Herein is described a unique case of breast carcinoma with two different types of giant cells noted in both cytological and histological specimens. A 51-year-old Japanese woman noticed a hard mass in the upper outer quadrant of her left breast. Aspiration cytology exhibited numerous anaplastic giant cells; the cytological diagnosis was high-grade ductal carcinoma, although a few osteoclastic giant cells were also observed. A left simple mastectomy and sentinel lymph node biopsy were performed. Histologically, approximately 90% of the tumor was composed of giant cells; conventional invasive ductal carcinoma and ductal carcinoma in situ were found focally at the periphery of the tumor. The main part of the tumor contained both anaplastic, neoplastic giant cells and non-neoplastic, osteoclastic giant cells that were distinguishable from nuclear atypism. The presence of the two types of giant cells was also confirmed on immunohistochemistry using a histiocytic marker (CD68) and two epithelial markers (AE1/AE3 and CAM5.2). Based on the latest World Health Organization classification, the diagnosis was pleomorphic carcinoma with osteoclastic giant cells. To the authors' knowledge there has been no previous report on this subject except for a single case mentioned in Rosen's Breast Pathology.
Introduction
Squamous cell carcinoma arising from a suprapubic cystostomy tract is a rare complication of an indwelling catheter and is caused by long‐term inflammation and mechanical irritation. Prognosis is relatively poor. Biomarkers in the cancer pathway have not been investigated.
Case presentation
A 61‐year‐old woman with a 34‐year history of suprapubic catheter placement presented with a rapidly growing elevated lesion around the cystostomy site. Tumor biopsy confirmed squamous cell carcinoma. Local excision with partial cystectomy was performed. Multiple metastases were identified 5 months later. The patient died 14 months after the initial treatment. Immunohistochemical analysis of the resected specimen revealed alterations in vascular endothelial growth factor, epidermal growth factor receptor, cyclooxygenase‐2, and Ki‐67.
Conclusion
We encountered a case of squamous cell carcinoma arising from a suprapubic cystostomy tract. Immunohistochemical analysis revealed activation of multiple carcinogenic pathways in cancer cells, including those for angiogenesis, signal transduction by epidermal growth factor receptor, inflammation, and cell proliferation.
Abbreviations & Acronyms AMPC = amphicrine prostate cancer composed of cells coexpressing AR and NE genes AR = androgen receptor ARI = AR signaling inhibitor ARLPC = AR-low prostate cancer ARPC = AR-high prostate cancer CGA = chromogranin A CK5/6 = cytokeratin5/6 CT = computed tomography DNPC = double-negative tumors lacking the expression of AR and NE genes EP = etoposide and cisplatin H&E = hematoxylin and eosin LHRH = luteinizing hormonereleasing hormone mCRPC = metastatic castrationresistant prostate cancer NE = neuroendocrine NEK6 = mitotic-related serine/ threonine kinase NSE = neuron-specific enolase PCa = prostate cancer PDX = patient-derived xenograft PSA = prostate-specific antigen SCNPC = tumors with small cell or NE gene expression without AR activity SYP = synaptophysin
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