PMC1184104_01
Tumor was grossly firm and circumscribed (1a). The histological pattern was microcystic (1b) with abundant intra and extracellular secretory material as showed by the colloidal iron stain which was diffuse and strongly positive (1c). The tumor was positive for S-100 protein (1d).
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F1
On macroscopic examination the tumor was firm and circumscribed (Figure 1a). Microscopy showed the classical features of secretory carcinoma with a microcystic pattern (Figure 1b) with abundant intra and extracellular secretory material. Colloidal iron staining highlighted the secretory material (Figure 1c). On immunohistochemistry, the tumor cells were positive for S-100 protein (Figure 1d) but negative for estrogen and progesterone receptor and HER2 (Dako, Carpinteria, CA). 2 of 24 resected lymph nodes were positive for metastatic carcinoma.
FISH images confirming the presence of the t(12;15). In 2a, the presence of the ETV6-NTRK3 fusion is demonstrated by the close proximity of a red signal (ETV6 from chromosome 12) with a green signal (NTRK3 from chromosome 15) in each cell. In 2b, each cell shows separation of red and green probes flanking the NTRK3 gene from chromosome 15.
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F2
A t(12;15) translocation fusion probe assay (Fig. 2a) and a chromosome 15 NTRK3 gene split-apart assay (Fig. 2b) were used to detect the t(12;15) translocation.
Disease recurrence at the chest wall (3a) and lung metastasis (3b). There were two hard nodules in the chest wall and three ipsilateral axillary nodules. In the lung several nodular metastases were present as well as a right sided pleural effusion.
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F3
The patient returned to clinic eighteen months later with two hard nodules in the surgical resection area measuring 8 x 8 cm and 4 cm x 4 cm, (one ulcerated), and three left axillary subcutaneous nodules, two measuring 2 x 2 cm and one 3 x 3 cm (Figure 3a). A chest CT scan identified pulmonary metastases with a right pleural effusion (Fig. 3b).
Disease in the chest wall (4a) and lung (4b) after radiation and concurrent chemotherapy. There was only minor response in the chest wall disease and essentially no change in the lung.
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F4
Post-treatment, there was no change in the pulmonary disease and there was minor response of chest-wall and axillary disease (Figure 4a and 4b).