Faculty of Medicine

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    Myoepithelial carcinoma of the breast arising in adenomyoepithelioma. A case report.
    (Springer, 2001-09)
    Yashar, Genghis
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    Ivkovski, Ljube
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    Kubelka, Katerina
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    Zografski, George
    Introduction: Adenomyoepithelioma (AME), and especially myoepithelial carcinoma (MC), the malignant variant of this tumor, is a rare breast neoplasm. This report comprises the pathological features of a breast MC arising in AME with an aggressive clinical course. Case report: A 48-year old woman with a palpable mass in the right breast was admitted in November 1998. A month later following FNAB, surgical excision was performed. During the follow-up period of 17 months, until the patient's death, two local recurrences developed. Despite the aggressive chemotherapy, administrated after the first recurrence, subsequently bone, pulmonary and brain metastases appeared. Results: The primary tumor was an ovoid, white-grey, encapsulated mass measuring 4x3,5x1,5 cm. Microscopically, this biphasic tumor was composed of rare tubules surrounded by interlacing bundles of spindle cells exhibiting mild atypia. It was initially classified as a benign phyllodes tumor. The immunohistochemical analyses performed after the second recurrence proved the myoepithelial origin of the neoplasm (S-100, cytokeratin and alpha-SMA positive cells), with a high mitotic index (11 MF/10 HPF), and an immunophenotype indicating aggressive biological potential (steroid receptor negative, 50% Ki-67 and 30% p53 positive cells). Therefore, it was reclassified as MC arising in spindle cell type of AME. Conclusion: The histopathological diagnosis of AME could be very difficult, especially when a distinction from other spindle cell breast neoplasms must be done. Immunohistochemistry is essential to confirm the diagnosis, having in mind the reported pathological characteristics and the immunohistochemical profile of recurrent and malignant tumors of this type.
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    Immunohistochemical study of phyllodes tumor of the breast
    (Springer, 1999-09)
    Yashar, Genghis
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    ;
    Kubelka, Katerina
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    Zografski, George
    Phyllodes tumor ('PT) is a rare, fibroepithelial breast neoplasm with unpredictable prognostic and controversial therapeutic aspects. Aims: The aim of this retrospective study is to evaluate Ki-67 and CD34 antigen expression, as well as estrogen (ER) and progesterone receptor (PgR) status in stromal cells, as additional diagnostic criteria in assessing different types of PT. Methods: Routinely processed, formalin-fixed and paraffin-embedded surgical specimens from 47 cases of PT were stained by immunoperoxidase technique using Ki-67, CD34, ER and PgR monoclonal antibodies. On the basis of histopathological criteria proposed by Azzopardi, 6 malignant, 12 borderline and 29 benign PT have been evaluated. The mean size of the tumour was 9.4 cm (range 2.8-20 era). During the follow-up period (mean 50, range 2-127 months), recurrences were observed in 8 patients (17%). Results: The proliferating index determined by Ki-67 antigen expression was significantly different between histologically benign PT (19%), borderline PT (25%) and malignant PT (50%). There was a difference of the human progenitor cell CD34 antigen expression in malignant PT (50%), borderline PT (50%) and benign PT (30%). As expected, the stromal cells in various types of PT were mostly ER negative and PgR positive. Conclusions: Our preliminary results suggest that CD34 positivity and high proliferative index of Ki-67 antigen in stromal cells are more frequently associated with high grade PT. Therefore, the immunohistochemical features could provide better discrimination between different PT types. The prognostic implications of these observations should be evaluated in additional studies.
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    Apocrine carcinoma in situ with microinvasion – A case report
    (Macedonian Association of Pathology, 2016-09)
    Ognenoska-Jankovska, Biljana
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    Qerimi, Adelina
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    Stojkoska, Elena
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    Objective: Invasive apocrine carcinoma is a very rare type of breast malignancy, with an incidence of 0.5-4%, which presumably develops from apocrine precancerous lesions. We report a case of microinvasive apocrine carcinoma which was diagnosed by fine needle aspiration cytology (FNAC) and confirmed by histopathology. Material and Methods: A 45-year-old woman following a routine mammography that showed irregular spiculated mass measuring approximately 2.5cm in the upper outer quadrant of the left breast was referred to our Department for FNAC. The patient subsequently underwent left-sided quadrantectomy and axillary lymph node dissection, followed by postoperative adjuvant chemotherapy and radiotherapy. After 3 years of follow-up, no local recurrence or metastases were found. Results: FNAC yielded moderately cellular smears composed of loosely cohesive clusters of large, polygonal cells with abundant, basophilic and granular cytoplasm suggestive of malignant neoplasm with apocrine features. On gross examination of the quadrantectomy specimen, a grayish-white, solid growth with pushing borders measuring 2.5x1.7x1.5 cm was identified. Twenty-one lymph nodes measuring from 0.3 to 1.3 cm were dissected. Histologically atypical apocrine adenosis, low- and high-grade apocrine ductal carcinoma in situ (ADCIS) and 9 foci of microinvasive apocrine carcinoma (0.1-0.5mm) were found. Apocrine metaplasia was identified in the surrounding ducts. No nodal involvement was observed and the surgical margins were tumor free. Immunohistochemistry revealed that malignant cells (ADCIS and microinvasive carcinoma) were strongly positive for gross cystic disease fluid protein-15, Her2, and androgen receptor, and negative for estrogen and progesterone receptors. Ki67 proliferative index was approximately 15-20%, while 20-25% of the tumor cells were immunoreactive for p53. Conclusions: Here we report a case in which all of the stages involved in apocrine carcinoma progression were identified, from benign metaplasia to hyperplasia, atypia, ADCIS, to microinvasive cancer.