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The following paragraph is difficult to read because it lacks the benefit of many of the writing tips we have just discussed. Before studying my revision, copy and paste, and then edit this passage yourself, finding ways to use all four paragraph writing tips:

  1. Think of each paragraph as a unit of thought. Focus it on a single main topic, and be sure that topic is clearly conveyed to the reader.
  2. Select a principle of order and make it evident to your reader. Make a brief outline of your main topics, and then organize the sequence of ideas within a paragraph or group of paragraphs.
  3. Sequence for understanding: Provide a context before introducing new ideas.
    • Paragraphs: Use first sentence to introduce topic and last sentence to summarize
    • Sentences in paragraphs: Begin with familiar information and end with new information
  4. Verbally link your ideas in a paragraph together, using summative references to preceding ideas, repetitions and parallel constructions, and transitional linkages.

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Both tubular carcinoma (TC) and radial sclerosing lesion (RSL) can have a similar gross and histologic appearance. The crucial diagnostic difference is in the recognition of the outer myoepithelial cell layer surrounding the epithelium of RSL, which is in turn encircled by the basement membrane. Tubules of TC are lined by a single layer of well differentiated malignant epithelium without the outer myoepithelial cell layer. Myoepithelial cells can be highlighted by immunostaining for smooth muscle actin (SMA) or for S-100 protein. Antibodies to SMA also stain myofibroblasts, which can be abundant in the stroma of tubular carcinoma, with some of them approximating the malignant tubules thus creating a false impression of a myoepithelial cell layer. S-100 immunostaining has been reported to have poor specificity for myoepithelial cells in the breast. Maspin, or mammary serpin, is considered to be related to the serpin family of protease inhibitors. Although it appears to have a tumor suppressor effect in in-vitro studies, its precise function in-vivo is not clear. Metallothionein is a low molecular weight protein with heavy metal binding properties. Maspin and metallothionein have been reported to be expressed at very high levels in mammary myoepithelium. In this study we determined the efficacy of maspin and metallothionein immunohistochemistry in illustrating the myoepithelial cell layer as compared to SMA and S-100 in distinguishing radial sclerosing lesion from tubular carcinoma.