissues and undifferentiated areas showing true embryoids. To distinguish between the clear cell and YST components, the following antibodies were used: HNF1-β, napsin-A, cytokeratin 7 (CK7), PAX8, EMA, AFP, SALL4, villin, glypican-3 (GPC-3), GATA3, HepPar-1, OCT4, CDX2, CD30 and SOX2. HNF1-β, CK7, EMA and GPC-3 were often expressed in both components. Other markers had higher specificity for each cellular lineage; napsin-A and PAX8 were expressed only in CCC, while SALL4, villin, AFP and HepPar-1 were positive in the glandular YST component but negative in the clear cell component. OCT4 expression occurred in six of 10 cases and consistently in teratoma (four of four). CONCLUSIONS There is considerable immunophenotypical overlap between the two components in these mixed neoplasms, and a panel of markers should be used to facilitate the distinction. We propose that OCT4-expressing somatic cancer cells differentiate into GCT and represent spontaneously induced pluripotent stem cells, possibly conditioned by age-related epigenetic factors. These neoplasms have features of prepubertal type GCT showing lack of 12p gain, preponderance of YST and coexistence with immature neuroectoderm. However, there may also be undifferentiated stem cell areas with embryoid bodies, of the type seen in postpubertal testicular GCT, but lacking a complete embryonal carcinoma immunophenotype.
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Affiliation(s)
| | - Jaime Prat
- Autonomous University of Barcelona, Barcelona, Spain
| | - Maolly Schuldt
- Department of Pathology, University of Granada, Granada, Spain
| | | | - Baljeet Kaur
- Imperial College Healthcare NHS Trust, London, UK
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Hou Y, Shen R, Chaudhary S, Tonkovich D, Li Z. Utility of different immunostains for diagnosis of metastatic breast carcinomas in both surgical and cytological specimens. Ann Diagn Pathol 2017; 30:21-27. [DOI: 10.1016/j.anndiagpath.2017.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
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Mirsadraei L, Hodkoff A, Jones K, Shabaik A, Kader AK, Saenz CC, Montironi R, Tacha DE, Fadare O, Hansel DE. Serous Carcinoma Mimicking Primary Urothelial Carcinoma on Clinical Evaluation and Pathology: A Potential Diagnostic Pitfall. Arch Pathol Lab Med 2017; 142:168-177. [DOI: 10.5858/arpa.2017-0004-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Serous carcinoma of the gynecologic tract often involves the external bladder wall and can occasionally mimic primary urothelial carcinoma of the bladder.
Objective.—
To define the spectrum of morphologic and immunohistochemical features that characterize serous carcinoma involving the bladder wall and its distinction from urothelial carcinoma.
Design.—
We reviewed all cases of serous carcinoma secondarily involving the bladder wall from the University of California San Diego and Polytechnic Institute for histopathologic and immunohistochemical features.
Results.—
We identified 20 cases of Müllerian high-grade serous carcinoma involving the bladder wall. Five cases were clinical mimics of urothelial carcinoma, including 2 cases that presented as a large, transmural, primary bladder mass without precedent gynecologic history in women younger than 60 years, and 3 cases presumed to be new bladder carcinoma occurring distant to a serous carcinoma diagnosis. A subset of cases were morphologic mimics of urothelial carcinoma, which showed nested growth patterns (2 of 20; 10%), squamouslike foci (2 of 20; 10%), spindled/sarcomatoid growth (2 of 20; 10%), basaloid morphology (3 of 20; 15%), and syncytial growth patterns (1 of 20; 5%). Immunohistochemical stains in 17 cases showed immunoreactivity for CK7 (17 of 17; 100%), WT1 (17 of 17; 100%), uroplakin (UP) II (1 of 17; 6%), p63 (2 of 17; 12%), GATA3 (2 of 17; 12%), and PAX8 (17 of 17; 100%).
Conclusions.—
A subset of serous carcinomas involving the bladder wall can mimic urothelial carcinoma. Awareness of this mimicker and use of an immunohistochemical panel that includes CK7, WT1, UPII, PAX8, p63, and GATA3 can be helpful in confirming the diagnosis.
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Abstract
A 59-year-old woman with a remote history of invasive ductal carcinoma of the breast was found on a follow-up computed tomography scan of her brain to have a 1-cm lesion in the right frontal lobe in 2008. In the ensuing years, before her current admission, multiple imaging studies of the brain revealed that the lesion was stable and it was, therefore, interpreted as a small area of encephalomalacia related to a thrombosed cortical vein, a cavernoma, or treated metastatic breast cancer. In 2013, the patient underwent a bilateral salpingo-oophorectomy for ovarian tumors that were diagnosed as bilateral serous cystadenofibromas. A partial omentectomy showed no evidence of implants. In June 2016, the brain lesion was completely excised and diagnosed as an atypical proliferative (borderline) serous tumor. Immunohistochemical staining demonstrated that the tumor cells were immunoreactive for Pax8, WT-1, ER, and CK-7 and negative for Gata-3, PR, TTF-1, CDX-2, Napsin A, and CK-20, which was consistent with that diagnosis. We present a brief review of possible mechanisms to account for this unusual presentation and speculate that the most likely one is exfoliation of fallopian tube epithelial cells into the peritoneal cavity, which then gain access to lymphatics resulting in cells implanting in the brain and subsequently progressing to an atypical proliferative (borderline) serous tumor.
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Abstract
Merkel cell carcinoma and melanoma can each occur primarily in breast skin, or metastasize to the breast. The breast is a rare site of metastasis of essentially any and every type of tumor, including carcinomas, sarcomas, and hematolymphoid neoplasms, and 10-30% of breast metastases may represent the initial presentation of disease. Although metastases generally recapitulate histologic features of the primary tumor, they are diagnostically challenging given their rarity and morphologic overlap with breast carcinoma, including special types of breast cancer. Histologic clues may include lack of carcinoma in situ, lack of central elastosis, pattern of infiltration around normal breast structures, yet none of these are specific. Careful correlation with clinical history and judicious use of immunostain panels is essential in approaching these cases.
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Affiliation(s)
- Megan L Troxell
- Stanford University School of Medicine, Dept of Pathology, L235 300 Pasteur Drive, Stanford, CA 94305, United States.
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Byrne DJ, Deb S, Takano EA, Fox SB. GATA3 expression in triple-negative breast cancers. Histopathology 2017; 71:63-71. [DOI: 10.1111/his.13187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/14/2017] [Indexed: 12/17/2022]
Affiliation(s)
- David J Byrne
- Department of Pathology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Siddhartha Deb
- Department of Pathology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Elena A Takano
- Department of Pathology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Stephen B Fox
- Department of Pathology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Pathology; the University of Melbourne; Melbourne Victoria Australia
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