Immunohistochemistry For S-100 Protein Research Articles

Sensory innervation of the human shoulder joints in healthy and in chronic pain shoulder syndromes

BackgroundAfferent innervation of shoulder joints plays a fundamental role in nociception and mechanoception and its alteration result in shoulder´s disease that course with pain and functional disability. MethodsJoints shoulder from healthy subjects (n = 20) and with chronic pain shoulder syndromes (n = 17) were analyzed using immunohistochemistry for S100 protein to identify nerve structures (nerve fibers and sensory corpuscles), coupled with a quantification of the sensory formations. Sensory nerve formations were quantified in 13 distinct areas in healthy joint shoulder and in the available equivalent areas in the pathological joints. Statistical analyses were conducted to assess differences between healthy shoulder and pathological shoulder joint (p< 0.05). ResultsAll analyzed structures, i.e., glenohumeral capsule, acromioclavicular capsule, the extraarticular structures (subcoracoid region and subacromio-subdeltoid bursa) and intraarticular structures (biceps brachii tendon and labrum articulare) are variably innervated except the extrinsic coracoacromial ligament, which was aneural. The afferent innervation of healthy human shoulder joints consists of free nerve endings, simple lamellar corpuscles and Ruffini’s corpuscles. Occasionally, Golgi-Mazzoni’s and Pacinian corpuscles were found. However, the relative density of each one varied among joints and/or the different zones within the same joint. As a rule, the upper half and anterior half of healthy glenohumeral capsules have a higher innervation compared to the lower and posterior respectably. On the other hand, in joints from subjects suffering chronic shoulder pain, a reduced innervation was found, involving more the corpuscles than free nerve endings. ConclusionsOur findings report a global innervation map of the human shoulder joints, especially the glenohumeral one, and this knowledge might be of interest for arthroscopic surgeons allowing to develop more selective and unhurt treatments, controlling the pain, and avoiding the loss of afferent innervation after surgical procedures. To the light of our results the postero-inferior glenohumeral capsular region seems to be the more adequate to be a surgical portal (surgical access area) to prevent nerve lesions.

Peripheral Nerve Sheath Tumors Resembling Human Atypical Neurofibroma in Goldfish (Carassius auratus, Linnaeus, 1758).

Simple SummaryIn animals, especially in fish, dermal neoplasms are a common finding. A distinction between peripheral nerve sheath tumors (PNSTs) and other spindle cell tumors (SCTs) is not always possible when relying exclusively on routine cytological and histopathological findings. The current study aims to determine a minimal subset of stains required to correctly identify PNSTs in goldfish and describes, in detail, six dermal nodules that resemble atypical neurofibroma in humans. Interestingly, muscular and fibroblastic tumors were excluded using Azan trichrome staining, while Alcian blue and Gomori’s reticulin stains revealed the presence of intratumoral areas of mucins and basement membrane fragments, respectively. In addition, PAS and PAS with diastase pretreatment confirmed the latter finding and revealed intra- and extracellular glycogen granules. Immunohistochemistry displayed reactivity for S100 protein, CNPase, and phosphorylated and non-phosphorylated neurofilament-positive axons. Altogether, these findings suggested that Azan trichrome staining, Gomori’s reticulin staining, and immunohistochemistry for S100 protein and CNPase represent a useful set of stains to identify and characterize PNSTs in goldfish.Skin spindle cell tumors (SSTs) frequently occur in fishes, with peripheral nerve sheath tumors (PNSTs) being the most commonly reported neoplasms in goldfish. However, distinguishing PNSTs from other SCTs is not always possible when relying exclusively on routine cytological and histopathological findings. Therefore, the aim of this study is to characterize six skin nodules, resembling atypical neurofibromas in humans, found in six cohabiting goldfish (Carassius auratus), and to determine a minimal subset of special stains required to correctly identify PNSTs in this species. Routine cytology and histopathology were indicative of an SCT with nuclear atypia in all cases, with randomly distributed areas of hypercellularity and loss of neurofibroma architecture. Muscular and fibroblastic tumors were excluded using Azan trichrome staining. Alcian blue and Gomori’s reticulin stains revealed the presence of intratumoral areas of glycosaminoglycans or mucins and basement membrane fragments, respectively. PAS and PAS–diastase stains confirmed the latter finding and revealed intra- and extracellular glycogen granules. Immunohistochemistry displayed multifocal, randomly distributed aggregates of neoplastic cells positive for S100 protein and CNPase, intermingled with phosphorylated and non-phosphorylated neurofilament-positive axons. Collectively, these findings are consistent with a PNST resembling atypical neurofibroma in humans, an entity not previously reported in goldfish, and suggest that Azan trichrome staining, reticulin staining, and immunohistochemistry for S100 protein and CNPase represent a useful set of special stains to identify and characterize PNSTs in this species.

Interobserver reproducibility of perineural invasion of prostatic adenocarcinoma in needle biopsies

Numerous studies have shown a correlation between perineural invasion (PNI) in prostate biopsies and outcome. The reporting of PNI varies widely in the literature. While the interobserver variability of prostate cancer grading has been studied extensively, less is known regarding the reproducibility of PNI. A total of 212 biopsy cores from a population-based screening trial were included in this study (106 with and 106 without PNI according to the original pathology reports). The glass slides were scanned and circulated among four pathologists with a special interest in urological pathology for assessment of PNI. Discordant cases were stained by immunohistochemistry for S-100 protein. PNI was diagnosed by all four observers in 34.0% of cases, while 41.5% were considered to be negative for PNI. In 24.5% of cases, there was a disagreement between the observers. The kappa for interobserver variability was 0.67–0.75 (mean 0.73). The observations from one participant were compared with data from the original reports, and a kappa for intraobserver variability of 0.87 was achieved. Based on immunohistochemical findings among discordant cases, 88.6% had PNI while 11.4% did not. The most common diagnostic pitfall was the presence of bundles of stroma or smooth muscle. It was noted in a few cases that collagenous micronodules could be mistaken for a nerve. The distance between cancer and nerve was another cause of disagreement. Although the results suggest that the reproducibility of PNI may be greater than that of prostate cancer grading, there is still a need for improvement and standardization.

Immunophenotypic Characterization of Germ Cell Tumor–Derived Primitive Neuroectodermal Tumors: Evidence for Frequent Neuronal and/or Glial Differentiation

Primitive neuroectodermal tumors (PNETs) may arise as a somatic-type malignancy in germ cell tumors. In this setting, most PNETs resemble those of the central nervous system and lack chromosome 22 translocations. However, description of the morphologic and differentiation spectrum of PNETs arising from germ cell tumors is lacking. To investigate the morphologic and immunohistochemical features of these tumors, concentrating on neuronal and glial features. We selected cases based on a morphologically identifiable glial and/or differentiated neuronal component in association with the undifferentiated PNET. Immunohistochemistry for glial fibrillary acidic protein, S100 protein, synaptophysin, chromogranin A, and SOX11 was performed on tumors with available material, with the scoring of both staining intensity (0-3) and extent (0-3). Thirteen qualifying PNETs of testicular origin with available immunohistochemical stains or stainable material were identified. The complete stain panel was performed in 10 tumors. SOX11 demonstrated positive staining in the undifferentiated PNET component of all tumors (10 of 10) and was rarely positive in the differentiated (ie, neuronal/glial) component (1 of 10; focal and weak); synaptophysin was slightly less sensitive in the undifferentiated component (12 of 13; often focal and weak) and also showed positivity in the neuronal/glial component (5 of 13). Glial fibrillary acidic protein and S100 were more frequently positive in the differentiated areas (83% and 77%, respectively) compared with undifferentiated areas (25% and 17%, respectively). SOX11 is a sensitive immunohistochemical marker for testicular PNET, particularly those lacking differentiation. Testicular PNETs often demonstrate glial and/or neuronal differentiation. Differentiation is marked by the acquisition of S100 and glial fibrillary acidic protein expression and SOX11 loss.

Granular Cell Tumor Confined To The Muscularis Propria Of The Appendix: A Case Report

Abstract Introduction/Objective Granular cell tumors (GCTs) are exceedingly rare soft tissue tumors that are usually benign and are thought to arise from Schwann cell origin. GCTs most commonly occur in the skin, subcutaneous tissue, and oral cavity. However, they can involve any organ, including the gastrointestinal (GI) tract, of which esophagus is most common, followed by large intestine. We report a case of a 58 year old female who presented with acute appendicitis, followed by an appendectomy to reveal an incidental GCT. Methods This report is a retrospective study of an appendiceal GCT in which we reviewed the case and the histology. In addition, a brief literature review of gastrointestinal GCTs was performed to further elucidate the incidence, location, histopathology, and differential diagnoses for this lesion. Results Histological analysis of the tumor nodule reveals nests of epithelioid cells with abundant granular eosinophilic cytoplasm. The nuclei are bland, small, and round to oval, with rare spindled morphology. Immunohistochemistry for S-100 protein shows diffuse strong cytoplasmic and nuclear positivity, which is suggestive of Schwann cell origin. In the GI tract, GCTs are routinely confined to the mucosa, submucosa, or both; however the tumor nodule in our case is contained within the muscularis propria. Conclusion It is estimated that 5–11% of GCTs occur in the gastrointestinal tract, while only 13 GCT cases of the appendix have been reported. In addition to the previously stated rarity, is the limited involvement of the muscularis propria, with which GCTs typically are not associated. To our knowledge, this is the first confirmed GCT of the appendix that solely involves the muscularis propria, in English medical literature.

PRIMARY ORAL MELANOMA: A CASE REPORT WITH IMMUNOHISTOCHEMICAL FINDINGS

Melanoma is a potentially aggressive and rare malign neoplasm of melanocytic origin. Only 1% occur in oral mucosa, and it is more aggressive compared with the cutaneous counterpart. The tumor occurs more frequently in the hard palate and gingiva. The aim of this study is to report a case of primary oral melanoma in a 70-year-old female patient. Multiple asymptomatic pigmented lesions were observed in the upper vestibular gingiva and hard palate. An incisional biopsy was performed. Microscopic findings revealed proliferation of pleomorphic epithelioid and plasmacytoid cells positive by immunohistochemistry for S-100 protein, HMB-45, Melan-A, and Ki-67 (80%) confirming the diagnostic of oral melanoma. The patient was forwarded to a head and neck surgeon service for treatment. This study showed the importance of histopathologic and immunohistochemical evaluation to determine the morphologic aspects of oral melanoma to establish the final diagnosis.

Fibrovascular Tumor-Like Lesions of the Facial Nerve

Background: Facial nerve tumors (FNTs) are relatively rare benign lesions that arise from any segment of the facial nerve (FN). About half of all patients present with FN dysfunction, mainly long-standing or progressive facial paralysis. Diagnosis of an FNT is usually based on radiological imaging and confirmed by histological study. Most reported cases of FNTs are schwannomas and hemangiomas. Objectives: The aim of this study was to review 4 cases of lesions with clinical, radiological, and surgical findings that suggested an FNT, the pathology revealing a fibrovascular proliferation with no clear signs of a specific tumor. Method: Medical records of patients who had surgery due to an FN lesion were reviewed. Cases with known tumoral lesions were excluded. Four patients with tumor-like lesions were identified. Their imaging studies were re-evaluated. The pathological study included hematoxylin-eosin, Masson’s trichrome, and immunohistochemistry for S100 protein, neurofilaments, CD31, Wilms’ tumor 1 (WT1), and D240. Results: The 4 cases revealed tumor-like fibrovascular lesions that could not be classified as typical pathological entities. All cases had a complete facial palsy preoperatively. Computed tomography and magnetic resonance imaging (MRI) suggested schwannoma or hemangioma. A complete excision was achieved, and a facial reconstruction was performed immediately after interruption. Postoperative FN function was improved in all cases. The histological study showed nervous tracts of normal morphology, with fibrous and vascular tissue interspersed in variable proportions. All cases showed areas of fibrosis with Masson’s stain. In all cases, nervous tissue and Schwann cells tested positively for neurofilaments and S100, respectively. In vascular areas, endothelial cells stained positively for CD31, and negatively for D240 and WT1. Conclusions: Fibrovascular lesions of the FN may mimic primary FNTs, especially schwannomas and hemangiomas. Surgical excision with grafting or nerve transfer is the procedure of choice if a complete facial paralysis is found. This unusual condition should be considered when counseling patients with FN lesions. The lack of hyperintensity on MRI T2-weighted images may suggest the presence of fibrous tissue.

CORRELATION BETWEEN S100 PROTEIN EXPRESSION WITH CLINICAL STAGING NASOPHARYNGEAL CARCINOMA TYPE III

Abstract Introduction: Nasopharyngeal carcinoma is the most found head and neck cancer, which originated from a nasopharyngeal epithelial cell, and predilection site commonly at rosen muller fossa. S100 protein inflammatory mediators are involved in the regulation of cellular processes including inflammation and malignancy. S100 protein plays a central role in the proliferation, regulation of cell apoptosis and metastasis causing continuing growth of cancer cells through activation of STAT3 by IL-6, NF-κB, ROS. Objective: This study aimed to determine the correlation between S100 protein expression levels to the clinical stage of NPC WHO type III. Method: This research is a cross-sectional analytic study. This study was held in the Anatomical Pathology Department of Hasan Sadikin Hospital from August until October 2015. The study was conducted using 29 pieces of secondary data, medical records and paraffin blocks anatomical pathology of NPC patients were examined S100 protein immunohistochemistry. Result: This study was performed from 29 subjects (18 males and 9 females). There was a strong positive correlation between histoscore S100 protein expression with clinical staging p&lt;0.05. There is a significant correlation between S100 protein expression with the clinical stage of NPC WHO type III using double regression analysis (F=15.676, p=0.000). Conclusion: There were significant correlation S100 protein expression levels to clinical stage nasopharyngeal carcinoma WHO type III.

Schwannoma of hypopharynx: A Rare Entity

We report the case of a 55-year old Caucasian female who presented with dysphagia after being operated for a brain glioblastoma. Fiberoptic endoscopy and magnetic resonance imaging showed a submucosal tumefaction of the posterior hypopharyngeal wall. Direct laryngoscopy and biopsy did not reveal a definitive diagnosis. The lesion was completely removed using a transoral C02 laser, and histopathological examination of the lesion showed a diagnosis of hypopharyngeal schwannoma. The patient recovered uneventfully and has remained clinically and radiologically disease-free for 6 months. Surgical excision and S100 protein immunohistochemistry remain the gold standards for treatment and diagnosis of hypopharyngeal schwannomas.

Clinicopathological features of composite pheochromocytoma

Objective: To detect the clinicopathological features, immunophenotype, diagnosis, and differential diagnosis of composite pheochromocytoma(CP). Methods: Five cases of CP were collected at Zhejiang Provincial People's Hospital from January 2011 to January 2019. The clinical, radiological, histologic, immunohistochemical and outcome data were analyzed; the diagnosis and differential diagnosis were discussed. Results: The patients' age range was 52-68 years (mean 59 years, median 54 years), There were 4 males and 1 female, and the male to female ratio was 4∶1. Tumor size was 3-4 cm (mean 3.6 cm, median 3.5 cm). The most common clinical manifestation was adrenal mass. Histologically, the classical feature was two distinct morphologic components, one with tumor cells arranged in irregular nests, and with fine granular and basophilic oramphophilic cytoplasm; the other was composed of scattered ganglion cells in the background of Schwann cells organized in interwoven bundles. The components of pheochromocytoma expressed PHOX2B(5/5), synaptophysin (5/5), CgA (5/5), the sustentacular cells expressed S-100 protein; the components of ganglioneuroma expressed S-100 protein (5/5), NF (5/5), the ganglion cells were weakly positive for PHOX2B, synaptophysin and CgA. All the cases were surgically resected and all patients were free of recurrence at follow-up. Conclusions: CP is rare adrenal tumor, and it has typical histologic features but no specific clinical manifestations. Attention should be paid to its characteristic histomorphology with the use of PHOX2B, CgA, synaptophysin and S-100 protein immunohistochemistry that is helpful for its diagnosis.

Predominance of Granular Cell Tumours among Testicular Tumours of Rabbits (Oryctolagus cuniculi f. dom.)

Testicular neoplasms are reported rarely in pet and laboratory rabbits (Oryctolagus cuniculi f. dom.), with interstitial cell tumours being the most commonly described testicular neoplasm. In this retrospective study, paraffin wax-embedded testicles with neoplastic changes from 52 rabbits were investigated. Five out of 52 animals exhibited more than one tumour type, resulting in a total of 57 tumours. Granular cell tumours were the most prevalent neoplasm with 36 examples (63%) out of the 57 testicular tumours. Interstitial cell tumours, Sertoli cell tumours and seminomas occurred less frequently. Granular cell tumours of the testis are rare in rabbits. Histological similarities between granular cell and interstitial cell (Leydig cell) tumours in haematoxylin and eosin-stained tissue sections may lead to misdiagnoses. The periodic acid-Schiff reaction or immunohistochemistry for periaxin and S100 protein, as well as ultrastructural analysis, are useful methods to confirm the diagnosis.

Granular Cell Tumor of the Bladder: A Report of Six Cases

To better characterize granular cell tumor of the bladder, with only 20 cases reported to date and unclear management guidelines. We report five benign and one malignant granular cell tumor of the bladder. Patients were in the age range of 33 to 73 years. The size of tumor ranged from 0.2 to 6.3 cm. Two benign granular cell tumors were incidental findings with others presenting with painless hematuria. Benign granular cell tumors infiltrated the muscularis propria and were confirmed by immunohistochemistry for S100 protein with negative stains for keratins. The malignant granular cell tumor involved the entire bladder wall with extension into perivesical tissue. Benign granular cell tumors were treated by transurethral resection (TUR) or partial cystectomy; all patients were disease free at last follow-up. The malignant granular cell tumor was treated by anterior exenteration and bilateral pelvic lymphadenectomy. This patient developed pulmonary and pleural metastases 2 years after surgery. Given the locally infiltrative nature of granular cell tumors and that 50% of reported benign granular cell tumors with sufficient follow-up recurred following initial TUR, it is prudent to recommend partial cystectomy if technically feasible. A later TUR at a time of tumor regrowth could result in obstruction of ureters depending on their location and with greater infiltrative growth, with larger subsequent resections be needed for complete removal. In other cases, immediate repeat TUR after a diagnosis of granular cell tumor would lessen the likelihood of local recurrence. Either partial or radical cystectomy is needed for the rare malignant granular cell tumor.

Quantitative perineural invasion is a prognostic marker in prostate cancer

This study aimed to investigate the prognostic value of a quantitative, detailed, yet practical analysis of perineural invasion in radical prostatectomy specimens in a high-risk prostate cancer cohort. A total of 114 patients with prostate cancer who underwent radical prostatectomy between 2000 and 2013 were analysed. Using S100 protein immunohistochemistry assisted in the detection of nerves. In the area of closest proximity of the tumour to the dorso-lateral margins, nerves were counted and the infiltration of nerves was categorised (0-3). Category 0 was nerves without immediate tumour-cell-contact. All nerves being fully surrounded by tumour (classical perineural carcinosis) were categorised group 3. Two further categories discriminated between nerves that were touched either by carcinoma cells below 50% of the circumference (category 1) or above (category 2). Perineural carcinosis (Pn1) was seen in 61.4% of cases and correlated positively with ISUP grades, pT categories and presence of intraductal carcinoma but failed significance on Kaplan-Meier analysis. A more quantitative analysis of percentual perineural involvement did demonstrate significant survival differences: cases with less than one Pn1-positive nerve in 5 high power fields had longer survival times. Incomplete perineural involvement (category 1-2) did not have a prognostic value, endorsing the current definition of perineural carcinosis as full circumferential encasement of a nerve by tumour cells. A quantitative analysis of the percentage of nerves positive for perineural invasion has a higher prognostic value than the classical dichotomous statement on the mere presence of perineural invasion.

Mammary analog secretory carcinoma of the thyroid gland: A primary thyroid adenocarcinoma harboring ETV6–NTRK3 fusion

AbstractETV6–NTRK3 fusion was identified in several cancers including the recently described mammary analog secretory carcinoma (MASC) of the salivary glands and a minority of papillary thyroid carcinomas. We describe three cases of primary MASC of the thyroid gland and provide a detailed clinical and pathological characterization of the tumor morphology, immunoprofile, and genetic background. Immunohistochemistry for PAX8, TTF-1, thyroglobulin, mammaglobin, GCDFP-15, S-100 protein, and p63 was used to define the tumor immunophenotype. Fluorescence in situ hybridization for ETV6 rearrangement was performed in three, and the next-generation sequencing assay MSK-IMPACT™ (Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets) was performed in two cases. Primary MASC of the thyroid occurred in two women and one man, age 47–72 years. All patients presented with high T stage, infiltrative, locally aggressive tumors with extrathyroidal extension. Two cases were associated with well-differentiated papillary thyroid carcinoma. Histologically, they appeared as low-grade tumors, resembling MASC of the salivary glands and labeled positive for mammaglobin, GCDFP-15, S-100 protein, p63, weakly positive for PAX8, and negative for TTF-1 and thyroglobulin. Fluorescence in situ hybridization revealed ETV6 rearrangement in all cases. In two tested cases MSK-IMPACT™ confirmed the presence of ETV6–NTRK3 gene fusion. Two patients had at least two local recurrences, one was alive with disease, and one was alive and free of disease after 14 and 17 years, respectively. The third patient was alive and free of disease after 2 years. MASC of the thyroid is histologically, immunophenotypically, and genetically similar to its salivary gland counterpart. Thyroid MASC can be associated with a well-differentiated papillary thyroid carcinoma component, supporting follicular cell origin. Clinically, these carcinomas may show frequent recurrences but are associated with long-term survival. Patients with MASC of the thyroid may potentially benefit from Trk molecular-targeted therapy.

Malignant peripheral nerve sheath tumour in a sow

Nodular lung lesions in swine are frequently due to abscesses or granulomatous pneumonia. Although tumours are rarely reported in modern pig farming, they should be considered as a differential diagnosis when nodular lung lesions are found. A first-parity sow exhibiting respiratory signs was euthanized. Several whitish firm nodules, not encapsulated, ranging in diameter from 0.5 to 5 cm were present in all lung lobes. Microscopically, the nodules were composed of dense neoplastic cells, mainly in Antoni types A and B patterns, infiltrative and with development of emboli. All neoplastic cells stained positively by immunohistochemistry for vimentin and S-100 protein, with variable immunostaining for glial fibrillary acidic protein and stained negative for cytokeratin. Based on the gross, histological and immunohistochemical features, the tumor was diagnosed as malignant peripheral nerve sheath tumour.

Immunohistochemical analysis of mechanoreceptors in transverse acetabular ligament and labrum: a prospective analysis of 35 cases.

The labrum and transverse acetabular ligament (TAL) are classically described as distinct anatomical structures with abundant mechanoreceptors and free nerve fibers. They deepen the joint and act as natural barriers against dislocation, thus providing additional stability. We hypothesized that severe coxarthrosis leads to elimination of labrum and TAL mechanoreceptors. This study evaluated the microscopic anatomy of the labrum and TAL and specifically investigated the neurological status of these structures. Labral and TAL specimens from 35 consecutive patients with coxarthrosis undergoing total hip arthroplasty were dissected into a total of 4 specimens per hip. Formaldehyde-fixed specimens were evaluated for the presence of mechanoreceptors and free nerve endings by neurofilament protein and S-100 protein immunohistochemistry and microscopy. Mechanoreceptors were identified in the labral (2.3/high power field) but not TAL specimens, with a sharp delineation between the tissues. In contrast, both labrum and TAL showed good vascularity with abundant free nerve fibers within fibrous connective tissue (mean, 2.6 sensory fibers/ high power field vs 3.1/high power field, respectively). This study demonstrated that the TAL lacks mechanoreceptors. However, TAL and labrum free nerve fibers suggest potential roles as hip pain generators.

Mammary analogue secretory carcinoma (MASC) of salivary gland in four Mexican patients.

The Clinco-pathological, immunohistochemical and molecular findings of four cases of Mammary Analogue Secretory Carcinoma (MASC) of salivary glands found in Mexico are described. The cases were extracted from 253 salivary gland tumors from a single institution in Mexico City. The 85 candidates for initial selection were: low grade mucoepidermoid carcinoma (MEC) (N=70 ), acinic cell cancinoma (AciCC) (N=14), papillary cystadenocarcinoma (N=1), and adenocarcinoma NOS (N=0). Tumors with some histological features consistent with MASC (N= 17, 6.7%) were studied by immunohistochemistry for mammaglobin, STAT5, and S-100 protein and four cases were positive (1.5%), thus the diagnosis of MASC was established, and these were submitted for molecular studies for ETV6-NTRK3. Fusion gene was demonstrated in three cases, two had been erroneously diagnosed as poorly granulated AciCC, and one as low grade MEC with microcystic pattern. Female gender predominated (3:1); one occurred in the parotid, two in minor salivary glands and one in the submaxillary gland; infiltrating borders, atypical mitosis and lymph node metastases were seen in the parotideal tumor. Two patients with major salivary gland tumors are alive and well at 10 and 20 months respectively, the two patients with minor salivary gland tumors are lost. It can be concluded that is important to think in MASC in poorly granulated AciCC and low grade MEC with microcystic pattern. Immunohistochemisty studies confirm the diagnosis, preferentially supported by molecular studies. MASC may follow aggressive behavior or transform into a high grade neoplasm. Key words:Acinic cell carcinoma, ETV6-NTRK3, Mammary Analogue Secretory Carcinoma, secretory breast carcinoma.

Histological Study of the Cavernous Nerve Mesh Outside the Periprostatic Region: Anatomical Basis for Erectile Function after Nonnerve Sparing Radical Prostatectomy

We identified the cavernous nerve mesh that exists caudal or posterior to the periprostatic region between the bilateral slings of the levator ani. We also assessed whether nonnerve sparing radical prostatectomy could be modified. Using histological sections from 24 elderly cadavers we investigated nerve anatomy by immunohistochemistry for S100 protein, neuronal nitric oxide synthase, vasoactive intestinal polypeptide and tyrosine hydroxylase. The cavernous nerve mesh formed a U-shaped column attached to the lateral and posterior aspects of the rhabdosphincter. It was greater than 10 mm thick along the anteroposterior axis and 5 to 10 mm wide from the lateral margin of the rhabdosphincter. Composite neuronal nitric oxide synthase positive nerves ran obliquely with a highly tortuous course. The anterior margin of the nerve mesh corresponded to the anterior margin of the rhabdosphincter. Nerve mesh left-right communication was seen at and near the anterior margin. Bilateral periprostatic nerves joined posterior to the urethra and immediately anterior to the rectourethralis muscle, forming a midsagittal nerve mesh corresponding to the base of the U. The periprostatic nerves also formed a mesh or bundle but it was much thinner and smaller than the U-shaped mesh along the rhabdosphincter. Neuronal nitric oxide synthase positive nerves consistently contained tyrosine hydroxylase positive sympathetic nerve fibers but there were few vasoactive intestinal polypeptide positive fibers. The pudendal nerve and its branches were negative for neuronal nitric oxide synthase. Bilateral resection of the neurovascular bundle does not remove all cavernous nerves because these nerves cover the rhabdosphincter and perirectum caudal to the level of the apex of the prostate.

Matrix-producing metaplastic carcinoma: a clinicopathologic and prognostic analysis of 16 cases with review of literature

To study the clinicopathologic features, immunophenotype and prognosis of matrix-producing metaplastic carcinoma (MPC). Sixteen cases of MPC diagnosed between 2002 and 2012 in West China Hospital were identified. The clinicopathologic features were analyzed. Immunohistochemistry for E-cadherin, S-100 protein, CK5/6, HCK, PCK, CK7, CK8, p63, SMA, EMA, CD99, MSA, CK14, EGFR, ER, PR, HER2 and Ki-67 was performed with EnVision method. The clinical outcome was evaluated and compared to matched controls of invasive ductal carcinoma. All patients were women and ranged in age from 29 to 69 years (median age 48 years). The median size of primary tumor was 4 cm. Most of the tumors were well-circumscribed with expansile and multinodular appearance. Histology showed invasive carcinoma with a direct transition from carcinoma to cartilaginous/chondromyxoid matrix without an intervening spindle cell component. Tumor distribution was either nodular or diffuse. The matrix component accounted for 10%-80% of the tumor volume. All the tumors were strongly positive for S-100 protein and basal-like cytokeratin with triple negative phenotype (ER, PR and HER2 negative). Alcian blue stain was positive for the cartilaginous/chondromyxoid matrix. Compared with invasive ductal carcinoma, patients with MPC had increased locoregional recurrence (P = 0.010), increased distant recurrence (P = 0.011) and shorter disease-free survival (P = 0.017). MPC is a rare variant of mammary metaplastic carcinoma with unique characteristics of morphology and immunohistochemical staining pattern. This subtype seems to have aggressive biologic behavior.

Morphology in conjunction with immunohistochemistry is sufficient for the diagnosis of mammary analogue secretory carcinoma.

The recently described mammary analogue secretory carcinoma (MASC) is a low-grade salivary gland malignancy that harbors the recurrent cytogenetic abnormality t(12;15) (p13;q25) ETV6-NTRK3. Confirmation of this is currently considered the gold standard for diagnosis. Some have postulated that morphology together with supporting immunohistochemistry is sufficient to diagnose MASC. In this study we retrospectively review a series of 19 MASCs diagnosed based on histology in conjunction with immunohistochemistry; subsequently we performed in situ hybridization using an ETV6 break-apart probe. Immunohistochemistry for S100 protein and mammaglobin as well as fluorescence in situ hybridization using the Vysis ETV6 Dual Color Break-Apart FISH Probe Kit were performed on all cases. The 19 cases were from 12 females and 7 males with ages ranging from 16 to 76 years (mean = 45 years). Sixteen cases were from the parotid gland, 1 case was from a periparotid lymph node and 2 cases were from the submandibular gland. All 19 cases demonstrated moderate to strong expression of S100 protein. Eighteen cases demonstrated strong, diffuse expression of mammaglobin, while one case had only rare tumor cells that strongly expressed mammaglobin. Eighteen of 19 cases (95 %) demonstrated the ETV6 rearrangement by fluorescence in situ hybridization. Given that morphology together with immunohistochemistry is highly correlated with the ETV6 gene rearrangement, we conclude that molecular confirmation is not required to diagnose MASC.