Background : Assessment of the biological malignancy of DCIS is important as a factor related to indications for breast-conserving therapy and subsequent stump recurrence. We assessed the biological malignancy of each grade in the Van Nuys (VN) Classification and the Nottingham (Nott) Classification. Methods : The surgical specimens from 24 patients with DCIS were examined. Immonohistochemistry was used to assess the expression of ER, p53, Ki-67 (MIB-1), and Her2/nue in the tumor cell of 24 patients with DCIS. We classified DCIS by VN and Nott systems and compared Grade 3 tumors with the other grades (Grade 1 and 2). Results : VN Grade 3 (VN3) DCIS had high ER-negative (P=0.01) and P53-positive (P=0.05) rates, and frequently had a high Ki67 1. I. (P=0.03). Three of the 4 specimens highly positive for Her2/nue (P=0.08) were VN3. The Nott Grade 3 (Nott3) specimens were all ER-negative (P=0.03) and frequently P53-positive (P=0.04), and all had a high Ki67 L. I (P=0.04). Similar to VN3 DCIS, 3 of the 4 specimens highly positive for Her2/nue (P=0.003) were Nott3. However, 3 specimens that were judged to be nuclear grade (NG) 3 noncomedo type DCIS and VN3 were classified as Nott 1 and 2, not Nott 3. Of these 3 specimens, 2 were ER-negative, 1 was p53 positive, and 2 had a high Ki67 L. I., indicating that non-Nott 3 cancer is not necessarily low-malignant. Conversely, all Nott3 cancers were classified as VN3. Conclusion : The results suggested that the nuclear-grade-based VN system may be a more reliable classification in terms of grade of malignancy that the histological-type-based Nott systems.
A large tumor was incidentally identified by whole body CT scanning. It was formed by two components : a low-density area with wall partitions and a high-density area that was well-encapsulated. Fine-needle aspiration (FNA) was performed under colonoscopy for definitive diagnosis. Histological examination revealed that the tumor consisted of mature adipose tissues and hematopoietic marrow including all three myelopoietic cell lines. This observation indicated that the tumor was extraadrenal myelolipoma. Myelolipoma is a benign tumor. If it is correctly diagnosed and show no symptoms, surgical resection will be unnecessary. Although multiocular extraadrenal myelolipomas is quite rare, and no cases had been reported until now, it is important that these diseases are considered and diagnosed pathologically before surgery is performed.