Intraductal papilloma arising from the accessory parotid gland: A case report and literature review

RATIONALE

Intraductal papillomas of the accessory parotid glands are extremely rare benign tumors that are most commonly derived from minor salivary glands and are easily misdiagnosed as other diseases. Studying these lesions by pathology and immunohistochemistry can raise awareness of the disease, reduce the rate of misdiagnosis, and provide more precise treatments.

PATIENT CONCERNS

A 35-year-old man first presented to our hospital with a 6-month history of a painless mass on his left parotid gland.

DIAGNOSES

The patient was diagnosed with intraductal papilloma of the accessory parotid gland by pathology and immunohistochemistry.

INTERVENTIONS

The mass was completely resected.

OUTCOMES

After 2 years of postoperative follow-up, the patient recovered well without recurrence.

LESSONS

Intraductal papilloma of the accessory parotid gland is very rare, and can easily be misdiagnosed as sialadenoma papilliferum, inverted ductal papilloma, or papillary cystadenoma, among others. It is necessary to analyze its pathology and immunohistochemistry in comparison with other diseases. Early excision and long-term follow-up are necessary to provide optimal treatment and to better understand the pathological processes of intraductal papilloma.

Immunohistochemical profile of the estrogen and progesterone receptors in mammary benign lesions

The immunohistochemical diagnosis for estrogen and progesterone receptors must be carried out in the tracking of every primary tumor, benign or malign, especially in the case of in situ carcinoma.

MATERIAL AND METHOD

We have studied the expression of estrogen and progesterone receptors in benign lesions, identifying phenotypes depending on the presence of estrogen and progesterone receptors.

RESULTS

The result "positive" or "negative" in the report sent to the doctor is not sufficient, the inclusion of the total score in the case of a positive result, the clone used, the usage / non-usage of antigenic exposure and also the quality control being necessary. The benign mammary lesions occur in the context of a hormonal imbalance, which, in the long run runs the risk of developing a mammary carcinoma.

CONCLUSION

The further study of the hormonal spectrum of those lesions, considered as pre-malignant, may lead to the identification of some groups of hyperplastic lesions, presenting a high risk for developing a mammary cancer.

[Clinicopathologic and immunohistochemical study of 187 cases of intraductal papillary neoplasm of breast]

OBJECTIVE

To evaluate the diagnostic approach and criteria for intraductal papillary neoplasms of breast.

METHODS

According to the criteria of 2003 WHO classification, 187 cases of intraductal papillary neoplasm of breast were identified and enrolled into the study. The clinical and histologic features were reviewed and immunohistochemical study for CD10, p63, CK14, CK5/6, CK7, MGB1 and p53 were carried out on 53 cases.

RESULTS

Amongst the 187 cases studied, there were 128 cases of intraductal papilloma, 16 cases of atypical intraductal papilloma and 43 cases of intraductal papillary carcinoma. They showed a spectrum of morphologic features including epithelial and stromal hyperplasia and secondary changes. The expression of myoepithelial markers, including CD10 and p63, significantly decreased in ascending order from intraductal papillomas, atypical intraductal papillomas and intraductal papillary carcinomas (P < 0.001). The expression of basal cell markers, including CK5/6 and CK14, showed a mosaic pattern in benign lesions and significantly decreased or was absent in atypical and carcinomatous lesions (P < 0.001). In contrast, the luminal cell marker CK7 expressed in the three groups with no statistically significant difference (P = 0.06). On the other hand, the expression of MGB1 in intraductal papillary carcinomas was much lower than that in the other two groups (P = 0.002 and P = 0.007). The staining for p53 was negative in all of the three groups.

CONCLUSIONS

Intraductal papillary neoplasms of breast represent a heterogeneous group of lesions with various morphologic appearances. Correlation with immunostaining results for myoepithelial markers, basal-type cytokeratins and luminal epithelial markers are helpful in arriving at a definitive diagnosis.

[Fiberoptic ductoscopy in 1,025 cases of nipple discharge]

OBJECTIVE

To assess the value of fiberoptic ductoscopy (FDS) in the diagnosis of nipple discharge.

METHODS

Clinical records of 1,025 patients with nipple discharge undergoing FDS from February 2006 to March 2008 were reviewed.

RESULTS

There were obviously differences in the FDS diagnosis of various nipple discharge traits. The diagnosis by FDS was pathologically confirmed in 93.7%of patients with nipple discharge (404/431).

CONCLUSION

FDS can effectively improve the diagnosis of nipple discharge,and has great clinical significance.

Immunohistochemical staining of papillary breast lesions

The separation of ductal papilloma from intraductal papillary carcinoma of the breast on hematoxylin and eosin stained sections often presents diagnostic difficulty. Immunohistochemical staining is often employed in diagnosis, historically with smooth muscle actin (SMA). In this study, the staining characteristics of a panel of myoepithelial markers (calponin, p63, P-cadherin), were compared with SMA, and the epithelial expression of CD44s was assessed in 99 papillary lesions. SMA, calponin, and p63 demonstrated myoepithelial cells in 61%, 63%, and 65% of papillary lesions, respectively. However, specificity was quite variable. Calponin-stained stromal myofibroblasts (35% of cases), vessel pericytes (92%), and endothelial cells (69%), though each to a lesser degree than SMA. Calponin also showed cross reactivity with epithelium in 18% of cases. p63 was almost completely restricted to myoepithelial cell nuclei, and did not stain vascular smooth muscle or myofibroblasts. However, p63 stained the epithelial component in one papillary carcinoma, a basal layer of cells in 1 biphasic invasive carcinoma, and the cytoplasm in 1 case. P-cadherin stained both epithelial and myoepithelial cells. The epithelial expression of CD44s and did not distinguish papillomas from papillary carcinomas. Thus, P-cadherin and CD44s are not useful in the characterization of papillary lesions. Given increased specificity as compared with SMA, the combination of p63 and calponin is recommended for analysis of breast papillary lesions.

Myoepithelial cells in solid variant of intraductal papillary carcinoma of the breast: a potential diagnostic pitfall and a proposal of an immunohistochemical panel in the differential diagnosis with intraductal papilloma with usual ductal hyperplasia

We examined myoepithelial status in intraductal papillary carcinoma (IPC) along with the expression of high-molecular weight cytokeratin (HMWK) and neuroendocrine markers, with special reference to the differential diagnosis of solid intraductal papillary carcinoma(SIPC) and intraductal papilloma with usual ductal hyperplasia (IP-UDH). Twenty-six (93%) of the twenty-eight intraductal papillomas (IP) had myoepithelial cells in >70% of the epithelial-stromal interface of the intraluminal proliferating component. Six (29%) of twenty-one SIPC had almost complete myoepithelial layer like IP-UDH at the epithelial-stromal interface. HMWK (34 beta E-12) was diffusely positive in 14 (93%) of 15 IP-UDH, but 16 (76%) of 21 SIPC were completely negative for HMWK. Neuroendocrine markers were positive in 14 (67%) of SIPC, but all 28 IPs were completely negative. If only the presence of myoepithelial cells is emphasized as a benign hallmark, about 30% of SIPCs may be underdiagnosed as IP-UDH. However, by using a combination of myoepithelial markers, HMWK, and neuroendocrine markers, all of the 36 solid intraductal papillary lesions were properly classified as benign and malignant. Solid intraductal papillary lesions meeting at least two of the following criteria are highly likely to be malignant: (1) absence of myoepithelial cells(<10% of epithelial-stromal interface of intraluminal proliferating component), (2) negative HMWK(<10%), (3) positive neuroendocrine markers (>10%).

Double immunostaining with p63 and high-molecular-weight cytokeratins distinguishes borderline papillary lesions of the breast

Papillary breast lesions remain a source of diagnostic confusion because the full range of epithelial proliferations may arise within, or secondarily involve, papilloma. The expression of p63 and high-molecular-weight cytokeratins (HMWCK) was studied simultaneously in 33 papillary lesions including intraductal papilloma (IP, n = 10), atypical papilloma (AP, n = 8) and intraductal papillary carcinoma (IPC, n = 15) by double immunostaining. The myoepithelial cell nuclei were stained dark brown whereas the cytoplasms of usual ductal hyperplasia (UDH) and myoepithelium were stained purple. The myoepithelial layer was recognized as a dark brown dotted line at the epithelial stromal junction in all IP (10/10), most AP (7/8) and some IPC (7/15), suggesting that the retained myoepithelial layer in the papillary processes does not necessarily guarantee benignity. However, the malignant epithelial cells in AP and IPC were typically recognized as monotonous populations unstained with either chromogen. These monotonous cells contrasted with the proliferating cells of UDH in papilloma, which had intense purple cytoplasm in a mosaic-like fashion. The present data suggest that the double immunostaining with the two popular antibodies p63 and HMWCK is a useful tool for reproducible classification of papillary breast lesions.

The value of p63 and CK5/6 expression in the differential diagnosis of ductal lesions of breast

In order to explore the value of p63, smoothmuscle actin (alpha-SMA) and cytokeratin 5/6 (CK5/6) in the differential diagnosis of ductal lesions of breast, 88 tissue specimens of ductal lesions of breast were collected and examined histologically by HE staining. By using immunohistochemistry, the expression of p63, alpha-SMA and CK5/6 was detected. The results showed that in 38 cases of benign breast lesions, the proliferating cells were all positive for p63 and alpha-SMA. In 19 cases of ductal carcinoma in situ (DCIS) and 7 cases of intraductal papillary carcinoma, alpha-SMA positive cells formed a layer of continuous embroider-shaped structure and the p63 positive cells formed a layer of evenly separated embroider-shaped structure around the ducts. There was no cross-reaction between p63 and interstitial myofibroblasts and vascular smooth muscle cells. In 38 cases of benign breast lesions, the positive rate of CK5/6 expression was 100%. In 5 cases of atypical ductal hyperplasia, there were few positive cells in the ducts. In 19 cases of CDIS, no tumor cells expressed CK5/6. In 19 cases of invasive ductal carcinoma, almost no CK5/6 was detectable. It was suggested that p63 could serve as a novel specific marker for the identification of breast myoepithelial cells. CK5/6 is of value in differentiating ductal proliferation of varying degrees, especially in the differentiation between cancerous and non-cancerous changes. Simultaneous detection of p63, CK5/6 and alpha-SMA can help increase the diagnostic accuracy of breast diseases.

The role of immunohistochemistry for smooth-muscle actin, p63, CD10 and cytokeratin 14 in the differential diagnosis of papillary lesions of the breast

BACKGROUND

Histological differentiation of mammary papillary lesions can be difficult. The evaluation of myoepithelial cells can be helpful, with benign papilloma showing a continuous myoepithelial cell layer, which becomes attenuated or absent in malignant papillary lesions.

METHODS

A large series of 100 papillomas (28 papillomas with florid epithelial hyperplasia) and 68 papillary carcinomas (9 invasive, 44 in situ, and 15 ductal carcinomas in situ (DCIS) involving papillomas) of the breast were stained for myoepithelial cells by immunohistochemistry using antibodies to smooth-muscle actin (SMA), p63, CD10 and cytokeratin (CK) 14.

RESULTS

In the papillomas, using these four antibodies, myoepithelial cells were positive in 88%, 99%, 91% and 95% of cases, respectively, with SMA showing marked stromal component cell staining and CD10 showing epithelial and stromal staining. CK14 also showed epithelial staining in 71% of papillomas and 96% of papillomas with florid epithelial hyperplasia. In the papillary carcinomas, 36 (53%) cases showed staining of myoepithelial cells that were scattered, discontinuous and diminished in number and the remaining 32 (47%) cases did not show myoepithelial cells. Invasive papillary carcinoma has the lowest proportion (33%) with myoepithelial cells, and DCIS involving papillomas had the highest proportion (87%).

CONCLUSIONS

p63 had the highest sensitivity and did not cross-react with stromal cells and only rarely with epithelial cells. CK14 has the added ability to distinguish between florid epithelial hyperplasia involving papilloma and DCIS involving papillomas. CK14 and p63 may be used as an adjunct in assessing difficult papillary lesions of the breast.

Expression of androgen receptors and inhibin/activin alpha and betaA subunits in breast apocrine lesions

The importance of androgens and their receptors inhibin and activin remains unknown for mammary epithelial cells. We investigated the role of these hormones in breast apocrine lesions (BAL) using immunohistochemistry to study androgen receptors (AR) and the inhibin/activin alpha and betaA subunits. Forty-two cases of BAL were evaluated, including 22 cases of fibrocystic disease (FCD) showing prominent apocrine changes, 10 intraductal papillomas with extensive apocrine metaplasia, 5 cases of apocrine carcinoma in situ (CIS), and 5 cases of apocrine carcinoma. Fifty non-apocrine lesions were included as controls: 20 cases of FCD, 5 cases of DCIS, and 25 cases of invasive ductal carcinoma. AR was more frequently expressed in BAL than in non-apocrine lesions (p=0.001). AR expression was not related to tumor progression. AR showed a significant positive correlation with betaA subunits (r=0.832, p<0.001), and an inverse correlation with alpha subunits (r=-0.233). The alpha and betaA subunits demonstrated a significant inverse correlation with each other (r=-0.271, p=0.0048). As the expression of the alpha and betaA subunits reflects inhibin and activin A, respectively, AR and activin A may be implicated in apocrine morphogenesis, but not in tumor progression.

Diagnostic utility of p75 neurotrophin receptor (p75NTR) as a marker of breast myoepithelial cells

We evaluated the low affinity neurotrophin receptor (p75NTR) as a marker of breast myoepithelial cells. Immunohistochemical staining for p75NTR was performed on paraffin sections of 122 malignant breast lesions, 28 benign lesions and the adjacent normal breast tissue. The staining pattern was compared to those of myosin heavy chain and p63. p75NTR immunostain was consistently positive and compatible with p63 and myosin immunoreactivity in the myoepithelial cells of the normal mammary gland, benign breast lesions (six usual ductal hyperplasias, six specimens with sclerosing adenosis, eight intraductal papillomas, six fibroadenomas), and carcinoma in situ (18 ductal carcinomas in situ, two noninvasive papillary carcinomas, two lobular carcinomas in situ). The luminal cells were negative for p75NTR, but rare positive cells were noticed in the solid areas of some of the usual ductal hyperplasias. Four of 64 invasive ductal carcinomas (6%) and all metaplastic carcinomas (n = 3, 100%) showed a variable degree of p75(NTR) positivity. No p75NTR expression was found in the malignant cells in all in situ carcinomas, invasive lobular carcinomas (n = 11), tubular carcinomas (n = 10), invasive papillary carcinomas (n = 6), mucinous carcinomas (n = 4), and medullary carcinomas (n = 2). No myosin immunoreactivity was seen in the luminal/tumor cells, but p63 pattern of staining in the luminal/tumor cells was quite similar to that of p75NTR. Although significant p75NTR immunoreactivity was noticed in the vessels, nerves, and stromal component of fibroadenomas, no difficulties in the evaluation of the immunostain of myoepithelial cells were encountered. Our study shows that p75NTR is a useful marker for breast myoepithelial cells and can be used to rule out invasive disease as well as to evaluate difficult for diagnosis sclerosing lesions. Our data suggest a role of neurotrophins in the development of fibroepithelial breast tumors and some of the breast carcinomas.

[Study of HOXA5 gene expression in breast carcinoma]

OBJECTIVE

To study mRNA and protein expression of HOXA5 gene in breast carcinoma, to correlate the expression of HOXA5 gene with clinicopathologic parameters and to explore the possible role of HOXA5 gene in carcinogenesis, progression and metastasis of breast carcinoma.

METHODS

TaqMan real-time reverse transcriptase-polymerase chain reaction (RT-PCR) was applied on 60 cases of primary breast carcinoma and 24 cases of benign mammary lesions in order to detect mRNA expression of HOXA5 gene. Immunohistochemical study using polyclonal antibody against HOXA5 was also performed. Statistical analysis was carried out to analyze the correlation between HOXA5 gene expression and various clinical parameters in these breast cancer patients.

RESULTS

(1) The relative expression level of HOXA5 mRNA ranged from 0.73 to 193.07 (average = 20.85) in primary breast carcinoma, in contrast to 5.42 to 81.91 (average = 30.94) in benign mammary lesions. Compared with benign mammary lesions, a significant reduction in expression of HOXA5 mRNA was noted in primary breast carcinoma (P < 0.01). (2) There was a decreased or completely diminished HOXA5 protein expression in breast carcinoma. (3) HOXA5 mRNA expression was significantly lower in lymph node-positive cases, when compared with that in lymph node-negative cases (P < 0.05). A significant difference of HOXA5 protein expression was also observed in both groups (P < 0.01). Immunohistochemical staining of HOXA5 was either negative or weakly positive in lymph node-positive cases. On the other hand, moderately or strongly positive HOXA5 staining was noted in lymph node-negative cases. (4) Neither mRNA nor protein expression of HOXA5 gene correlated with clinicopathologic parameters such as age of patients, size of tumor, clinical stage, pathologic subtype or histologic grade (P > 0.05).

CONCLUSIONS

Disordered expression of HOXA5 gene may play a role in the carcinogenesis of breast cancer. Reduced expression of HOXA5 gene may be related to the metastatic potential of breast carcinoma cells.

Cytokeratins in Papillary Lesions of the Breast

We studied 50 papillary lesions (25 papillomas and 25 papillary ductal carcinomas in situ, DCIS) diagnosed at Singapore General Hospital, for immunohistochemical expression of cytokeratin (CK) 5/6, CK14, and 34betaE12. The immunoscore (proportion of stained cells multiplied by staining intensity) was compared between the two groups. Cytokeratin expression was corroborated by confocal microscopy. Results were applied to a separate series of 43 papillary tumors from Hong Kong (HK). CK5/CK6, CK14, and 34betaE12 showed higher immunoscores in papillomas (mean values, 107.6, 186.6, and 113.1, respectively) than papillary DCIS (mean values, 12, 29.6, and 34.5, respectively; P<0.0001, P<0.001, and P<0.02, respectively). A cutoff immunoscore threshold of 50 appeared discriminatory between papilloma and papillary DCIS, and this value was applied to the HK cases, with CK5/CK6, CK14, and 34betaE12 correctly predicting 25 (89.3%), 26 (92.9%), and 27 (96.4%), respectively, of 28 HK lesions labeled as papillomas; while they corroborated 13 (86.7%), 13 (86.7%), and 5 (33.3%), respectively, of 15 HK cases diagnosed as papillary DCIS. Review of discordant cases showed that lesions were small, derived from core biopsies, or disclosed accompanying invasive carcinoma. When both SGH and HK cases were combined as a group, the sensitivity of an immunoscore of 50 or less in the diagnosis of papillary DCIS was 95%, 85%, and 62.5% for CK5/CK6, CK14, and 34betaE12, respectively, while the specificity was 86.8%, 94.3%, and 86.8%, respectively. CK immunohistochemistry can aid in evaluating papillary breast lesions. 34betaE12 does not appear as useful in identifying papillary DCIS.

Metaplastic spindle cell breast tumors arising within papillomas, complex sclerosing lesions, and nipple adenomas

Micropapillomas/papillomas and complex sclerosing lesions of the breast have been associated with a slightly increased risk for subsequent carcinoma, although benign squamous metaplasia and reactive hypercellular stroma are seen within these lesions. There are few reports of these fibrosclerotic lesions associated with metaplastic tumors. Here we describe a series of metaplastic tumors arising within fibrosclerotic breast lesions. Thirty-three metaplastic tumors associated with fibrosclerotic lesions were selected from a breast pathology consultative practice. Relevant clinical and pathological features were reviewed. Representative sections were evaluated immunohistochemically for expression of cytokeratins, vimentin, and smooth muscle and muscle-specific actins. Both the metaplastic component (spindled and squamous cells) and the glandular elements were graded. The metaplastic tumors arose within papillomas (20 cases), complex sclerosing lesions (7 cases), both papilloma and complex sclerosing lesions (3 cases), and nipple adenoma (3 cases). A majority of the metaplastic tumors showed a dominant spindle cell component with various degrees of atypia, ranging from fibromatosis-like (16 cases) to low-grade (13 cases), intermediate-grade (2 cases), and high-grade (2 cases) fibrosarcoma phenotype. Squamous metaplasia was present in 25 cases, and low-grade glandular elements, in 21 cases. Eleven tumors had a low-grade adenosquamous growth pattern. Ductal carcinoma in situ was present in 7 cases, and invasive mammary carcinoma, in 5 cases. The very low-grade tumors were histologically similar to limited areas of stromal reaction and myofibroblastic proliferation, seen in partially sclerotic micropapillomas/papillomas and complex sclerosing lesions, but usually more cellular. Cytokeratin positivity (13+/13 tested) supports the metaplastic nature of the more plump spindled cells. The spindle cells were also positive for vimentin (8+/8 tested) and smooth muscle (2+/5 tested) and muscle-specific actins (6+/6 tested). Spindle cell metaplastic tumors, from fibromatosis-like to fibrosarcoma, may arise within a variety of fibrosclerotic breast lesions.

Expression of E-cadherin in normal, hyperplastic and neoplastic feline mammary tissue

This paper describes an immunohistochemical study of the expression of E-cadherin in four samples of normal, eight samples of hyperplastic and 19 samples of neoplastic feline mammary tissue. In the normal tissues, the luminal epithelial cells showed a strong pattern of staining for E-cadherin at the cell-cell boundaries, whereas the myoepithelium showed no immunoreactivity. In the hyperplastic tissues and the five benign neoplasms, there were disturbances in the expression of E-cadherin in the luminal epithelium, in the form of the coexistence of membranous and cytoplasmic staining, together with immunoreactivity in a small percentage of myoepithelial cells. In 11 of 14 carcinomas, there was a reduction or absence of E-cadherin expression and abnormalities in the pattern of immunostaining; these changes were more pronounced in cribriform and solid carcinomas.

Quantity of mutant K-ras gene in pancreatic secretions for diagnosis of pancreatic carcinoma with different assays: analysis of 100 patients

BACKGROUND

Two types of quantitative assay kits for K-ras mutations, PCR-preferential homoduplex formation assay (PHFA) and enriched PCR and enzyme-linked mini-sequence assay (ELMA), were recently developed. The K-ras mutations were analyzed using these assays.

MATERIALS AND METHODS

DNA was extracted from the pancreatic juice which was obtained by endoscopy from 38 patients with pancreatic neoplasms (23 adenocarcinomas and 15 intraductal papillary neoplasms) and from 62 without it.

RESULTS

The results of the two methods were mutually correlative. K-ras mutation was detected at high levels (mutant ras genes occupied >2% of all K-ras genes) in 25 of the 38 cases (66%) with pancreatic neoplasm. It was also detected at high levels in 9 of the 14 cases (64%) with pancreatic cyst. In contrast, the mutant gene was detected at a lower level (<2%) in other cases.

CONCLUSIONS

Quantitative analysis of the mutant ras gene provided a useful tool for diagnosing the pancreatic carcinoma when the percentage of the mutant is high, especially when the types of mutation were either GAT or GTT.

[Study of CD44v6 protein expression in intraductal papilloma and its malignant transformation of breast]

BACKGROUND & OBJECTIVE

CD44v6 plays an important role in the malignant transformation of breast epithelia and is differentially expressed in normal and neoplastic breast tissue. The diagnostic value of this marker in differentiating malignant from benign breast lesions has not been well examined. This study was designed to evaluate the diagnostic value of CD44v6 protein in distinguishing between benign and malignant papillary lesions of the breast, which is be difficult morphologically, by determining the level of CD44v6 expression in different lesions of the breast.

METHODS

The level of CD44v6 protein was detected by immunohistochemistry in 111 paraffin-embeded blocks.

RESULT

The positive expressive rates of CD44v6 protein in the basal epithelial cells of the normal tissue, intraductal papilloma, and its malignant transformation, intraductal carcinoma, invasive ductal carcinoma were 95.00%, 85.72%, 66.66%, 66.66%, and 0.00% respectively. The difference between the intraductal papilloma and its malignant transformation was not significant(P > 0.05). However, the positive expressive rates of CD44v6 protein in the luminal epithelial cells of the above lesions were 5.00%, 20.41%, 83.34%, 93.33%, and 100% respectively. There was difference between intraductal papilloma and its malignant transformation(P < 0.01).

CONCLUSION

CD44v6 detection by immunohistochemistry is useful in distinguishing intraductal papilloma from its malignant transformation of the breast.

Altered mucin expression is a field change that accompanies mucinous (colloid) breast carcinoma histogenesis

Mucinous carcinomas of the breast, so-called colloid carcinomas, exhibit better prognoses than their nonmucinous breast counterparts. This biological difference exhibited by mucinous breast carcinomas prompted us to examine the relationship of mucin expression to colloid carcinoma histogenesis. We studied 50 colloid carcinomas, 50 noncolloid cancers, and 50 normal breasts by hematoxylin-eosin (H&E) and Alcian blue staining, mucin immunohistochemistry, in situ hybridization with a battery of MUC riboprobes, and ancillary digital image analysis. We observed luminal mucin in normal ducts in 80% of colloid carcinomas compared with 10% of noncolloid carcinomas and 6% of normal breasts (P < .01). In the cases of colloid carcinoma that showed mucin-filled ducts, luminal mucin was observed in 40% of the normal ducts and acini, 40% to 75% of the ducts involved by hyperplasia, atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS), respectively, and in 50% of the co-incidental areas of cysts (mucoceles), adenosis, fibroadenoma, and intraductal papilloma (P < .01). Immunohistochemistry showed that colloid carcinomas showed strong MUC2 cytoplasmic immunoreactivity and decreased MUC1 immunoreactivity compared with noncolloid carcinomas. In situ hybridization studies indicated fivefold increased MUC2 signals and twofold increased MUC5 signals within adjacent and remote normal epithelium in only the colloid carcinoma cases (P < .01; P < .05). In these cases of colloid carcinoma, these increased MUC2 and MUC5 signals were also observed in areas of hyperplasia, ADH, DCIS, and invasive carcinoma. In contrast, the noncolloid carcinomas showed fivefold increased MUC1 signals but no increases in MUC2 or MUC5. In mixed colloid/noncolloid carcinomas, the colloid areas had identical mucin expression patterns as the pure colloid carcinomas, but there was a loss of MUC2 and MUC5 expression and a gain of MUC1 expression in the noncolloid areas that was therefore identical to the pattern observed in pure noncolloid carcinoma. In this study, we conclude that the altered expression of mucin so characteristic of colloid carcinoma is also a field change present in adjacent and remote normal breast epithelium.

[Immunohistochemical study of c-erbB-2 and p53 protein in breast papillomatosis and its malignant transformation]

OBJECTIVE

To evaluate the levels of c-erbB-2 and p53 protein in different stages of papillomatosis of breast and its malignant transformation and value for early diagnosis.

METHODS

Levels of c-erbB-2 and p53 protein were detected by immunohistochemistry in 184 paraffin-embeded blocks.

RESULTS

c-erbB-2 protein expression was seen in all stages of papillomatosis with different degrees of proliferation and in tissues undergone malignant transformation. The rate of overexpression increased with the degree of proliferation. The p53 protein expression was not found in papillomatosis with mild to severe proliferation. It was only overexpressed in 3.5% of carcinoma arising from papillomatosis, but increased to 25% when invasion occurred.

CONCLUSION

c-erbB-2 assay may be helpful for detection of early malignant change of the highly proliferative papillomatosis, especially when histopathological evidence of malignancy is still lacking. p53 protein is of no significant diagnostic value in these lesions.

Co-expression of tenascin and fibronectin in epithelial and stromal cells of benign lesions and ductal carcinomas in the human breast

Tenascin (TN)-C and fibronectin (FN), which are glycoproteins of the extracellular matrix (ECM), are up-regulated in cancer tissues, including breast cancer. For assessment of their involvement in cancer invasion, it is important to know which cells are responsible for their production and secretion. The distribution of cells expressing TN and FN mRNAs in benign and malignant human breast tissues was therefore analysed by in situ hybridization, using digoxigenin-labelled cRNA probes, in addition to demonstrating the proteins immunohistochemically. Both mRNAs were expressed in epithelial cancer as well as in stromal cells in a large fraction of the tumours, with co-expression in individual cells. In cancers with intraductal components and/or those consisting of large nests, the mRNAs were more often expressed in the cancer than in the stromal cells. In scirrhous carcinomas, in contrast, the stromal cells were almost always positive for TN and FN mRNAs, while the cancer cells only rarely exhibited TN or FN expression. In benign lesions including adenosis, fibroadenoma and intraductal papilloma, the expression patterns also varied. These findings indicate that TN and FN co-expressed by cancer cells and stromal cells are probably involved in the intraductal extension and early invasion of cancer cells and in the remodelling of cancer stroma.

Cytologic evaluation of nipple discharge in relation to mammary neoplasia

Spontaneous nipple discharge as a presenting symptom was seen in 80 patients out of 3500 patients referred for cytologic examination of breast during last 5 years. Gross appearance of nipple discharge was bloody (33), serous (29), milky (16) and yellowish (2). Cytology smears showed 5 cases of carcinoma and 14 cases of intraductal papilloma. One out of two cases of male nipple discharge revealed malignant cells. Bloody nipple discharge was more often associated with carcinoma and intraductal papilloma. Hence it underscored the importance of cytologic evaluation of bloody nipple discharge.

Breast cancer diagnosis by lactate dehydrogenase isozymes in nipple discharge

BACKGROUND

The diagnosis of breast cancer based on nipple discharge, often the only clinical manifestation of early breast cancer, is currently unsatisfactory. Because M subunits of lactate dehydrogenase (LDH) have been noted to increase in cancer tissue, the author assessed the value of using LDH isozyme patterns in nipple discharge for the diagnosis of breast cancer.

METHODS

LDH isozyme levels in (1) nipple discharge of patients diagnosed as having breast cancer, intraductal papilloma, mastopathy, drug-induced nipple discharge, mastitis, or benign nipple discharge; (2) control samples of normal nipple discharge (milk) 6 days, 1-5 months, and 6 months to 2 years postpartum; (3) the serum of patients presenting with nipple discharge; and (4) normal and cancerous breast tissue extracts were measured using a Ciba-Corning LDH isozyme system (Ciba Corning Diagnostic Corp., Tokyo, Japan).

RESULTS

LDH isozyme levels in the nipple discharge of patients with benign breast diseases displayed various patterns. Levels in the nipple discharge of patients with breast cancer, including noninvasive carcinoma, tended to increase in ascending order from LDH1 to LDH5. This pattern was similar to that in breast cancer tissue and was unrelated to the pattern in serum.

CONCLUSION

LDH isozyme assay of nipple discharge may be a useful technique for providing a supporting diagnosis of breast cancer.

Immunohistochemical studies of S-100 protein expression in myoepithelial cells of benign breast diseases and normal breast tissues

We studied benign breast diseases using polyclonal anti S-100 protein and monoclonal anti a-subunit or beta-subunit of S-100 protein antibodies. The antibody gave positive staining in most of the cytoplasms and nuclei of the myoepithelial cells of normal breast tissues, gynecomastia, fibroadenoma, intraductal papilloma and mastopathy. However, immunohistochemical methods using the monoclonal antibodies for them did not reveal positive staining in the myoepithelial cells.

ErbB-2 protein levels in nipple discharge: role in diagnosis of early breast cancer

The levels of c-erbB-2 oncoprotein (ErbB-2 protein) in nipple discharge were evaluated together with those of carcinoembryonic antigen (CEA) in 9 patients with breast cancer, 2 patients with borderline lesions, 8 patients with intraductal papilloma, and 19 patients with fibrocystic change. When the tentative cutoff value was set at 40 ng/ml in the nipple discharge, elevated ErbB-2 protein levels were found in all 3 patients with palpable breast cancer and 3 of the 6 patients with nonpalpable cancer. Two of the 8 patients with intraductal papilloma had high ErbB-2 protein levels. A combination test with CEA resulted in positive detection in all cancer patients. Two patients with borderline lesions, 2 with intraductal papilloma and 2 with fibrocystic change were positive in a combination test. In addition, elevated ErbB-2 protein levels in nipple discharge correlated well with the overexpression of ErbB-2 protein in the tumor. All the patients with ErbB-2 protein levels over 100 ng/ml in their nipple discharge had comedo or solid intraductal carcinomas. Thus, measurement of ErbB-2 protein levels in nipple discharge can assist in the diagnosis of intraductal carcinoma and also in detecting tumors with a high proliferation rate and an overexpression of ErbB-2 protein: usually comedo or solid carcinomas.