A 73-year-old woman showed marked exophytic growth of a tumor (25 × 23 × 14 mm) of the nipple over a period of 2 months. Histologically, numerous tumor nodules with no apparent keratinization were observed in the exophytic lesion. The tumor cells also showed little invasion to the dermis and no metastasis to the axillary lymph nodes (LN). The tumor cells were immunohistochemically positive for cytokeratins (CKs; AE1/AE3 and 34βE12), epithelial membrane antigen (EMA), and p53, but negative for Ber-EP4 and human papilloma virus (HPV). The MIB-1 index was 56%. Some tumor cells were also positive for some neuroendocrine markers, and showed some tonofilaments and neurosecretory granules in the cytoplasm under electron microscopy. We made the differential diagnosis of mammary ductal carcinoma, basal cell carcinoma (BCC), Paget's disease, and neuroendocrine carcinoma including Merkel cell carcinoma. The final diagnosis was poorly differentiated squamous cell carcinoma (SCC) showing exophytic growth with neuroendocrine differentiation (ND) in the nipple. To our knowledge, although only five cases of Bowen's disease have been reported in the nipple, such a unique SCC has not been reported previously.
We have isolated an antigen defined by the monoclonal antibody KMO1 from tissue culture supernatant as a glycoprotein and from cancer cells as a glycolipid. The antigenic determinant was a carbohydrate. Antibody KMO1 inhibited the binding activity of 19-9 to CA19-9, but 19-9 antibody did not inhibited the binding activity of KMO1 to KMO1 antigen. The glycolipid antigen of KMO1 was a monosialoganglioside and was separated into 3 components on thin layer chromatography. The 19-9 antibody reacted with one of the components. These results suggest that the KMO1 antigen is similar to but not identical to CA19-9.
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