- Email: [email protected]
Glioblastoma with signet-ring morphology
Correspondence
1357
Cartaginese did not list the grade composition of their TN and non-TN populations. We hope that publication of more studies on IMP3 expression in breast cancer can further elucidate this important question. Ashraf Khan MD, FRCPath Otto Walter MD Department of Pathology UMass Memorial Medical Center Worcester, MA E-mail address: [email protected] doi:10.1016/j.humpath.2010.05.005
References [1] Rakha EA, El-Sayed ME, Green AR, Lee AH, Robertson JF, Ellis IO. Prognostic markers in triple-negative breast cancer. Cancer 2007;109: 25-32. [2] Dent R, Trudeau M, Pritchard KI, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 2007;13: 4429-34. [3] Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry. Cancer 2007;109:1721-8.
as polyphenotypic immunohistochemical expression, focal loss of INI-1 protein (which can be demonstrated immunohistochemically), and monosomy 22 (which can be demonstrated by fluorescence in situ hybridization) in the rhabdoid areas of the tumor [3]. Those alterations are also shared by other malignant rhabdoid tumors of the central nervous system (atypical teratoid/rhabdoid tumor), kidneys, and soft tissue [4,5]. In most of these rhabdoid tumors, the SMARCB1/INI1 gene, located in chromosome band 22q11.2, is inactivated by deletions and/or mutations. In conclusion, immunohistochemistry (or fluorescence in situ hybridization) to assess expression of SMARCB1/INI1 may be useful in the diagnosis of tumors with rhabdoid and/ or signet-ring cell features inside or outside the central nervous system. Marc Pusztaszeri MD Pathology and Cytology laboratory Unilabs-Cytopath Avenue-Cardinal-Mermillod 36 1227 Carouge, Switzerland E-mail address: [email protected] Johannes Alexander Lobrinus MD Pathology Department Geneva University Hospital 1211 Geneva, Switzerland
Glioblastoma with signet-ring morphology
doi:10.1016/j.humpath.2010.05.009
To the Editor, We read with great interest the recent article (case study) by Martin et al [1] reporting a glioblastoma with signet-ring morphology. Primary central nervous system tumors with signet-ring morphology are exceedingly rare, and to our knowledge, true signet ring cells have not been reported previously in glioblastomas. From the data and the pictures presented in this article, we believe that this glioblastoma is an epithelioid and/or rhabdoid glioblastoma (or a glioblastoma with focal epithelioid and/or rhabdoid features), which are also rare entities, rather than a glioblastoma with true signet ring cells or signet-ring cell morphology. Rhabdoid cells and signet ring cells look very similar, and there is morphological overlap. They both share a large globular cytoplasmic inclusion that displaces the nucleus at the periphery of the cell. In case of rhabdoid cells, electron microscopy has shown that these consist of aggregates of whorled intermediate filaments (rhabdoid inclusions) [2], such as it is presented here. In their case study, the authors did not mention rhabdoid glioblastoma in the differential diagnosis and did not perform special investigations in this regard, which would have been essential to differentiate between these 2 diagnoses. Indeed, the rhabdoid variant often has special characteristics such
References [1] Martin SE, Bonnin JM, Hall DC, Hattab EM. Glioblastoma with signetring morphology: a case report and review of the literature. HUM PATHOL 2010;41:443-6. [2] Haas JE, Palmer NF, Weinberg AG, Beckwith JB. Ultrastructure of malignant rhabdoid tumor of the kidney. A distinctive renal tumor of children. HUM PATHOL 1981;12:646-57. [3] Kleinschmidt-DeMasters BK, Alassiri AH, Birks DK, Newell KL, Moore W, Lillehei KO. Epithelioid versus rhabdoid glioblastomas are distinguished by monosomy 22 and immunohistochemical expression of INI-1 but not claudin 6. Am J Surg Pathol 2010;34:341-54. [4] Haberler C, Laggner U, Slavc I, et al. Immunohistochemical analysis of INI1 protein in malignant pediatric CNS tumors: lack of INI1 in atypical teratoid/rhabdoid tumors and in a fraction of primitive neuroectodermal tumors without rhabdoid phenotype. Am J Surg Pathol 2006;30:1462-8. [5] Sigauke E, Rakheja D, Maddox DL, et al. Absence of expression of SMARCB1/INI1 in malignant rhabdoid tumors of the central nervous system, kidneys and soft tissue: an immunohistochemical study with implications for diagnosis. Mod Pathol 2006;19:717-25.
Glioblastoma with signet-ring morphology—reply To the Editor, Pusztaszeri and Lobrinus raise an important point in their letter regarding our case report of a glioblastoma with
1357
Cartaginese did not list the grade composition of their TN and non-TN populations. We hope that publication of more studies on IMP3 expression in breast cancer can further elucidate this important question. Ashraf Khan MD, FRCPath Otto Walter MD Department of Pathology UMass Memorial Medical Center Worcester, MA E-mail address: [email protected] doi:10.1016/j.humpath.2010.05.005
References [1] Rakha EA, El-Sayed ME, Green AR, Lee AH, Robertson JF, Ellis IO. Prognostic markers in triple-negative breast cancer. Cancer 2007;109: 25-32. [2] Dent R, Trudeau M, Pritchard KI, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 2007;13: 4429-34. [3] Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry. Cancer 2007;109:1721-8.
as polyphenotypic immunohistochemical expression, focal loss of INI-1 protein (which can be demonstrated immunohistochemically), and monosomy 22 (which can be demonstrated by fluorescence in situ hybridization) in the rhabdoid areas of the tumor [3]. Those alterations are also shared by other malignant rhabdoid tumors of the central nervous system (atypical teratoid/rhabdoid tumor), kidneys, and soft tissue [4,5]. In most of these rhabdoid tumors, the SMARCB1/INI1 gene, located in chromosome band 22q11.2, is inactivated by deletions and/or mutations. In conclusion, immunohistochemistry (or fluorescence in situ hybridization) to assess expression of SMARCB1/INI1 may be useful in the diagnosis of tumors with rhabdoid and/ or signet-ring cell features inside or outside the central nervous system. Marc Pusztaszeri MD Pathology and Cytology laboratory Unilabs-Cytopath Avenue-Cardinal-Mermillod 36 1227 Carouge, Switzerland E-mail address: [email protected] Johannes Alexander Lobrinus MD Pathology Department Geneva University Hospital 1211 Geneva, Switzerland
Glioblastoma with signet-ring morphology
doi:10.1016/j.humpath.2010.05.009
To the Editor, We read with great interest the recent article (case study) by Martin et al [1] reporting a glioblastoma with signet-ring morphology. Primary central nervous system tumors with signet-ring morphology are exceedingly rare, and to our knowledge, true signet ring cells have not been reported previously in glioblastomas. From the data and the pictures presented in this article, we believe that this glioblastoma is an epithelioid and/or rhabdoid glioblastoma (or a glioblastoma with focal epithelioid and/or rhabdoid features), which are also rare entities, rather than a glioblastoma with true signet ring cells or signet-ring cell morphology. Rhabdoid cells and signet ring cells look very similar, and there is morphological overlap. They both share a large globular cytoplasmic inclusion that displaces the nucleus at the periphery of the cell. In case of rhabdoid cells, electron microscopy has shown that these consist of aggregates of whorled intermediate filaments (rhabdoid inclusions) [2], such as it is presented here. In their case study, the authors did not mention rhabdoid glioblastoma in the differential diagnosis and did not perform special investigations in this regard, which would have been essential to differentiate between these 2 diagnoses. Indeed, the rhabdoid variant often has special characteristics such
References [1] Martin SE, Bonnin JM, Hall DC, Hattab EM. Glioblastoma with signetring morphology: a case report and review of the literature. HUM PATHOL 2010;41:443-6. [2] Haas JE, Palmer NF, Weinberg AG, Beckwith JB. Ultrastructure of malignant rhabdoid tumor of the kidney. A distinctive renal tumor of children. HUM PATHOL 1981;12:646-57. [3] Kleinschmidt-DeMasters BK, Alassiri AH, Birks DK, Newell KL, Moore W, Lillehei KO. Epithelioid versus rhabdoid glioblastomas are distinguished by monosomy 22 and immunohistochemical expression of INI-1 but not claudin 6. Am J Surg Pathol 2010;34:341-54. [4] Haberler C, Laggner U, Slavc I, et al. Immunohistochemical analysis of INI1 protein in malignant pediatric CNS tumors: lack of INI1 in atypical teratoid/rhabdoid tumors and in a fraction of primitive neuroectodermal tumors without rhabdoid phenotype. Am J Surg Pathol 2006;30:1462-8. [5] Sigauke E, Rakheja D, Maddox DL, et al. Absence of expression of SMARCB1/INI1 in malignant rhabdoid tumors of the central nervous system, kidneys and soft tissue: an immunohistochemical study with implications for diagnosis. Mod Pathol 2006;19:717-25.
Glioblastoma with signet-ring morphology—reply To the Editor, Pusztaszeri and Lobrinus raise an important point in their letter regarding our case report of a glioblastoma with