Journal of Pathology and Translational Medicine

Case Studies

Combined Adenosquamous and Large Cell Neuroendocrine Carcinoma of the Gallbladder: Jiyoon Jung, Yang-Seok Chae, Chul Hwan Kim, Youngseok Lee, Jeong Hyeon Lee, Dong-Sik Kim, Young-Dong Yu, Joo Young Kim; J Pathol Transl Med. 2018;52(2):121-125. Published online October 5, 2017; DOI: https://doi.org/10.4132/jptm.2017.08.20

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Large cell neuroendocrine carcinoma (LCNEC) of the gallbladder is extremely rare and usually combined with other type of malignancy, mostly adenocarcinoma. We report an unusual case of combined adenosquamous carcinoma and LCNEC of the gallbladder in a 54-year-old woman. A radical cholecystectomy specimen revealed a 4.3×4.0 cm polypoid mass in the fundus with infiltration of adjacent liver parenchyma. Microscopically, the tumor consisted of two distinct components. Adenosquamous carcinoma was predominant and abrupt transition from adenocarcinoma to squamous cell carcinoma was observed. LCNEC showed round cells with large, vesicular nuclei, abundant mitotic figures, and occasional pseudorosette formation. The patient received adjuvant chemotherapy. However, multiple liver metastases were identified at 3-month follow-up. Metastatic nodules were composed of LCNEC and squamous cell carcinoma components. Detecting LCNEC component is important in gallbladder cancer, because the tumor may require a different chemotherapy regimen and show early metastasis and poor prognosis.

Citations

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Does the size of the neuroendocrine-carcinoma component determine the prognosis of gallbladder cancer?
Ya-Fei Hu, Jun-Ke Wang, Wen-Jie Ma, Hai-Jie Hu, Han-Fei Gu, Fei Liu, Tian-Run Lv, Si-Qi Yang, Yu-Shi Dai, Rui-Qi Zou, Yan-Wen Jin, Fu-Yu Li
Frontiers in Endocrinology.2024;[Epub] CrossRef
Comparison of Metastatic Patterns Among Neuroendocrine Tumors, Neuroendocrine Carcinomas, and Nonneuroendocrine Carcinomas of Various Primary Organs
Hyung Kyu Park, Ghee Young Kwon
Journal of Korean Medical Science.2023;[Epub] CrossRef
Clinical features and outcomes analysis of Gallbladder neuroendocrine carcinoma
Man Jiang, Yijing Zhang
Journal of Cancer Research and Therapeutics.2023; 19(4): 910. CrossRef
Primary mixed large cell neuroendocrine carcinoma and adenocarcinoma of the gallbladder: A case report and literature review
Tingting Yu, Shike Li, Zhuo Zhang
Asian Journal of Surgery.2022; 45(11): 2336. CrossRef
Mixed neuroendocrine-non-neuroendocrine neoplasm of the gallbladder: case report and literature review
Xu Ren, Hong Jiang, Kan Sun, Xufu Qin, Yongping Qu, Tian Xia, Yan Chen
Diagnostic Pathology.2022;[Epub] CrossRef
Neuroendocrine Neoplasms of the Gallbladder: A Clinicopathological Analysis of 13 Patients and a Review of the Literature
Pengyan Wang, Jingci Chen, Ying Jiang, Congwei Jia, Junyi Pang, Shan Wang, Xiaoyan Chang, Oronzo Brunetti
Gastroenterology Research and Practice.2021; 2021: 1. CrossRef
Gallbladder Mixed Neuroendocrine-Non-neuroendocrine Neoplasm (MiNEN) Arising in Intracholecystic Papillary Neoplasm: Clinicopathologic and Molecular Analysis of a Case and Review of the Literature
Amedeo Sciarra, Edoardo Missiaglia, Mounir Trimech, Emmanuel Melloul, Jean-Philippe Brouland, Christine Sempoux, Stefano La Rosa
Endocrine Pathology.2020; 31(1): 84. CrossRef
Mixed neuroendocrine-non-neuroendocrine carcinoma of gallbladder: case report
Adam Skalický, Lucie Vištejnová, Magdaléna Dubová, Tomáš Malkus, Tomáš Skalický, Ondřej Troup
World Journal of Surgical Oncology.2019;[Epub] CrossRef

Low-Grade Adenosquamous Carcinoma of the Breast with Diverse Expression Patterns of Myoepithelial Cell Markers on Immunohistochemistry: A Case Study: Yoon Jin Cha, Gi Jeong Kim, Byeong-Woo Park, Ja Seung Koo; Korean J Pathol. 2014;48(3):229-233. Published online June 26, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.3.229

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Abstract PDF

This paper reports a case of low-grade adenosquamous carcinoma (LGASC) arising in a 69-year-old woman, who presented with a 1-cm palpable mass on her right breast. Core needle biopsy diagnosed the mass as a fibroadenoma. After six months, the mass increased in size, and the patient received subsequent mammotome excision. On microscopic examination, bland-looking small glands were infiltrating into the fibrotic stroma with lymphocytic infiltrates at the periphery. Hematoxylin and eosin staining revealed relatively easily detectable myoepithelial cells along the outside in each of the glandular structures with variable degrees of squamous metaplasia. Based on histologic features, the patient was diagnosed with LGASC. LGASC is a rare variant of metaplastic carcinoma, which is characterized by a favorable prognosis. Due to the bland cytology and presence of myoepithelial cells, LGASC can be misdiagnosed as benign lesion. Additionally, inconsistent expression of myoepithelial markers could aid the diagnosis of LGASC.

Citations

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Low-Grade Adenosquamous Carcinoma of the Breast Masquerading as a Fibroepithelial Lesion on Core Biopsy: A Challenging Case
Natthawadee Laokulrath, Esther Chuwa, Mihir Gudi, Puay Hoon Tan
Pathobiology.2024; : 1. CrossRef
High rate of PIK3CA mutations but no TP53 mutations in low‐grade adenosquamous carcinoma of the breast
Guillaume Bataillon, Laetitia Fuhrmann, Elodie Girard, Emanuelle Menet, Marick Laé, Mathieu Capovilla, Isabelle Treilleux, Laurent Arnould, Frederique Penault‐Llorca, Roman Rouzier, Caterina Marchiò, Ivan Bieche, Anne Vincent‐Salomon
Histopathology.2018; 73(2): 273. CrossRef
Low-grade Adenosquamous Carcinoma Coexisting with Sclerosing Adenosis of the Breast: A Case Report
Ryoko Oi, Ichiro Maeda, Yoshio Aida, Yukari Yabuki, Toru Nishikawa, Yoshihide Kanemaki, Koichiro Tsugawa, Masayuki Takagi
Journal of St. Marianna University.2017; 8(1): 31. CrossRef
Low-grade Adenosquamous Carcinoma of the Breast
Haruko SAKAMOTO, Akihiko SHIMANA, Hideaki HORI, Kouki TOKUDA, Hitoshi TSUBOUCHI, Miki TAKENAKA, Rin YAMAGUCHI
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2017; 78(9): 1983. CrossRef
Small Glandular Proliferations of the Breast With Absent or Attenuated Myoepithelial Reactivity by Immunohistochemistry: A Review Focusing on the Differential Diagnosis and Interpretative Pitfalls
Paula S. Ginter, Sandra J. Shin, Timothy M. D'Alfonso
Archives of Pathology & Laboratory Medicine.2016; 140(7): 651. CrossRef
Bilateral synchronous low-grade adenosquamous carcinoma of the breast: A Case report with review of the current literature
J.L. Senger, P. Meiers, R. Kanthan
International Journal of Surgery Case Reports.2015; 14: 53. CrossRef
A Nation-Wide Cancer Registry-Based Study of Adenosquamous Carcinoma in Taiwan
Yuan-Tzu Lan, Kuo-Hung Huang, Chien-An Liu, Ling-Chen Tai, Ming-Huang Chen, Yee Chao, Anna Fen-Yau Li, Shih-Hwa Chiou, Yi-Ming Shyr, Chew-Wun Wu, Wen-Liang Fang, Sheng-Nan Lu
PLOS ONE.2015; 10(10): e0139748. CrossRef

Case Reports

Primary Adenosquamous Carcinoma of Jejunum.: Soon Ran Kim, Jung Weon Shim, Hye Kyung Ahn, Young Euy Park, Dae Gi Song, Young Cheol Lee, Myung Seuk Lee; Korean J Pathol. 1997;31(2):182-184.

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Abstract PDF: Adenosquamous carcinomas of the intestine are rare tumors, especially when they occur in the small bowel. We report a case of primary adenosquamous carcinoma of the proximal jejunum in a 66 year old woman with no underlying pathologic condition. The tumor mainly consisted of well differentiated squamous cell carcinoma showing keratin pearl and conspicuous intercellular bridges, and minor portion revealed well differentiated adenocarcinoma. The tumor seemed to have originated from the mucosal epithelium, invading the entire wall and metastasizing to the regional lymph nodes. Previous reports of adenosquamous carcinoma of the small intestine have been associated with metastatic disease from distant sites or intestinal duplication. In the colon, squamous cell differentiation have been seen in about 0.05% of adenocarcinomas and in 0.4% of adenomata. The pathogenesis of squamous cell carcinoma of the intestine is unknown, but some possible mechanisms are proposed. :1)malignant transformation of squamous cell epithelium in the submucosa, 2)aberrant differentiation of stem cells to squamous cell with subsequent malignant change, 3)squamous metaplasia of glandular cells with subsequent malignant change, 4)transformation of an adenosquamous into an epidermoid carcinoma.

Well Differentiated Adenosquamous Carcinoma of Lung Mimicking Benign Lesions in Fine Needle Aspiration Cytology: Report of a Case .: Jong Yup Bae, Hoon Kyu Oh, Jae Bok Park; Korean J Cytopathol. 2004;15(2):101-105.

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Abstract PDF: Fine needle aspiration (FNA) cytological examination is an appropriate method for the evaluation of pulmonary nodules. In major types of lung cancer, its diagnostic accuracy is quite high. However, it is sometimes difficult, using this technique, to differentiate between some unusual phenotypes including adenosquamous carcinoma, bronchioloalveolar carcinoma (BAC), neuroendocrine tumor, mucoepidermoid carcinoma, and sclerosing hemangioma. Here, we present a case involving extremely well differentiated adenosquamous carcinoma, mimicking benign lesions, such as pulmonary scar and adenomatoid malformation with squamous metaplasia. The patient was a 68-year-old man presenting with a solitary pulmonary nodule (1.6x1.6 cm), which was incidentally found at the periphery of the right lower lobe. FNA revealed some clusters of glandular cells with minimal atypia, in addition to squamous cells at a nearly full maturational state. Histological examination verified the cytological diagnosis on a lobectomy specimen. The tumor exhibited a well differentiated adenocarcinoma component, mimicking the bronchioles in scarred lung tissue, and a well differentiated squamous cell carcinoma component, mimicking the squamous cell nests of adenoacanthoma, in the other organs. In the present case, the possibility of adenosquamous carcinoma should have been considered if squamous cells were seen in the FNA from the peripheral pulmonary nodule, even though they appeared to be benign.

Adenosquamous Carcinoma of the Ampulla of Vater: A Report of Two Cases.: Da keun Lee, Cheol Keun Park, Geung hwan Ahn, Sung Ju Kim, Jin Seok Heo, Kyu Taek Lee, Sang hui Park, Kee Taek Jang; Korean J Pathol. 2006;40(2):160-164.

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Abstract PDF: Primary adenosquamous carcinoma of the ampulla of Vater is extremely rare. We report two cases of adenosquamous carcinoma of the ampulla of Vater in a 48-year-old female and an 80-year-old female patient. The gross appearance was a polypoid mass in both cases. Histologically, the majority of the two tumors was composed of squamous cell carcinoma with some intermingled glandular adenocarcinoma components in both cases. Squamous cell carcinomas showed an abrupt transition from the normal glandular epithelium or glandular adenocarcinoma. Although the two cases revealed duodenal wall invasion and lymph node metastasis was found in case 2, both patients are still alive at 19 and 46 months after surgery, respectively.

Adenosquamous Carcinoma of the Stomach: Report of three cases with immunohistochemical study.: Chang Won Ha, Na Hye Myong, Kyung Ja Cho, Ja June Jang; Korean J Pathol. 1991;25(4):382-386.

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Abstract PDF: Adenosquamous carcinoma originating in the stomach is relatively rare, and the occurrence of such tumor is interesting with respect to its histogenesis. We describe three cases of gastric adenosquamous carcinoma in a 39-year-old man, a 58-year-old woman and a 52-year-old man. They were grossly classified as Borrmann type III or II, revealing no difference from usual advanced gastric adenocarcinomas. Microscopically three cases showed well or moderately differentiated squamous cell carcinoma component occupying large areas of the tumors. Areas of transition from glandular to squamous epithelium were frequently observed. Metastatic foci in the regional lymph nodes also were consisted of two elements. On immunohistochemical study, CEA immunoreactivity was found not only in adenocarcinoma component but also in squamous cell components, in comparison to cytokeratin which was detected only in squamous areas. The immunohistochemical findings of CEA reactivity in both components, and the presence of microscopic transitional zones support the hypothesis of squamous metaplasia occurring in an already existing adenocarcinoma in the development of adenosquamous carcinoma of the stomach.

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