Benign Squamous Metaplasia Research Articles

A case of Bilharzial tubercle in a migrant from zimbabwe, diagnosed late through cystoscopy and histology, with negative schistosomiasis serology [Indirect Hemagglutination (IHA)

We report a case of Bilharzial tubercle in a migrant from Zimbabwe, recognised 10 years later through flexible cystoscopy and histological findings. A 21-year-old female presented to her local doctor with six months history of supra-pubic pain and dyspareunia without systemic symptoms. Her past medical history included intermittent asymptomatic haematuria since 2006 attributed to thin membrane disease, migraine and sinusitis. She had freshwater exposure in a rural region in Africa prior to migration to Australia 11 years ago. Her urine dipstick showed erythrocytes count of 137×106/L. Schistosomiasis serology (IHA) was negative. Pelvic ultrasonography showed a focal 8×5 mm lesion in the posterior bladder wall suspicious for neoplastic aetiology. Cystoscopy demonstrated patchy changes on bladder mucosa and a persistent bladder wall mass, which was nodular and suspicious for Bilharzial tubercle. A 7 mm fragment of the bladder lesion showed urothelium with mucosal ulceration and dense mixed inflammation with large numbers of eosinophils. Numerous calcified schistosoma eggs were present within the mucosa and lamina propria. The mucosa showed reactive changes and there was benign squamous metaplasia without evidence of malignancy. She was treated with praziquantel 20 mg/kg orally with food, for 2 doses and 4 hours apart with resolution of her symptoms, haematuria and lesion.

P16/Ki-67 Immunostaining is Useful in Stratification of Atypical Metaplastic Epithelium of the Cervix

Cervical metaplastic squamous epithelium exhibiting atypia insufficient for a diagnosis of cervical intraepithelial neoplasia (CIN) is usually reported as "atypical squamous metaplasia" (ASM). Stratification impacts treatment since the differential is often between reactive and high grade CIN (CIN II, III). Diagnosis with H&E is associated with low intra/interobserver concurrence. P16/Ki-67 immunostains are helpful to assess cervical biopsies for HPV-associated lesions but staining in metaplastic squamous epithelium has received little attention. This study aims to establish staining characteristics of metaplastic squamous epithelium and determine if p16/Ki-67 is useful in ASM stratification. 80 cervical biopsies containing morphologically normal and dysplastic squamous metaplasia were retrieved to determine the staining characteristics of metaplastic epithelium utilizing p16/Ki-67 immunostains. These included 21 benign squamous metaplasia (BSM) from benign cervices, 15 BSM present adjacent to HPV/CIN lesions, and 44 CIN involving squamous metaplasia. Serial sections with controls were stained for p16 and Ki-67 and in-situ hybridization (ISH) for low-risk (LR) and high-risk (HR) HPV was performed. P16 was recorded as negative, spotty, or band-like. Ki-67 was recorded as positive when present in >50% of lesional nuclei. Results were correlated with H&E diagnosis. 95% of the BSMs, whether from normal cervices or adjacent to HPV/CIN were p16/Ki-67 negative. 81% HG CINs involving squamous metaplasia were p16 band/Ki-67 positive. Low grade CIN (CIN I) involving metaplastic epithelium showed a broad distribution of p16/Ki-67 staining patterns. Based on these criteria, 20 ASM were evaluated. 10% of the ASM cases were p16 band/Ki-67 positive indicating HG CIN. 60% of the ASMs were p16/Ki-67 negative indicating reactive change (all with the exception of one case being HPV negative). The remaining 30% of the ASM cases showed variable positivity for p16 and Ki-67 and could not be stratified into the two categories. Thus p16/Ki-67 staining is helpful in stratification of ASM as reactive or CIN.

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.

Cytologic characterization of bronchial epithelial changes in small cell carcinoma of the lung: Boucher LD, Yoneda K. Pathology/Lab. Medicine Service, Veterans Affairs Medical Center, 2250 Leestown Road, Lexington, KY 40511-1093. Acta Cytol 1995; 39: 69–72

Cytologic specimens obtained by fiberoptic bronchoscopy were examined in 111 cases; the diagnosis of small cell carcinoma of the lung was established with this procedure. The findings of cytologic examination were compared to those of histologic examination of the biopsy specimens obtained simultaneously. Our aim was to evaluate other cell components in the specimen besides small cell carcinoma. The majority of the cases showed morphologic changes in the bronchial epithelium, which ranged from benign squamous metaplasia (59%) to atypical squamous metaplasia (8%) and squamous cell carcinoma (8%). In 6% of cases a large cell carcinoma component was found in addition to the small cell carcinoma. The findings show a good correlation with those of histologic examination of the biopsy specimens, indicating that cytologic examination is an excellent procedure for detecting concomitant changes in the bronchial epithelium in the setting of small cell carcinoma of the lung.

Epidermal growth factor receptor expression and endometrial cancer histotypes.

Epidermal growth factor receptor (EGF-R) has been implicated in the growth of endometrial cancer. In the present study, immunostaining of EGF-R was investigated in different endometrial cancer histotypes. For this purpose 34 surgical samples of primary endometrial carcinoma were studied using monoclonal anti-EGF-R antibody. The endometrial carcinomas were classified according to the International Society of Gynaecological Pathology (I.S.G.P.). EGF-R expression was observed in: 1 of 5 classical endometrioid adenocarcinomas (AE), in 8 of 9 endometrial adenocarcinomas with benign squamous metaplasia (AA), and in 3 of 14 adenosquamous adenocarcinomas (AS). In mucinous (M) and serous papillary adenocarcinoma (SP) EGF-R immunostaining was not observed. The EGF-R positivity was observed in endometrial cancer with squamous (SQ) differentiation, especially in those with benign SQ metaplasia. These results suggest that EGF-R immunostaining is related to the endometrial cancer histotype regardless of the tumor grade or extent of miometrial invasion.

Bronchial epithelial changes associated with small cell carcinoma of the lung

From 1976 to 1991, 151 cases of small cell carcinoma of the lung were diagnosed by fiberoptic bronchoscopic biopsy at our institution. One hundred twenty-eight of 151 cases provided suitable material for the examination of the morphologic changes in the bronchial surface epithelium. Thirty-seven percent of the cases showed normal bronchial epithelium, 47% showed benign squamous metaplasia, 9% showed atypical squamous metaplasia, and 5% showed squamous cell carcinoma in situ. Immunohistochemical examination for bombesin and epidermal growth factor was performed on selected biopsy specimens. The biopsy specimens chosen for immunohistochemistry included 20 specimens that showed normal bronchial epithelium, 20 specimens with benign squamous metaplasia, 12 specimens with atypical squamous metaplasia, and seven specimens with squamous cell carcinoma in situ. All the specimens showed positive staining with anti-bombesin. With anti-epidermal growth factor 10% of biopsy specimens with normal epithelium showed positive staining. The positive reaction increased from 25% for biopsy specimens with benign squamous metaplasia to 58% for biopsy specimens with atypical squamous metaplasia and to 71% for biopsy specimens with carcinoma in situ. These findings suggest a connection between epidermal growth factor production by small cell carcinoma of the lung cells and changes in the bronchial surface epithelium.

Cancerization of Eccrine Sweat Ducts in Bowenʼs Disease as Studied by Light Microscopy, DNA Spectrophotometry and Immunohistochemistry

This study assesses the incidence, histogenesis, and significance of eccrine sweat duct involvement in Bowen's disease (BD). In a review of 96 cases of BD, four showed eccrine duct involvement on hematoxylin and eosin-stained histologic sections. One case was analyzed for deoxyribonucleic acid (DNA) ploidy by using computerized image analysis on Feulgen-stained slides. Sections were also stained immunohistochemically, using antibodies to carcinoembryonic antigen (CEA), gross cystic disease fluid protein (GCDFP), and S-100 protein, and for cytokeratins (CAM 5.2, AE 1/3). Our results showed that, in BD, (a) the eccrine sweat ducts can be extensively involved by atypical cells, (b) the atypical eccrine duct cells had an aneuploid DNA pattern, and (c) the atypical eccrine duct cells were negative for CEA, GCDFP, and S-100 protein but were positive for cytokeratins. We conclude that (a) the frequency of eccrine duct involvement in BD is relatively low (approximately 4 to 9%), (b) the aneuploid DNA pattern makes a benign squamous metaplasia unlikely, (c) the immunohistochemical results exclude coincidental Paget's disease or carcinoma of eccrine sweat glands, (d) the involvement of eccrine sweat ducts may represent a direct extension of the neoplastic epidermal keratinocytes, and (e) this process may have practical implications in the recurrence of superficially treated cases of BD.

CASE OF ADENOSQUAMOUS CARCINOMA OF THE GALLBLADDER WITH A MIXTURE OF HISTOLOGICAL TYPES

We have treated a patient with adenosquamous cell carcinoma of the gallbladder. Most carcinomas of the gallbladder are adenocarcinomas, and few are adenosquamous cell carcinomas. The origins of squamous cell carcinomas in this location are not understood, because healthy mucosa of the gallbladder have no squamous cells. There are few reports of benign squamous metaplasia of the mucosa of the gallbladder in Japan. Benign squamous metaplasia and the interesting histology of the gallbladder in this case are discussed.