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Background. Myelolipomas are uncommon benign tumors composed of mature adipose tissue mixed with hematopoietic elements occuring both in adrenal glands and in extra-adrenal locations; the presacral region is the most frequent extra-adrenal location. We present the unique case of a presacral myelolipomadiagnosed by fine needle cytology (FNC) and core needle biopsy (CNB) in a women-with a concurrent breast cancer. Methods. A 55 year-old women was admitted at our institution with the cytological diagnosis of right breast cancer and a non- characterized presacral lump. The images from a noncontrast pelvic CT showed a 5 x 4 cm heterogeneous presacral mass without invasion or erosion of the anterior sacrum and with mixed fat and soft tissue attenuation. The patient uderwent a CT guided FNC and CNB. The air-dried Diff Quick stained smears showed trilineage hematopoietic elements in a background of mature fat cells. The histological slides showed mature adipose tissue admixed with cellular stroma in the absence of bone trabeculae. The stroma consisted of myeloid, erythroid and megakaryocytic forming cell lines. Results. A diagnosis of presacral myelolipoma was made on the basis of these morphological findings in conjunction with the radiological imaging. MR imaging, recommended for further characterization, showed a lobulated mass, with mixed fat/soft tissue signal and without bony invasion. Pre-contrast fat-suppressed images showed loss of signal intensity in the areas which were previously iso-intense to fat, providing further confirmation of a significant fat component of the mass. The patient was treated only for the breast cancer with a right supero–external quadran -tectomy and the ipsilateral axillary lymph node dissection; surgical biopsy of the presacral mass was not performed. Follow up MR at 5 and 16 months of the presacral mass showed stability of the lesion without significant interval change in size, appearance, or signal characteristics.

Background. Myofibroblastoma of the breast is an uncommon benign mesenchymal neoplasm that occurs predominantly in elderly men. Methods. A 64-years-old woman presented a slowly growing lump in her left breast. A mammogram revealed a 15 mm radiopaque lesion with regular margins and no microcalcifications and ultrasonography showed well-circumscribed, oval, hypoechoic mass measuring 28 mm, in the upper outer quadrant of the left breast. A US-Guided Fine Needle Aspiration Cytology (US-FNAC) was performed, showing tumour cells arranged in cohesive groups or in fascicular clusters and, in the background, naked nuclei. The cells were spindle shaped with a scanty amount of cytoplasm, oval nuclei with finely granular chromatin and occasional inconspicuous nucleoli. Fragments of stromal collagen were observed. The lesion was diagnosed as a mesenchymal proliferation without atypia and surgical biopsy was recommended. The patient underwent a surgical excision biopsy and histologic examination showed a 2.8 x 2.1 cm nodular mass, well- circumscribed although not truly capsulated, firm, rubbery, with a whirling appearance and a greyish external surface on cut sections. The slides showed a well-defined hyalinised tumour with a spindle cell proliferation and abundant dense fibrous collagen; the lesion was circumscribed by a thin “pseudocapsule” of compress glandular stroma. The spindle cells were arranged in short and haphazardly intersecting fascicles and clusters and were mixed with broad bands of brightly eosinophilic hyalinised collagen. Individual cells were bland-looking and showed a single ovoid nucleus with, occasionally, one or two nucleoli. Mitotic figures were uncommon and cytological atypia was not observed. Mast cells were conspicuous. The spindle cells stain positively for vimentin, CD34, desmin, H-caldesmon, CD99, bcl2. Results. The morphologic features, in conjunction with the immunophenotype, were consistent with a myofibroblastoma of the breast (classic type).

We analyzed immunohistochemically the expression of CD24 and spliced variants of CD44v5 and v9 in invasive micropapillary carcinoma (IMPC) of the breast that is a rather aggressive tumor characterized by alteration of cells adhesion molecules, early lymph node metastases and poor prognosis. We analyzed 31 high-grade IMPCs and compared their expression to 22 high grade (G3) invasive ductal carcinomas of the breast (IDCs). We found a higher expression of CD24 in high-grade IMPCs with a peculiar inverted apical localization, compared to IDCs, showing a strong cytoplasmic staining; normal breast tissue resulted completely negative. IMPCs showed reduced expression of CD44v5 and CD44v9 compared with IDCs, but without a statistical significant difference. This study demonstrated that IMPC represents a distinct entity of breast carcinoma with high expression of CD24 with a typical inverted apical membrane pattern and reduction of CD44 isoforms v5 and v9, compared to IDCs. These features could explain the high lymph-vascular invasion propensity and higher metastatic capability of these tumors and could be a useful tool for a future targeted therapy.

A number of chromosomal abnormalities have been described in the presence of central nervous system tumors; isochromosome 17q, representing a loss of heterozygosity for the short arm of the chromosome 17, is the one most frequently reported in association with medulloblastoma. The purpose of this study was to evaluate the prognostic correlation of this variable, compared with other variables (surgery extent and radiotherapy), with survival.We looked for the presence of i(17q) in 32 children affected by posterior fossa tumors, including 16 medulloblastomas and 2 teratoid/rhabdoid tumors. For our study we used both karyotypic analysis and the fluorescence in situ hybridization (FISH) procedure, both on fresh and on paraffin-embedded tissues. Cytogenetic analysis allowed us to detect a hitherto unreported abnormality in medulloblastoma: ins(1;10)(q31;q23q26). Moreover, 16 of the 32 patients analyzed by FISH were found to be positive for the presence of i(17q): the 2 with teratoid/rhabdoid tumors, 11 of 16 with medulloblastomas, plus 1 with ependymoblastoma and 2 with anaplastic astrocytomas. As far as the outcome of medulloblastoma patients is concerned, we found that 8 out of the 10 children whose tumor had been totally removed had a favorable outcome regardless of the presence of i(17q): 4 were i(17q) positive and 4 i(17q) negative.Although it was impossible to draw any definitive conclusion about detection of i(17q) in central nervous system tumors in infancy, particularly in the case of medulloblastoma, we suggest that this chromosomal abnormality is not an independent prognostic factor, but may be a marker for uncontrolled cell proliferation.