Cases reported "Breast Neoplasms"

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1/19. Pigmented carcinoma of the breast: an ultrastructural study.

    A pigmented skin lesion on a breast removed for carcinoma resembled melanoma by routine light microscopy, but correlation with immunohistochemistry and electron microscopy established that carcinoma cells within the upper dermis were intermingled with a proliferation of non-neoplastic melanocytic cells. Ultrastructurally, the tumor cells possessed desmosomes and intracytoplasmic lumina and mature melanosomes were present in their cytoplasm. The melanocytic cells were identified as melanocytes or melanophages, and it was concluded that the tumor in the skin was a passively pigmented carcinoma and not a melanoma or metaplastic breast carcinoma.
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2/19. Multifocal, nascent, and invasive myoepithelial carcinoma (malignant myoepithelioma) of the breast: an immunohistochemical and ultrastructural study.

    This report describes the light microscopic (LM), immunohistochemical (IHC), and electron microscopic (EM) features of a multifocal, nascent, and invasive myoepithelial carcinoma of the breast. By LM, the spindle cells disclosed fibrillar acidophilic cytoplasm, mild nuclear atypia, and a low mitotic index. Myoepithelial differentiation was established through IHC (single- and double-labeling techniques) and EM: periductal and infiltrating spindle cells coexpressed total muscle actin, alpha-smooth muscle actin, vimentin, cytokeratin 14, and pankeratin, and their EM features were characteristic of myoepithelial cells, i.e., perinuclear tonofilaments, subplasmalemmal bundles of microfilaments with dense bodies, intermediate junctions, poorly developed desmosomes, pinocytic vesicles, and fragmented external lamina. No invasive epithelial cells disclosed luminal differentiation (by LM, IHC, EM), identifying, thus, this neoplasm as a pure spindle cell myoepithelial carcinoma of the breast.
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3/19. Spindle cell carcinoma of the breast.

    A case of spindle cell carcinoma of the breast in association with myoepithelial cell hyperplasia is presented. Immunocytochemistry demonstrated labelling of tumour cells for cytokeratin, vimentin and S-100 protein. Electronmicroscopy showed desmosomes and bundles of tonofilaments as well as fine filaments in the cytoplasm. The findings in the present case point to the metaplastic spindle cell nature of squamous carcinoma of the breast. The possible role of myoepithelial cells in the origin of the spindle cell component is discussed.
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4/19. carcinoma of the breast with metaplasia to chondrosarcoma: a light and electron microscopic study.

    Two carcinomas of the breast containing large areas of sarcomatous tissue were studied by light and electron microscopy. In one of these, the sarcomatous element was frankly cartilaginous and in the other, predominantly myxoid but with small cartilaginous-looking foci. By light microscopy, a highly suggestive metaplastic transition could be traced from cells within the epithelial nests to those within the sarcomatous lobules. Ultrastructurally, cells in the former region showed epithelial characteristics and those in the latter region, mesenchymal and/or cartilaginous features. The carcinomatous cells contained desmosomes and formed intercellular spaces lined by microvilli; a few cells showed prominent profiles of rough endoplasmic reticulum. In the first case, the cells in the immediate vicinity of the epithelial nests and those in the fully developed cartilaginous regions showed a progressive dilatation of their endoplasmic reticulum to form large sac-like structures filled with a finely granular and floccular material. The intercellular matrix was electron lucent and contained scattered dense particles, fibrillo-granular material and collagen fibres. Condensation of this material at some distance from the cell resulted in the formation of lacunae. In the second case, the cells in the myxoid areas also showed prominent dilatation of endoplasmic reticulum.
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5/19. Differentiation of metastatic breast carcinoma from Stewart-Treves angiosarcoma. Use of anti-keratin and anti-desmosome monoclonal antibodies and factor viii-related antibodies.

    A chronic brawny edema developed in the shoulder and arm ipsilateral to the site of a previous mastectomy in a 68-year-old woman. Bluish nodules and telangiectasia admixed with more superficial papules and plaques developed subsequently. Histologically, many of these lesions showed angiocentric clusters of large hyperchromatic tumor cells, often with lumina in the center. It was difficult to differentiate two possibilities, ie, postmastectomy angiosarcoma in lymphedema (Stewart-Treves syndrome) and nodulotelangiectatic metastasis of the original breast carcinoma. Monoclonal anti-keratin antibody and anti-desmosome antibody identified keratin and desmosomes in the tumor cells, whereas staining with factor viii-related antigen yielded negative results. Electron microscopy revealed, in addition to keratin filaments and desmosomes, typical secretory cells and lumen formation. A combined use of specific monoclonal and polyclonal antibodies is helpful in the determination of tumor origins.
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6/19. Malignant myoepithelioma (myoepithelial carcinoma) of the breast: an ultrastructural and immunocytochemical study.

    This report describes the light (LM) and electron microscopic (EM) features and the results of an indirect immunofluorescence study (IF), the latter using monoclonal and monospecific antibodies to cytoskeletal proteins, of a malignant, invasive and metastatic breast myoepithelioma. A 53-year-old female underwent mastectomy for a large necrotic mammary tumor that had invaded the overlying skin. By LM, the neoplasm was composed of interlacing bundles of large, elongated and interspersed stellate cells with acidophilic cytoplasm. The neoplastic cells displayed a moderate degree of anaplasia, high mitotic activity, and strong tendency for necrosis. Stromal desmoplasia was marked, especially toward the center of the neoplasm. By IF, the tumor cells revealed bright cytoplasmic fluorescence with antibodies to actin, prekeratin, and cytokeratin. A few scattered spindle cells, which stained with the anti-vimentin and anti-actin anti-bodies, most likely represented stromal myofibroblasts. The anti-desmin reaction was negative. By EM, the neoplasm was composed of variably differentiated, elongated and stellate myoepithelial cells connected by desmosomes, enveloped by remnants of basal lamina, and containing pinocytotic vesicles, a well-developed rough endoplasmic reticulum, large Golgi areas, aggregates of intermediate filaments that were often arranged in dense curvilinear bundles (tonofilaments), and bundles of microfilaments with fusiform, dense bodies. The combined LM, EM, and IF study of this mammary tumor establishes its myoepithelial origin and, thus, identifies it as myoepithelial carcinoma distinct from other spindle cell breast tumors. This neoplasms was locally invasive and cytologically malignant; moreover, its malignancy was further confirmed by the development of lung and pleural metastases.
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7/19. myoepithelioma of the breast: histologic, immunologic, and electromicroscopic appearance.

    This report describes the histologic, immunologic, and ultrastructural features of a distinctive spindle-cell tumor of the female breast interpreted as pure myoepithelioma. By light microscopy, the tumor showed the mammary parenchyma replaced by bundles of fusiform cells, which cytoplasms contained myosin and actin, demonstrated immunologically. Ultrastructurally, the spindle cells were joined by mature desmosomes and presented parallel bundles of microfilaments and remnants of basal lamina.
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8/19. Alveolar variant of invasive lobular carcinoma of the breast: an electron microscopic study.

    Four cases of alveolar variant of invasive lobular carcinoma of the breast were examined by electron microscopy, and their appearance compared with those of in situ and classical invasive lobular carcinoma. The individual tumor cells in the alveolar variant were basically similar to those described in the other two lobular tumors. The neoplastic alveoli consisted mostly of light cells, although a few dark cells were sometimes seen at the periphery. The nuclei were large, rounded and rich in euchromatin. The cytoplasm contained a variable amount of mitochondria and endoplasmic reticulum, and a few cells had intracytoplasmic filaments. Numerous tumor cells with membrane-bound electron-dense granules were occasionally seen. A few cells also had intracytoplasmic lumina. Tumor cells were usually seen in close contact with each other. Interdigitating processes and desmosomes were present. In general the tumor cells were not surrounded by basal lamina, but most alveoli were surrounded by elongated fibroblasts or myofibroblasts. These findings confirm both the lobular and the invasive nature of this distinct variant of breast carcinoma.
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9/19. glycogen-rich clear cell carcinoma of the breast: a light and electron microscopic study.

    A glycogen-rich clear cell carcinoma arose in the breast of a 49-year-old woman. light microscopic examination of the neoplasm revealed both intraductal papillary growth and stromal invasion. Electron microscopic examination demonstrated neoplastic cells that contained massive quantities of nonmembrane-bound particulate glycogen and that formed numerous acini. Apically, these cells formed microvilli; laterally they formed tight junctions and desmosomes. Morphologic features of this neoplasm are similar to those of the fetal breast and to some other clear cell carcinomas arising elsewhere in the body.
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10/19. Infiltrating myoepithelioma of the breast.

    This report describes the histologic and ultrastructural features of a spindle cell myoepithelioma arising in the breast of a 60-year-old woman. By light microscopy, the tumor consisted of interlacing bundles of elongated cells sometimes arranged in a storiform pattern. No intraductal or invasive carcinoma was identified. Ultrastructurally, the neoplasm was composed of activated, differentiated myoepithelial cells showing evidence of squamous metaplasia, i.e., spindle-shaped cells joined by mature desmosomes and encompassed by remnants of basal lamina containing a well-developed rough endoplasmic reticulum, pinocytotic vesicles, prekeratin filaments, and longitudinally oriented bundles of microfilaments with fusiform densities. Numerous cisternae of rough endoplasmic reticulum suggested heightened metabolic activity, whereas the presence of cytoplasmic prekeratin filaments indicated squamous metaplasia. The cells comprising most previously reported "myoepitheliomas" examined by electron microscopy lacked many of the distinctive fine structural features of the normal myoepithelial cell. At present, the diagnosis of myoepithelioma should be based on strict ultrastructural criteria. The clinical behavior of this particular lesion in the breast is unknown. If the tumor follows the course of comparable salivary gland neoplasms, the likelihood of systemic spread is low. Primary therapy for a tumor proven to be an infiltrating myoepithelioma of the breast should be directed at complete excision of the lesion.
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