PMC7278299_01
The findings of gross, chest CT, FNA cytomorphologic and microscopic examinations of the giant male invasive IC specimens. (a) A 60-year-old male patient incidentally has a chief complaint of a gradual increase in size of a relatively hard and cystic right chest mass with subsequent skin erosion, exudate and hemorrhage for 2 years. The chest skin below the right nipple looks markedly swelling, tense and reddish. (b) Chest CT shows a huge, partly solid and cystic, and relatively well-demarcated tumor mass with upper high-density and bottom low-density area, measuring approximately 11 x 8 cm with a 7 x 4 cm solid part in diameter, arising from the right breast. (c) The FNA cytology specimen (Papanicolaou staining) contains a large number of small to large, sheet-like or papillary three-dimensional clusters of viable and atypical cuboidal to columnar epithelial cells (inset) with loss of myoepithelial components, in a severely inflammatory background with scattered siderophages. Original magnification: 200x (inset, 400x). (d) A gross examination from the surgical specimen shows a cystic and partly solid papillary-projected tumor lesion, with a gray-whitish cut surface, associated focally with skin invasion, measuring approximately 9 x 7 cm with a 6 x 4 cm solid area in diameter. Bar = 1 cm. (e) Microscopically, the solid parts of this tumor are predominantly composed of the intracystic proliferation of mildly atypical epithelial cells with absence of two-cell patterns in an exophytic and papillary or papillotubular growth fashion. These neoplastic cuboido-columnar cells have small to medium-sized, mildly hyperchromatic and enlarged nuclei, conspicuous nucleoli and abundant eosinophilic cytoplasm, arranged in microtubular or microcystic structures filled with eosinophilic proteinaceous materials (inset). Furthermore, these tumor nests only partly invade the dermis to epidermis (upper right). Bar = 100 microm. (f) Immunohistochemical findings show that those carcinoma cells are specifically and diffusely positive for estrogen receptor (ER) (left) and progesterone receptor (PgR) or p63 (lt.) and cytokeratins, including AE1/AE3 (rt.). Original magnification: 200x.
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A 60-year-old male patient with an unremarkable previous medical history, except for one family history of his mother's breast cancer, incidentally had a chief complaint of a gradual increase in size of a relatively hard and cystic right chest mass with subsequent skin erosion, exudate and hemorrhage (Figure 1(a)) for 2 years. The chest skin below the right nipple looked markedly swelling, tense and reddish (Figure 1(a)). Chest computed tomography (CT) showed a huge, partly solid and cystic, and relatively well-demarcated tumor mass with upper high-density and bottom low-density area, measuring approximately 11 x 8 cm with a 7 x 4 cm solid part in diameter, arising from the right breast (Figure 1(b)). FNA cytology sample from the cyst fluid (Figure 1(c)) unexpectedly contained a large number of small to large, sheet-like or papillary three-dimensional clusters of viable and atypical cuboidal to columnar epithelial cells with loss of myoepithelial components, in a severely inflammatory background with scattered hemosiderin-pigmented macrophages (i.e. siderophages) on Papanicolaou stain (Figure 1(c)). Fibrovascular cores of those clusters were not evident, and there was no definite evidence of a necrotic background. Tumor extirpation was thus performed, and a gross examination of the giant tumor revealed a cystic and partly solid papillary-projected tumor lesion, with a gray-whitish cut surface, associated focally with skin invasion, measuring approximately 9 x 7 cm with a 6 x 4 cm solid area in diameter (Figure 1(d)). Microscopically, the solid parts of the tumor were predominantly composed of the intracystic proliferation of mildly atypical epithelial cells with absence of two-cell patterns in an exophytic and papillary or papillotubular growth fashion (Figure 1(e)). On a high-power view, these neoplastic cuboido-columnar cells had small to medium-sized, mildly hyperchromatic and enlarged nuclei, conspicuous nucleoli, and abundant eosinophilic cytoplasm, arranged in microtubular or microcystic structures filled with eosinophilic proteinaceous materials (Figure 1(e)). Furthermore, these tumor nests only partly invaded the dermis to epidermis (Figure 1(e)), indicating that they were malignant carcinomatous foci. Immunohistochemical findings showed that the carcinoma cells were specifically and diffusely positive for estrogen receptor (ER) (Figure 1(f)) and progesterone receptor (PgR) (Figure 1(f)), whereas they were negative for cytokeratin 5/6, S-100 protein, p63, thyroid transcription factor-1, CEA, chromogranin A, synaptophysin and HER2/ErbB2.