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Malignant granular cell tumor is a rare neoplasm that has been reported to occur at various sites. Although there are no reliable histologic criteria to differentiate the benign from the malignant form of granular cell tumor, in many reported cases cellular pleomorphism and the presence of mitotic activity suggested an aggressive nature. We report a case of malignant granular cell tumor that involved the subcutaneous tissue in the sacrococcygeal area. The tumor showed cellular atypia on histologic sections, but mitotic figures were rare. The tumor recurred and produced widespread metastasis, resulting in the death of the patient. DNA flow cytometry demonstrated DNA diploidy, suggesting that such analysis may not be beneficial in predicting the behavior of these tumors.

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BACKGROUND: The recurrence or mortality rate of axillary lymph node-negative invasive breast cancer has been associated with the tumor S-phase fraction, which is measured by DNA flow cytometry. Because many of the studies that established this association were performed using frozen, pulverized tumor specimens, this association could not be tested for independence from the established prognostic factors of histologic and nuclear grading. METHODS: Histologic, nuclear, and mitotic grades, DNA ploidy, and S-phase fraction (SPF) were determined from paraffin-embedded tumors obtained from 280 women with node-negative invasive ductal carcinomas using standard grading schemes and flow cytometric techniques. These variables were compared with disease-free and cancer-specific survival (CSS) in univariate and multivariate analyses of these patients. RESULTS: Tumor diameter, SPF, histologic grade, and nuclear grade were significant predictors of disease-free survival (DFS); diameter and SPF had significant associations with CSS. Cox analysis showed histologic grade to be the only independent predictor of relapse, whereas diameter and SPF were independent predictors of mortality. The patients with low nuclear or histologic grade tumors had only a 5% risk of recurrence at 5 years. In contrast, 36% of patients in this series with medium-grade or high-grade high SPF tumors had a 30% risk of recurrence over the same interval. CONCLUSIONS: Histopathologic grading and flow cytometric determination of SPF appear to provide additive prognostic information for patients with early invasive ductal carcinomas of the breast.

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Twenty-one (8%) of 264 consecutive evaluable patients with clinical stage 1 endometrial carcinoma had histologic evidence of pelvic and/or para-aortic lymph node metastases. DNA flow cytometry was performed on both the primary tumor and nodal metastasis. Seventeen of 21 sets could be analyzed. Overall, 11 (65%) of the primary carcinomas were aneuploid. Nine of 17 (53%) had consistent ploidy patterns when the primary tumor and lymphatic metastasis were compared. The remaining 8 (47%) had aneuploid primaries with diploid nodal metastases. Five (83%) of the 6 patients with diploid primary tumors were alive without evidence of disease compared to 3 of 11 (27%) patients with aneuploid tumors (P < 0.05). Other predictors of disease outcome included tumor histology, lymph vascular space invasion, and depth of myometrial invasion. Ploidy status of the lymphatic metastasis was not important in terms of overall survival. All 8 patients with para-aortic nodal metastases had aneuploid primary carcinomas compared to 4 (44%) of 9 patients with pelvic node involvement only (P < 0.01). Mean survival was 31 months for patients with para-aortic node metastases compared to 51 months for patients with only pelvic node metastases. Comparison of survival curves among these two groups demonstrated a significant survival advantage in patients with regional nodal metastases (P = 0.032). S-phase fraction of both the primary tumor and lymphatic metastasis did not correlate with survival or predict disease outcome. DNA index of the primary tumor, as a continuous variable, was inversely proportional to survival, demonstrating poorer survivorship with incremental increases of DI. Ploidy status of the lymph node metastasis was an inconsistent reflection of the primary tumor's expression and behavior and, therefore, little additional information was gained by knowledge of the lymphatic ploidy status.

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BACKGROUND: Sarcoma are rare malignant neoplasms that originate from a mesenchymal cell line. The epidermal growth factor receptor (EGF-R) has been identified in these malignant neoplasms by immunohistochemical techniques. METHODS: This investigation has evaluated the gene amplification and expression of EGF-R and the homologous oncogene c-erbB-2 in soft tissue and osseous sarcomas by Southern and northern blot analysis. RESULTS: Amplification of EGF-R and c-erbB-2 was identified in 2 of 117 (1.7%) and 6 of 105 (5.7%) of the sarcomas, respectively. Increased expression of EGF-R and c-erbB-2 was identified in 21 of 43 (49%) and 35 of 94 (37%) sarcomas, respectively. CONCLUSIONS: The expression of these two genes in sarcomas appears to occur independently and not be associated with tumor histologic characteristics, grade, size, DNA content, or proliferative activity.

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Breast cancer is a common primary malignancy in women. On rare occasion the breast is also the site of metastatic disease. This report describes the evaluation of breast and axillary masses in a patient with known ovarian cancer, including the radiographic evaluation and special immunohistochemical stains with CA-125. Flow cytometric determinations and hormonal receptor analysis on both the primary and metastatic tumors demonstrate similar biologic characteristics. Both tumor sites demonstrated positive CA-125 staining, aneuploid DNA populations, moderately positive estrogen receptor content, and negative progesterone receptors. The mammogram demonstrated a well-circumscribed lesion with several areas of microcalcifications. Blood-borne metastasis from the ovary to the breast can show a varied clinical picture that can be differentiated from that of a primary breast carcinoma.

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Hemangiopericytomas of the orbit are rare tumors with low malignancy potential. To the authors' knowledge, only three previous cases of these tumors occurring in the lacrimal sac have been reported. The authors report a fourth case. Follow-up was obtained on the first reported case, and the patient in that case had a recurrence after 15 years. These tumors should be totally excised and followed for long periods of time.

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The monoclonal antibody (MAb) 44-3A6 detects a 40-kD cell surface protein on adenocarcinomas and may serve as an effective marker for glandular differentiation. Immunohistochemical analysis of 123 paraffin-embedded malignant breast tissue specimens, 27 normal or benign breast disease specimens and 10 atypical hyperplasia specimens from patients without breast cancer was performed with MAb 44-3A6. The antigen was identified in 76% of breast cancer specimens, 0% of normal or benign breast disease specimens and 88% of the atypical hyperplasia specimens. MAb 44-3A6 also detected this antigen on adjacent normal breast ductal cells in 88% of the breast cancer specimens. There was no statistically significant correlation between immunoreactivity and histological mitotic or nuclear grade, recurrence or overall survival. This study suggests that the cell surface antigen detected by the MAb 44-3A6 may serve as an important marker in the differentiation of normal breast epithelium into an atypical or malignant lesion.

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DNA flow cytometric analysis and conventional clinical factors were compared with disease outcome in 257 patients with node-negative infiltrating ductal carcinoma who had been treated between 1976 and 1983. Median follow-up was 80 months; none of the patients received adjuvant therapy. The relative prognostic importance of clinical variables, ploidy, and S-phase fraction was analyzed by Cox multivariate analysis. Ploidy was analyzable for 198 tumors and did not predict survival. Nuclear grade predicted disease-free survival for all patients. For 71 patients with diploid tumors, only high S-phase had a statistically significant association with relapse. For 127 patients with aneuploid tumors, tumor diameter predicted both disease-free survival and cancer death; histologic grade was also significant for predicting disease-free survival. In conclusion, flow cytometric determination of ploidy and S-phase fraction can provide valuable predictive information in node-negative breast cancer in addition to conventional variables.

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Ten neoplasms of endometrial stroma (one stromal nodule, four endolymphatic stromal myoses, and five stromal sarcomas) were compared using clinical data as well as histopathologic and flow cytometric parameters. None of the patients with stromal nodules or endolymphatic stromal myosis had extrauterine disease at presentation or tumors displaying a mitotic rate greater than 10/10 hpf (high-power fields), nuclear pleomorphism, atypical mitotic figures, DNA aneuploidy, or a high proliferative index (greater than 10% S phase cells). The stromal nodules were circumscribed and behaved in a benign fashion. The patients with endolymphatic stromal myosis had infiltrative tumors that behaved as low-grade cancers with good responses to therapy. Four of the five patients with stromal sarcoma had extrauterine disease at presentation as well as tumors characterized by a mitotic rate much greater than 10 mitoses/10 hpf, nuclear pleomorphism, atypical mitotic figures, DNA aneuploidy, and a high proliferative index. These four patients had aggressive disease with poor response to therapy. The fifth of the stromal sarcomas had a high mitotic rate, but lacked the other features linked with aggressive behavior; this patient has responded well to treatment. The mitotic count may not be the most useful criterion for predicting biologic behavior in endometrial stromal tumors since it does not always reflect an increased rate of cell turnover as demonstrated by the percentage of cells in the S phase. DNA analysis by flow cytometry yields a more accurate picture of tumor behavior.

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Nine cases of multiple focal extraovarian serous carcinoma were studied, and their gross, light microscopic, and ultrastructural features were compared with those of three serous ovarian tumors and three malignant mesotheliomas. On light microscopy, the multiple focal extraovarian serous carcinoma shared many features of the serous ovarian tumors. However, they also displayed some ultrastructural features shared by both serous ovarian tumors and malignant mesotheliomas, and other features more specific for malignant mesotheliomas. We concluded that the multiple focal extraovarian serous carcinomas probably arise from mesothelial cells modified by various müllerian influences and should be classified separately from the other two entities.

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The computed tomographic findings of mediastinal adenopathy and tracheal and bronchial stenosis associated with Wegener granulomatosis are reported in a young patient whose disease appeared limited to the airways and sinuses.

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