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Zhang Y, Wang N, Qiu Y, Jiang Y, Qin P, Wang X, Li Y, Meng X, Hao F. Preoperative lymph node metastasis risk assessment in invasive micropapillary carcinoma of the breast: development of a machine learning-based predictive model with a web-based calculator. World J Surg Oncol 2025; 23:154. [PMID: 40264141 PMCID: PMC12013222 DOI: 10.1186/s12957-025-03807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Accepted: 04/13/2025] [Indexed: 04/24/2025] Open
Abstract
BACKGROUND Invasive micropapillary carcinoma (IMPC) is a rare subtype of breast cancer characterized by a high risk of lymph node metastasis (LNM). The study aimed to identify predictors of LNM and to develop a machine learning (ML)-based risk prediction model for patients with breast IMPC. METHODS We retrospectively analyzed a cohort of 229 patients diagnosed with breast IMPC between 2019 and 2021. Patients were randomly assigned to training and test sets in a 7:3 ratio. Independent risk factors for LNM were identified using univariable and multivariable logistic regression analyses. Thirteen ML algorithms were trained and compared to determine the optimal model. Model performance was evaluated using the area under the curve (AUC), calibration plots, and decision curve analysis. Internal validation was performed using 100 iterations of tenfold cross-validation. RESULTS LNM was present in 158 patients (69%). Tumor size, histological grade, progesterone receptor staining intensity, and lymphovascular invasion were identified as independent predictors of LNM (all p < 0.05). Among the 13 ML models, logistic regression (LR) demonstrated the best performance, achieving an AUC of 0.88 in the test set. A nomogram based on the LR model was constructed to facilitate clinical application, showing excellent calibration, clinical utility, and a classification accuracy of 76% (95% confidence interval: 70%-82%). The median AUC across cross-validation iterations was 0.83 (interquartile range: 0.76-0.91). CONCLUSIONS This study identified key predictors of LNM in breast IMPC and developed a well-calibrated nomogram to support individualized treatment decision-making.
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Affiliation(s)
- Yan Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Nan Wang
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Yuxin Qiu
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Yingxiao Jiang
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Peiyan Qin
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Xiaoxiao Wang
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Yang Li
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
- Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang, China
| | - Xiangdi Meng
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China.
- Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang, China.
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Furong Hao
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China.
- Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang, China.
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Elzohery YHAM, Radwan AH, Gareer SWY, Mamdouh MM, Moaz I, Khalifa AM, Mohen OA, Elithy MFAA, Hassaan M. Micropapillary breast carcinoma in comparison with invasive duct carcinoma. Does it have an aggressive clinical presentation and an unfavorable prognosis? BMC Cancer 2024; 24:992. [PMID: 39129012 PMCID: PMC11318177 DOI: 10.1186/s12885-024-12673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/23/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Invasive micropapillary carcinoma (IMPC) was first proposed as an entity by Fisher et al. In the 2003 World Health Organization (WHO) guidelines for histologic classification of the breast tumors. IMPC was recognized as a distinct, rare histological subtype of breast cancer. IMPC is emerging as a surgical and oncological challenge due to its tendency to manifest as a palpable mass, larger in size and higher in grade than IDC with more rate of lymphovascular invasion (LVI) and lymph node (LN) involvement, which changes the surgical and adjuvant management plans to more aggressive, with comparative prognosis still being a point of ongoing debate. AIM OF THE STUDY In this study, we compared the clinicopathological characteristics, survival and surgical management of breast cancer patients having invasive micropapillary carcinoma pathological subtype in comparison to those having invasive duct carcinoma. METHOD This is a comparative study on female patients presented to Baheya center for early detection and treatment of breast cancer, in the period from 2015 to 2022 diagnosed with breast cancer of IMPC subtype in one group compared with another group of invasive duct carcinoma. we analyzed 138 cases of IMPC and 500 cases of IDC. RESULTS The incidence of LVI in the IMPC group was 88.3% in comparison to 47.0% in the IDC group (p < 0.001). IMPC had a higher incidence of lymph node involvement than the IDC group (68.8% and 56% respectively). IMPC had a lower rate of breast conserving surgery (26% vs.37.8%) compared with IDC. The survival analysis indicated that IMPC patients had no significant difference in overall survival compared with IDC patients and no differences were noted in locoregional recurrence rate and distant metastasis rate comparing IMPCs with IDCs. CONCLUSION The results from our PSM analysis suggested that there was no statistically significant difference in prognosis between IMPC and IDC patients after matching them with similar clinical characteristics. However, IMPC was found to be more aggressive, had larger tumor size, greater lymph node metastasis rate and an advanced tumor stage.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/pathology
- Breast Neoplasms/mortality
- Breast Neoplasms/surgery
- Middle Aged
- Prognosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/therapy
- Aged
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/surgery
- Adult
- Lymphatic Metastasis
- Neoplasm Invasiveness
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Affiliation(s)
- Yasmine Hany Abdel Moamen Elzohery
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
- Baheya Center for Early Detection and Treatment of Breast Cancer, Giza, Egypt.
| | - Amira H Radwan
- Department of Radiodiagnosis, NCI, Cairo University, Giza, Egypt
- Baheya Center for Early Detection and Treatment of Breast Cancer, Giza, Egypt
| | - Sherihan W Y Gareer
- Department of Radiodiagnosis, NCI, Cairo University, Giza, Egypt
- Baheya Center for Early Detection and Treatment of Breast Cancer, Giza, Egypt
| | - Mona M Mamdouh
- Department of Pathology, National Cancer Institute, Cairo University, Giza, Egypt
- Baheya Center for Early Detection and Treatment of Breast Cancer, Giza, Egypt
| | - Inas Moaz
- Department of Epidemiology and Preventive Medicine, National Liver Institute, Menoufia, Egypt
- Baheya Center for Early Detection and Treatment of Breast Cancer, Giza, Egypt
| | | | - Osama Abdel Mohen
- Baheya Center for Early Detection and Treatment of Breast Cancer, Giza, Egypt
| | | | - Mahmoud Hassaan
- Baheya Center for Early Detection and Treatment of Breast Cancer, Giza, Egypt
- Departement of Surgical Oncology, National Cancer Institute, Cairo University, Giza, Egypt
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Fakhry S, Nada YMAI, Mohamed MM, Kamal RM, Eltohamy MI, Taha SNM, Sweed EMM. Radiological characteristics of invasive micropapillary carcinoma of the breast. Clin Radiol 2024; 79:e34-e40. [PMID: 37858400 DOI: 10.1016/j.crad.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 10/21/2023]
Abstract
AIM To analyse the various imaging features of invasive micropapillary carcinoma (IMPC), a distinct variant of breast cancer, by mammography, ultrasound, and contrast-enhanced mammography. MATERIALS AND METHODS This study included 68 female patients with histopathologically proven invasive micropapillary carcinoma who underwent mammography, ultrasound, and contrast-enhanced mammography examinations. The findings encountered by each imaging tool were analysed using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. RESULTS In this retrospective study, 64.7% of cases were of the pure form of IMPC. Most of the cases showed an aggressive clinical course, with lymphovascular invasion noted in 76.5% of cases, while 60.3% of cases showed associated pathological lymphadenopathy. The N3 stage was reported in 25% of cases. On analysing the mammographic and ultrasound imaging findings, a significant association between irregular shape and a non-circumscribed margin with IMPC was found. Associated calcification was noted in 47% of cases. Pathological enhancement of moderate or marked conspicuity was noted in cases that underwent contrast-enhanced mammography, with the most commonly encountered finding being enhancing irregular and non-circumscribed masses. CONCLUSION The mammographic and ultrasound imaging features of IMPC are indistinguishable from other aggressive types of breast cancer. At contrast-enhanced mammography examination, pathological enhancement of moderate to marked conspicuity was shown in all cases. The observed strong association of IMPC with lymphovascular invasion and lymph node metastasis with higher nodal stage in this study mandate meticulous sonographic examination of the axilla, as well as the infra, and supraclavicular regions if pathological axillary lymphadenopathy was noted.
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Affiliation(s)
- S Fakhry
- Radiology Department, Cairo University, Cairo, Egypt; Radiology Department, Surgical oncology Department, and Pathology Deportment, Giza, Egypt.
| | | | - M Metawee Mohamed
- Radiology Department, Surgical oncology Department, and Pathology Deportment, Giza, Egypt
| | - R Mohamed Kamal
- Radiology Department, Cairo University, Cairo, Egypt; Radiology Department, Surgical oncology Department, and Pathology Deportment, Giza, Egypt
| | - M Ibrahim Eltohamy
- Radiology Department, Surgical oncology Department, and Pathology Deportment, Giza, Egypt; Surgical oncology Department, and Pathology Deportment., Cairo, Egypt
| | - S Nasser Mohamed Taha
- Radiology Department, Surgical oncology Department, and Pathology Deportment, Giza, Egypt; Surgical oncology Department, and Pathology Deportment., Cairo, Egypt
| | - E Mohamed Mustafa Sweed
- Radiology Department, Surgical oncology Department, and Pathology Deportment, Giza, Egypt; Radiology Department, Banha, Egypt
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Chen E, Du Y, Chen Y, Gan Y, Gao H, Hu X, Li Q, Zhang X. A web-based novel model for predicting prognostic value in patients with invasive micropapillary carcinoma in breast cancer: a real-world data retrospective cohort study. Updates Surg 2023; 75:1997-2004. [PMID: 37222906 DOI: 10.1007/s13304-023-01530-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
Invasive micropapillary carcinoma (IMPC) accounts for less than 2% of all invasive breast cancers and usually associates with poor survival, so we investigated the prognostic factors for IMPC using a large population-based database and designed a web-based novel model. Clinicopathological prognostic factors were evaluated using the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox regression analysis was performed to evaluate the prognostic value of variables on the overall survival. A web-based nomogram was finally constructed to predict the survival probability. The model was validated in an external dataset. A web-based model, combined with age, radiation, clinical stage, and hormone receptor (HR) immunochemistry status four prognostic factors, was constructed. The C-index (0.714, 95% CI 0.683-0.741), calibration curves, and decision curves showed that this model was superior in prediction. By determining the cut-off values, high-risk group and low-risk group were divided. The Kaplan-Meier survival curves showed that these two groups had significantly different survival rates (P < 0.0001). The result of C-index, calibration curves, and Kaplan-Meier survival curves were consistent in the validation cohort. The novel nomogram with four risk factors resulted in accurate prognostic prediction for IMPC.
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Affiliation(s)
- Endong Chen
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuan Du
- The 1St School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingying Chen
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yaowei Gan
- The 1St School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haoze Gao
- The 1St School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoqu Hu
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Quan Li
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Xiaohua Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Zhang M, Qin Y, Hou N, Ji F, Zhang Z, Zhang J. Authentication of a survival nomogram for non-invasive micropapillary breast cancer. Front Oncol 2023; 13:1156015. [PMID: 37503326 PMCID: PMC10369343 DOI: 10.3389/fonc.2023.1156015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Purpose We aimed at establishing a nomogram to accurately predict the overall survival (OS) of non-metastatic invasive micropapillary breast carcinoma (IMPC). Methods In the training cohort, data from 429 patients with non-metastatic IMPC were obtained through the Surveillance, Epidemiology, and End Results (SEER) database. Other 102 patients were enrolled at the Xijing Hospital as validation cohort. Independent risk factors affecting OS were ascertained using univariate and multivariate Cox regression. A nomogram was established to predict OS at 3, 5 and 8 years. The concordance index (C-index), the area under a receiver operating characteristic (ROC) curve and calibration curves were utilized to assess calibration, discrimination and predictive accuracy. Finally, the nomogram was utilized to stratify the risk. The OS between groups was compared through Kaplan-Meier survival curves. Results The multivariate analyses revealed that race (p = 0.047), surgery (p = 0.003), positive lymph nodes (p = 0.027), T stage (p = 0.045) and estrogen receptors (p = 0.019) were independent prognostic risk factors. The C-index was 0.766 (95% CI, 0.682-0.850) in the training cohort and 0.694 (95% CI, 0.527-0.861) in the validation cohort. Furthermore, the predicted OS was consistent with actual observation. The AUCs for OS at 3, 5 and 8 years were 0.786 (95% CI: 0.656-0.916), 0.791 (95% CI: 0.669-0.912), and 0.774 (95% CI: 0.688-0.860) in the training cohort, respectively. The area under the curves (AUCs) for OS at 3, 5 and 8 years were 0.653 (95% CI: 0.498-0.808), 0.683 (95% CI: 0.546-0.820), and 0.716 (95% CI: 0.595-0.836) in the validation cohort, respectively. The Kaplan-Meier survival curves revealed a significant different OS between groups in both cohorts (p<0.001). Conclusion Our novel prognostic nomogram for non-metastatic IMPC patients achieved a good level of accuracy in both cohorts and could be used to optimize the treatment based on the individual risk factors.
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Affiliation(s)
- Mingkun Zhang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shanxi, China
| | - Yuan Qin
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shanxi, China
| | - Niuniu Hou
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shanxi, China
- Department of General Surgery, Eastern Theater Air Force Hospital of People’s Liberation Army (PLA), Nanjing, China
| | - Fuqing Ji
- Department of Thyroid Breast Surgery, Xi’an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi’an, Shanxi, China
| | - Zhihao Zhang
- Department of Thyroid Breast Surgery, Xi’an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi’an, Shanxi, China
| | - Juliang Zhang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shanxi, China
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Nangong J, Cheng Z, Yu L, Zheng X, Ding G. Invasive micropapillary breast carcinoma: A retrospective study on the clinical imaging features and pathologic findings. Front Surg 2022; 9:1011773. [PMID: 36211280 PMCID: PMC9538921 DOI: 10.3389/fsurg.2022.1011773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To describe the clinical imaging and pathological features of invasive micropapillary breast carcinoma (IMPC), including breast mammography, sonography, magnetic resonance imaging (MRI), and molecular imaging findings. Patients and methods We retrospectively reviewed our institution's surgical pathology database and identified 65 patients with pathologically proven IMBC; 63/65 patients had available imaging results. Two radiologists retrospectively reviewed all imaging evaluations according to the Breast Imaging Reporting / Data System (BI-RADS) Lexicon. Clinical and histopathologic features, receptor statuses, and clinical follow-up data were recorded. Results Sixty-three patients were admitted with palpable abnormalities; one patient's mammogram revealed no abnormality (3.3%, 1/32), whereas 31 had abnormal mammograms (31/32, 96.8%) demonstrating 37 lesions. Twenty-four had irregular, spiculated masses, 12 had microcalcifications, and 19 had architectural distortion. Sonography detected 69 masses (54 patients), characterized by irregular shapes (61/69, 88.4%), hypoechoic structures (50/69, 72.4%), angular or spiculated margins (38/69, 55.1%; 30/69, 43.4%), echogenic halo (8/69, 11.5%), and abnormal vascularity (52/69, 75.3%). MRI detected 68 lesions (52 patients); 59/68 (86.8%) appeared as masses with angular or spiculated margins (32/68, 47.1%; 35/68, 51.4%), 58 exhibited irregular or lobulated shapes (58/68, 89.7%), 29 displayed heterogeneous internal enhancement (29/68, 42.5%), and 64 demonstrated type II or III washout kinetic curves (37/68, 55%; 27/68, 40%). Breast molecular imaging showed mild-to-moderate radiotracer uptake in 15 focal areas among 13 patients. Thirty-two, 38, and 43 patients had abnormal lymph nodes identified mammographically, by breast sonography, and by MRI, respectively. Immunohistochemistry revealed high estrogen receptor (90.5%), high progesterone receptor (71.6%), and low HER-2 (26.4%) positivity. Conclusion IMPC mammography, sonography, and MRI clinical imaging features highly suggest malignancy. Breast molecular imaging also contributed to the diagnosis. IMPC's invasiveness correlated well with regional lymph node metastasis. Radiologists and surgeons should be more attentive to these imaging findings and additional clinical and pathological IMPC features.
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Affiliation(s)
- Jiarui Nangong
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhongquan Cheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Leyi Yu
- Departament of Chronic Wound Repair Surgery, Beijing Haidian Hospital, Peking University, Beijing, China
| | - Xiaodan Zheng
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoqian Ding
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Correspondence: Guoqian Ding
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Verras GI, Tchabashvili L, Mulita F, Grypari IM, Sourouni S, Panagodimou E, Argentou MI. Micropapillary Breast Carcinoma: From Molecular Pathogenesis to Prognosis. BREAST CANCER (DOVE MEDICAL PRESS) 2022; 14:41-61. [PMID: 35310681 PMCID: PMC8926414 DOI: 10.2147/bctt.s346301] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/29/2022] [Indexed: 02/05/2023]
Abstract
Invasive micropapillary carcinoma (IMPC) of the breast is an infrequent type of breast cancer often discussed for its potency for lymphovascular invasion and difficulty in accurate imaging estimation. Micropapillary carcinomas are noted to be present as larger tumors, of higher histological grade and a notably higher percentage of disease-positive lymph nodes. Hormonal and HER-2 positivity in IMPC is also commoner when compared to other NST carcinomas. IMPC occurs either as a pure form or more often as a component of mixed Non-Specific Type (NST) carcinoma. The latest data suggest that despite having comparable survival rates to other histological subtypes of breast carcinoma, effective surgical treatment often requires extended surgical margins and vigilant preoperative axillary staging due to an increased incidence of lymph node invasion, and locoregional recurrence. Moreover, the presence of micropapillary in situ components within tumors also seems to alter tumor aggression and influence the nodal disease stage. In this review, we present an overview of the current literature of micropapillary carcinoma of the breast from biology to prognosis, focusing on biological differences and treatment.
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Affiliation(s)
| | - Levan Tchabashvili
- Department of Surgery, Breast Unit, University Hospital of Patras, Patras, Greece
| | - Francesk Mulita
- Department of Surgery, Breast Unit, University Hospital of Patras, Patras, Greece
| | | | - Sofia Sourouni
- Department of Radiology, University Hospital of Patras, Patras, Greece
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Noguchi H, Higashi M, Idichi T, Kurahara H, Mataki Y, Tasaki T, Kitazono I, Ohtsuka T, Tanimoto A. Rare histological subtype of invasive micropapillary carcinoma in the ampulla of Vater: A case report. World J Clin Cases 2021; 9:2671-2678. [PMID: 33889635 PMCID: PMC8040169 DOI: 10.12998/wjcc.v9.i11.2671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/18/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carcinoma of the ampulla of Vater is an uncommon ampullo-pancreatobiliary neoplasm, and the most common histological type is adenocarcinoma with a tubular growth pattern. Invasive micropapillary carcinoma (IMPC) is an aggressive variant of adenocarcinoma in several organs that is associated with lymph node metastasis and poor prognosis. IMPC was first described as a histological subtype of breast cancer; however, IMPC of the ampulla of Vater is extremely rare, with only three articles reported in the English literature.
CASE SUMMARY We have reported a case of IMPC of the ampulla of Vater in an 80-year-old man. Microscopically, the surface area of the carcinoma was composed of tubulopapillary structures mimicking intra-ampullary papillary-tubular neoplasm, and the deep invasive front area exhibited a pattern of IMPC. The carcinoma showed lymphatic invasion and extensive lymph node metastasis. The immunohistochemical study revealed mixed intestinal and gastric/pan-creatobiliary phenotypes.
CONCLUSION This rare subtype tumor in the ampulla of Vater showed a histologically mixed phenotype and exhibited aggressive behavior.
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Affiliation(s)
- Hirotsugu Noguchi
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Michiyo Higashi
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Tetsuya Idichi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Yuko Mataki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Takashi Tasaki
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Ikumi Kitazono
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Akihide Tanimoto
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
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Rodrigues MA, Caldeira-Brant AL, Gomes DA, Silveira TL, Chiarini-Garcia H, Cassali GD. Characterization of neoplastic cells outlining the cystic space of invasive micropapillary carcinoma of the canine mammary gland. BMC Vet Res 2021; 17:130. [PMID: 33761962 PMCID: PMC7992814 DOI: 10.1186/s12917-021-02807-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Invasive micropapillary carcinoma (IMPC) is a rare malignant breast tumor and a variant form of invasive ductal carcinoma that is an aggressive neoplasm of the human breast and canine mammary gland. The importance of the tumor microenvironment in cancer development has gradually been recognized, but little is known about the cell types outlining the cystic space of canine IMPC. This study aimed to characterize the neoplastic cells outlining the cystic space of IMPC. RESULTS Immunohistochemistry (IHC), immunofluorescence (IF), superresolution and transmission electron microscopy (TEM) were used to assess the cell types in the cystic areas of IMPCs. Cells expressing the mesenchymal markers alpha-smooth muscle actin (αSMA), Vimentin, and S100A4 outlined the cystic space of IMPC. Furthermore, loss of epithelial cell polarity in IMPC was shown by the localization of MUC1 at the stroma-facing surface. This protein modulates lumen formation and inhibits the cell-stroma interaction. Immunohistochemical and IF staining for the myoepithelial cell marker p63 were negative in IMPC samples. Furthermore, associated with peculiar morphology, such as thin cytoplasmic extensions outlining cystic spaces, was observed under TEM. These observations suggested cells with characteristics of myoepithelial-like cells. CONCLUSIONS The cells outlining the cystic space of IMPC in the canine mammary gland were characterized using IHC, IF and TEM. The presence of cells expressing αSMA, Vimentin, and S100A4 in the IMPC stroma suggested a role for tumor-associated fibroblasts in the IMPC microenvironment. The reversal of cell polarity revealed by the limited basal localization of MUC1 may be an important factor contributing to the invasiveness of IMPC. For the first time, the cystic space of canine mammary gland IMPC was shown to be delimited by myoepithelial-like cells that had lost p63 expression. These findings may enhance our understanding of the cellular microenvironment of invasive tumors to improve cancer diagnosis and treatment.
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Affiliation(s)
- Michele A Rodrigues
- Department of General Pathology, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, CEP: 31270-901, Brazil
| | - Andre L Caldeira-Brant
- Department of Morphology, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, CEP: 31270-901, Brazil
| | - Dawidson A Gomes
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, CEP: 31270-901, Brazil
| | - Tatiany L Silveira
- Department of General Pathology, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, CEP: 31270-901, Brazil
| | - Hélio Chiarini-Garcia
- Department of Morphology, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, CEP: 31270-901, Brazil
| | - Geovanni D Cassali
- Department of General Pathology, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, CEP: 31270-901, Brazil.
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Guan X, Xu G, Shi A, Zou Y, Zhan Y, Fan Z, Dong Y. Comparison of clinicopathological characteristics and prognosis among patients with pure invasive ductal carcinoma, invasive ductal carcinoma coexisted with invasive micropapillary carcinoma, and invasive ductal carcinoma coexisted with ductal carcinoma in situ: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23487. [PMID: 33327281 PMCID: PMC7738125 DOI: 10.1097/md.0000000000023487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 02/02/2023] Open
Abstract
This paper aimed to analyze the clinicopathological characteristics of invasive ductal carcinoma with an invasive micropapillary carcinoma component (IDC + IMPC), invasive ductal carcinoma with a ductal carcinoma in situ component (IDC + DCIS), and compare the clinicopathological characteristics and prognosis to those of IDC.A total of 1713 patients (130 IDC + IMPC cases, 352 IDC + DCIS cases, and 1231 pure IDC cases) who underwent appropriate surgery from June 2011 to September 2017 were retrospectively selected.Compared to the pure IDC and IDC + DCIS patients, the IDC + IMPC patients presented with more aggressive characteristics, such as a higher proportion of vascular invasion (P < .001), fewer progesterone receptor (PR)-positive patients (P < .001), a lower proportion of cases in American Joint Committee on Cancer stage I (P < .001), a higher recurrence risk (P < .001), more deaths (P < .001), and more metastatic cases (P < .001). Compared to the pure IDC and IDC + IMPC patients, the IDC+DCIS patients presented with less aggressive characteristics, such as a higher proportion of estrogen receptor-positive patients (P < .001) and PR-positive patients (P < .001), a lower proportion of cases with nerve invasion (P < .001) and vascular invasion (P < .001), a higher proportion of cases in American Joint Committee on Cancer stage I (P < .001), fewer deaths (P < .001), and fewer metastatic cases (P < .001). The patients with IDC + DCIS had significantly better disease-free survival (DFS) and overall survival (OS) compared to those with pure IDC and IDC + IMPC (P < .001). The patients with IDC + IMPC had significantly worse DFS and OS compared to those with pure IDC and IDC + DCIS (P < .001). In univariate analysis, the presence of an IMPC component in IDC (P = .007), estrogen receptor status (P = .05), and PR status (P = .003) were factors associated with OS. In multivariate analysis, coexisting IMPC (P = .04) was the only independent prognostic factor associated with OS.Compared to IDC and IDC + DCIS, IDC + IMPC had more aggressive characteristics and significantly worse DFS and OS. Compared to IDC and IDC + IMPC, IDC + DCIS had less aggressive characteristics and significantly better DFS and OS.
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Affiliation(s)
- Xin Guan
- Department of Breast Surgery, The First Hospital of Jilin University
| | - Guiying Xu
- The Second Breast Surgery Department of Jilin Cancer Hospital
| | - Aiping Shi
- Department of Breast Surgery, The First Hospital of Jilin University
| | - Yabin Zou
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yue Zhan
- Department of Breast Surgery, The First Hospital of Jilin University
| | - Zhimin Fan
- Department of Breast Surgery, The First Hospital of Jilin University
| | - Yi Dong
- The Second Breast Surgery Department of Jilin Cancer Hospital
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11
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Perron M, Wen HY, Hanna MG, Brogi E, Ross DS. HER2 Immunohistochemistry in Invasive Micropapillary Breast Carcinoma: Complete Assessment of an Incomplete Pattern. Arch Pathol Lab Med 2020; 145:979-987. [PMID: 33212478 DOI: 10.5858/arpa.2020-0288-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Invasive micropapillary carcinoma (IMPC) is a rare variant of breast carcinoma, composed of avascular morula-like tumor clusters surrounded by stromal spaces, which can affect the HER2 immunohistochemical (IHC) staining pattern. The 2013 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) HER2 testing guideline suggests moderate to intense but incomplete (basolateral) staining be considered equivocal. OBJECTIVES.— To perform a detailed assessment of HER2 IHC staining patterns in IMPC. DESIGN.— Hematoxylin-eosin and HER2 IHC slides were retrospectively reviewed to assess the morphology and HER2 IHC characteristics of IMPC. The 2018 ASCO/CAP guideline was applied. RESULTS.— The cohort consisted of 187 IMPCs from 181 patients with median age of 58 years. Homogeneous (≥90%) micropapillary component was found in 40% (75 of 187) of cases. Receptor profile was as follows: 75% (140 of 187) ER+ HER2-, 19% (37 of 187) ER+ HER2+, 4% (7 of 187) ER- HER2+, and 2% (3 of 187) ER- HER2-. Of 26 cases with HER2 IHC 3+, 65% (17 of 26) showed a basolateral staining pattern with strong intensity. HER2 fluorescence in situ hybridization (FISH) showed amplification in 26% (17 of 66) of HER2 IHC equivocal cases: 76% (13 of 17) showed basolateral staining pattern and 24% (4 of 17) complete staining, with weak to moderate (2), moderate (14), or moderate to strong (1) intensity. CONCLUSIONS.— The most frequent staining pattern was basolateral, seen in 49% of cases, including 65% HER2 IHC positive and 76% HER2 IHC equivocal/FISH amplified. If a basolateral pattern and weak to moderate staining is observed in IMPC, alternative testing should be performed to confirm the HER2 status.
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Affiliation(s)
- Marjorie Perron
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hannah Y Wen
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew G Hanna
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edi Brogi
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dara S Ross
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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12
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Zhou S, Yang F, Bai Q, Li A, Li M, Zhong S, Lv H, Shui R, Tu X, Bi R, Xu X, Cheng Y, Yu B, Tang S, Sun X, Zhou X, Yang W. Intense basolateral membrane staining indicates HER2 positivity in invasive micropapillary breast carcinoma. Mod Pathol 2020; 33:1275-1286. [PMID: 31974492 DOI: 10.1038/s41379-020-0461-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/31/2019] [Accepted: 12/31/2019] [Indexed: 11/09/2022]
Abstract
Invasive micropapillary carcinoma is characterized by the inside-out growth of tumor clusters and displays incomplete membrane immunostaining of HER2. According to the 2018 American Society of Clinical Oncology and the College of American Pathologists (ASCO/CAP) HER2-testing recommendation, moderate to intense but incomplete staining could be scored as immunohistochemical 2+. Furthermore, the criteria of immunohistochemical 3+ for this staining pattern are not mentioned. One hundred and forty-seven cases of invasive micropapillary carcinoma with moderate-to-intense HER2 immunostaining were enrolled. Invasive micropapillary carcinoma components of all cases were scored as immunohistochemical 2+ based on the 2018 ASCO/CAP recommendation. The invasive micropapillary carcinoma component varied from 10% to 100% (mean, 80%). Invasive micropapillary carcinoma components of all 147 tumors exhibited reversed polarity and incomplete basolateral HER2 membrane staining. One hundred and seventeen of the tumors (80%, 117/147) had moderate staining, and 38 (32%, 38/117) showed HER2 gene amplification by fluorescence in-situ hybridization. HER2 gene was amplified in all the remaining 30 tumors (20%, 30/147) that exhibited intense basolateral membrane staining. Besides, average HER2 signals per cell and ratio of HER2/CEP17 were significantly higher in the intense-staining tumors compared with the moderate-staining tumors (p < 0.0001). Follow-up data were available for 140 patients. None of the patients were died. The follow-up time ranged from 1 month to 99 months (median, 57 months). Thirteen (9%, 13/140) patients exhibited disease progression (recurrence or metastasis). HER2 gene amplification was correlated inversely with estrogen receptor (p = 0.000) and progesterone receptor (p = 0.000) expression, and positively with histological grade (p = 0.003) and disease progression (p = 0.000). Invasive micropapillary carcinoma with intense clear linear basolateral membrane immunostaining indicates HER2 positivity, even if the staining is incomplete. They should be classified as immunohistochemical 3+ rather than immunohistochemical 2+, which would avoid further fluorescence in-situ hybridization-testing procedure and greatly save the related time, labor, and financial costs. Ultimately, ensure all patients with HER2 gene amplification obtain effective targeted therapy in time.
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Affiliation(s)
- Shuling Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Fei Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Qianming Bai
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Anqi Li
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Ming Li
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Siyuan Zhong
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Hong Lv
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Ruohong Shui
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Xiaoyu Tu
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Rui Bi
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Xiaoli Xu
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Yufan Cheng
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Baohua Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Shaoxian Tang
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Xiangjie Sun
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Xiaoyan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, 200032, Shanghai, PR China. .,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, 200032, Shanghai, PR China.
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13
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Murciano-Goroff YR, Warner AB, Wolchok JD. The future of cancer immunotherapy: microenvironment-targeting combinations. Cell Res 2020; 30:507-519. [PMID: 32467593 PMCID: PMC7264181 DOI: 10.1038/s41422-020-0337-2] [Citation(s) in RCA: 491] [Impact Index Per Article: 98.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/29/2020] [Indexed: 02/08/2023] Open
Abstract
Immunotherapy holds the potential to induce durable responses, but only a minority of patients currently respond. The etiologies of primary and secondary resistance to immunotherapy are multifaceted, deriving not only from tumor intrinsic factors, but also from the complex interplay between cancer and its microenvironment. In addressing frontiers in clinical immunotherapy, we describe two categories of approaches to the design of novel drugs and combination therapies: the first involves direct modification of the tumor, while the second indirectly enhances immunogenicity through alteration of the microenvironment. By systematically addressing the factors that mediate resistance, we are able to identify mechanistically-driven novel approaches to improve immunotherapy outcomes.
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Affiliation(s)
| | - Allison Betof Warner
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Weill Cornell Medicine, New York, NY, 10065, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Jedd D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Weill Cornell Medicine, New York, NY, 10065, USA.
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
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14
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Ye F, Yu P, Li N, Yang A, Xie X, Tang H, Liu P. Prognosis of invasive micropapillary carcinoma compared with invasive ductal carcinoma in breast: A meta-analysis of PSM studies. Breast 2020; 51:11-20. [PMID: 32172190 PMCID: PMC7375573 DOI: 10.1016/j.breast.2020.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Invasive micropapillary carcinoma (IMPC) is a rare histological subtype of breast cancer. The outcome of IMPC remains controversial; we conducted a meta-analysis of propensity score matching (PSM) studies to evaluate the prognostic difference between IMPC and invasive ductal carcinoma (IDC). METHODS We searched PubMed, EMBASE and the Cochrane library for PSM studies comparing survival data between IMPC and IDC. The summarized odds ratios (ORs) and 95% confidence interval (95% CI) are calculated by STATA software utilizing fixed-effect or random-effect models, depending on the heterogeneity of the eligible studies. RESULTS Eight PSM studies including 2102 IMPC patients are included in the meta-analysis. Compared with IDC, IMPC has a similar overall survival (OS) (estimated OR = 0.87, 95% CI: 0.61-1.25), but a shorter relapse free survival (RFS) (estimated OR = 1.31, 95% CI: 1.06-1.61); the shorter RFS might owe to the significantly higher loco-regional recurrence rate of IMPC (estimated OR = 3.60, 95% CI: 1.99-6.52). Funnel plots and Egger's tests are used to evaluate publication bias and the p value for OS and RFS are 0.036 and 0.564 respectively. CONCLUSIONS Our results demonstrate that compared with IDC, IMPC exhibits a similar, even favorite OS, but a shorter RFS; and the shorter RFS might owe to the significantly higher loco-regional recurrence rate of IMPC. These results could contribute to the individualized therapy and follow-up strategies for IMPC patients.
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Affiliation(s)
- Feng Ye
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
| | - Ping Yu
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
| | - Na Li
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
| | - Anli Yang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
| | - Xinhua Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
| | - Peng Liu
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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15
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Taggart MW, Foo WC, Lee SM. Tumors of the Gastrointestinal System Including the Pancreas. ONCOLOGICAL SURGICAL PATHOLOGY 2020:691-870. [DOI: 10.1007/978-3-319-96681-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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16
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Lewis GD, Xing Y, Haque W, Patel T, Schwartz M, Chen A, Farach A, Hatch SS, Butler EB, Chang J, Teh BS. Prognosis of lymphotropic invasive micropapillary breast carcinoma analyzed by using data from the National Cancer Database. Cancer Commun (Lond) 2019; 39:60. [PMID: 31639071 PMCID: PMC6805396 DOI: 10.1186/s40880-019-0406-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Invasive micropapillary carcinoma (IMPC) is an uncommon subtype of breast cancer. Previous studies of this subtype demonstrated a higher propensity for lymph node metastases as compared with invasive ductal carcinoma (IDC). The purpose of the present study was to determine the clinical characteristics, outcomes, and propensity for lymph node metastasis of patients with IMPC of the breast recorded in the National Cancer Database (NCDB). Methods Records of patients with IMPC diagnosed between 2004 and 2014 were retrieved from the NCDB. Log-rank test was performed to evaluate associations of clinical characteristics with overall survival (OS). Cox proportional hazards model was used to determine variables associated with OS. Results Overall, 2660 patients with IMPC met the selection criteria; the 5-year OS rate was 87.5% and 24.9% of patients had nodal involvement at presentation. Patients with ≥ 4 positive lymph nodes had shorter OS than node-negative patients, whereas patients with 1–3 positive nodes had similar OS to node-negative patients. Age < 65 years, receipt of radiotherapy, and estrogen receptor positivity were also associated with prolonged OS. The benefit of radiotherapy was limited to IMPC patients undergoing lumpectomy; there was no benefit for the patients undergoing mastectomy (regardless of nodal positivity/negativity). Conclusions Favorable prognostic factors of IMPC patients included age < 65 years, < 4 positive lymph nodes, receipt of radiotherapy, and estrogen receptor positivity. The results presented herein suggest a survival benefit associated with radiotherapy in IMPC treatment, though this may be limited to the patients treated with lumpectomy.
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Affiliation(s)
- Gary D Lewis
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Yan Xing
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Tejal Patel
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Mary Schwartz
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Albert Chen
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Andrew Farach
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Sandra S Hatch
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Jenny Chang
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, 77030, USA.
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17
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Kano M, Hihara J, Kaneko M, Uemura K, Ohge H, Sueda T. Gastrectomy for invasive micropapillary carcinoma is associated with poorer disease-free and disease-specific survival. Int J Clin Oncol 2019; 24:1565-1573. [PMID: 31327070 DOI: 10.1007/s10147-019-01514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Invasive micropapillary carcinoma (IMPC) is a relatively rare subtype of gastric adenocarcinoma and has aggressive histopathologic characteristics, including lymphatic and vascular invasion. However, the associated long-term survival outcomes remain unclear. This study aimed to compare the clinicopathological characteristics and prognosis of gastric adenocarcinoma with and without IMPC using propensity score-matched (PSM) analysis. METHODS Patients with gastric adenocarcinoma who underwent gastrectomy between 2006 and 2015 were included in the analysis. PSM analysis was performed to compensate for the background heterogeneity between the groups. The primary endpoint was disease-free survival (DFS) after gastrectomy, and the secondary endpoints were disease-specific survival (DSS) and recurrence pattern. RESULTS Of 882 patients who underwent gastrectomy for gastric adenocarcinoma, with a follow-up duration greater than 36 months, 35 were diagnosed as having gastric adenocarcinoma with IMPC. After PSM, 70 patients, including 35 with IMPC and 35 without IMPC, were selected. Gastric adenocarcinoma with IMPC is characterized by lymphatic invasion (94% versus 69%, p = 0.012). Patients with IMPC had significantly poorer DFS than those without IMPC, with 3-year DFS rates of 62.2% and 93.4% (p = 0.003), respectively. Furthermore, a significant difference was also observed in DSS (p = 0.016); patients with IMPC more frequently developed liver metastasis (20%) than those without IMPC (3%, p = 0.006). CONCLUSIONS Resected gastric carcinoma with IMPC was associated with poorer DFS and DSS; furthermore, an increased rate of lymphatic invasion and liver metastasis was noted than in cases without IMPC.
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Affiliation(s)
- Mikihiro Kano
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Kabe-minami 2-1-1, Asakita-ku, Hiroshima, 731-0293, Japan.
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Kabe-minami 2-1-1, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Mayumi Kaneko
- Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Kenichiro Uemura
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ohge
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taijiro Sueda
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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18
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Gamba CDO, Damasceno KA, Ferreira IC, Rodrigues MA, Gomes DA, Alves MR, Rocha RM, Lima AE, Ferreira E, Cassali GD. The investigation of transcriptional repression mediated by ZEB2 in canine invasive micropapillary carcinoma in mammary gland. PLoS One 2019; 14:e0209497. [PMID: 30645591 PMCID: PMC6333364 DOI: 10.1371/journal.pone.0209497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023] Open
Abstract
The E-cadherin loss has frequently been associated with transcriptional repression mediated by transcription factors, such as the Zinc Finger E-Box Binding Homeobox-2 (ZEB2). Invasive micropapillary carcinomas (IMPCs) of the breast are aggressive neoplasms frequently related to lymph node metastasis and poor overall survival. In the canine mammary gland, IMPCs has just been reported and, based on its behavioral similarity with the human IMPCs, appears to be a good spontaneous model to this human entity. This study aimed to evaluate the relationship between E-cadherin and ZEB2 in a spontaneous canine model of invasive micropapillary carcinoma of the mammary gland. The correlation among gene expression (ZEB2 and CDH1) and clinicopathological findings was also explored. Nineteen cases of IMPC of the canine mammary gland were obtained, protein and mRNA expression were investigated through immunohistochemistry and RNA In Situ Hybridization, respectively. To better understand the relationship between E-cadherin and ZEB2, immunofluorescence was performed in canine IMPCs. Immunohistochemically, most of IMPCs showed 1+ (14/19, 73.7%) for E-cadherin; and positivity for ZEB2 was diagnosed in 47.4% of the IMPCs. Regarding the RNA In Situ Hybridization (ISH), most of IMPCs showed 4+ and 0+ for E-cadherin (CDH1) and ZEB2 respectively. Through immunofluorescence, the first and second more frequent combinatorial group were E-cadherin+ZEB2- and E-cadherin+ZEB2+; neoplastic cells showing concomitantly weak expression for E-cadherin and positivity for ZEB2 were frequently observed. A negative correlation was observed between E-cadherin and progesterone receptor expression in IMPCs. Based on these results, canine mammary IMPCs show E-cadherin lost and, at times reveals nuclear positivity for the transcription factor ZEB2 that seems to exert transcriptional repression of the CDH1.
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Affiliation(s)
- Conrado de Oliveira Gamba
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Curso de Medicina Veterinária, Universidade do Oeste de Santa Catarina, Campus aproximado de Campos Novos, Campos Novos, Santa Catarina, Brazil
| | - Karine Araújo Damasceno
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Laboratório de Patologia Experimental, Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| | - Izabel Cristina Ferreira
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Michele Angela Rodrigues
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dawidson Assis Gomes
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Resende Alves
- International Center of Research in Cancer (CIPE), A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Rafael Malagoli Rocha
- International Center of Research in Cancer (CIPE), A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Alessandra Estrela Lima
- Departamento de Patologia e Clínicas, Escola de Medicina Veterinária, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Enio Ferreira
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Geovanni Dantas Cassali
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Kaya C, Uçak R, Bozkurt E, Ömeroğlu S, Kartal K, Yazıcı P, İdiz UO, Mihmanlı M. The Impact of Micropapillary Component Ratio on the Prognosis of Patients With Invasive Micropapillary Breast Carcinoma. J INVEST SURG 2018; 33:31-39. [PMID: 29843540 DOI: 10.1080/08941939.2018.1474302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background and Objectives: Invasive micropapillary carcinoma (IMPC) of the breast is a rare and aggressive variant of invasive ductal carcinoma characterized by high-grade lymphovascular invasion and high rates of nodal metastasis. The prognostic significance of the micropapillary component (MC) ratio that constitutes this aggressive variation is controversial. In this study, we aimed to investigate the effect of the MC ratio on the prognosis of these patients. Methods: The data of 47 patients with IMPC were retrospectively reviewed. Patients were divided into two groups: MC ratio of 10-75% (Group 1) and greater than 75% (Group 2). The demographic characteristics of the patients, histopathologic features of the tumors, and survival rates were compared. Results: We detected no significant difference in demographic characteristics between groups 1 and 2 (p = 0.21). No significant difference was detected in terms of tumor diameter, lymph node metastasis, lymphovascular invasion, histologic grade, multicentricity, local recurrence, distant metastasis, and overall survival. Conclusion: In the micropapillary subgroup of invasive ductal carcinoma, although positive receptor characteristics are directly proportional to the increase in MC ratio, recurrence and survival rates are not affected by micropapillary component level.
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Affiliation(s)
- Cemal Kaya
- Department of General Surgery, Istanbul Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, İstanbul, Turkey
| | - Ramazan Uçak
- Department of Pathology, Istanbul Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, İstanbul, Turkey
| | - Emre Bozkurt
- Department of General Surgery, Istanbul Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, İstanbul, Turkey
| | - Sinan Ömeroğlu
- Department of General Surgery, Hınıs Şehit Yavuz Yürekseven State Hospital, Erzurum, Turkey
| | - Kinyas Kartal
- Department of General Surgery, Istanbul Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, İstanbul, Turkey
| | - Pınar Yazıcı
- Department of General Surgery, Istanbul Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, İstanbul, Turkey
| | - Ufuk Oğuz İdiz
- Department of General Surgery, Istanbul Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, İstanbul, Turkey
| | - Mehmet Mihmanlı
- Department of General Surgery, Istanbul Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, İstanbul, Turkey
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20
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Wu Y, Zhang N, Yang Q. The prognosis of invasive micropapillary carcinoma compared with invasive ductal carcinoma in the breast: a meta-analysis. BMC Cancer 2017; 17:839. [PMID: 29228910 PMCID: PMC5725780 DOI: 10.1186/s12885-017-3855-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/28/2017] [Indexed: 01/27/2023] Open
Abstract
Background Invasive micropapillary carcinoma (IMPC) of the breast is a rare variant of invasive ductal carcinoma (IDC). The prognosis of IMPC compared with that of IDC remains controversial; we conducted a meta-analysis to evaluate the prognostic difference between IMPC and IDC. Methods We searched the PubMed, Cochrane Library, and EMBASE databases for relevant studies comparing overall survival (OS), disease-specific survival (DSS), relapse-free survival (RFS), local-regional recurrence-free survival (LRRFS) or distant metastasis-free survival (DMFS) rates between IMPC and IDC. Fixed-effect and random-effect models were utilized based on the heterogeneity of the eligible studies. Heterogeneity was further evaluated by subgroup and sensitivity analyses. Results Fourteen studies with 1888 IMPC patients were included in the meta-analysis. The summarized odds ratio (OR) and 95% confidence interval (95% CI) was calculated to estimate the prognostic difference between IMPC and IDC. IMPC patients showed an unfavorable prognosis for RFS (OR; 2.04; 95% CI: 1.63–2.55) and LRRFS (OR: 2.82; 95% CI: 1.90–4.17) compared with IDC. However, no significant difference was observed in OS (OR: 0.93; 95% CI: 0.78–1.10), DSS (OR: 1.16; 95% CI: 0.95–1.40) and DMFS (OR: 0.95; 95% CI: 0.67–1.35) between IMPC and IDC. No obvious statistical heterogeneity was detected, except for DSS. Funnel plots and Egger’s tests did not reveal publication bias, except for RFS. Conclusions This analysis showed that IMPC patients have a higher rate of loco-regional recurrence than IDC patients. However, OS, DSS and DMFS were not significantly different between IMPC and IDC. These results could help clinicians select therapeutic and follow-up strategies for IMPC patients. Electronic supplementary material The online version of this article (10.1186/s12885-017-3855-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yun Wu
- Department of Breast Surgery, Qilu Hospital, Shandong University, No.107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Ning Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University, No.107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital, Shandong University, No.107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China. .,Pathology Tissue Bank, Qilu Hospital, Shandong University, No.107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China.
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21
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Wu SG, Zhang WW, Sun JY, Li FY, Chen YX, He ZY. Postoperative radiotherapy for invasive micropapillary carcinoma of the breast: an analysis of Surveillance, Epidemiology, and End Results database. Cancer Manag Res 2017; 9:453-459. [PMID: 29056854 PMCID: PMC5635851 DOI: 10.2147/cmar.s141338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Invasive micropapillary carcinoma (IMPC) of the breast poses a high risk of locoregional recurrence, and postoperative radiotherapy (PORT) may be beneficial in IMPC. Hence, we determined the clinical value of PORT in IMPC patients. Patients and methods We assessed clinicopathological factors extracted from the Surveillance, Epidemiology, and End Results database (2004–2013). Univariate and multivariate Cox proportional hazards regressions were performed to assess the independent prognostic factors on breast cancer-specific survival (BCSS) and overall survival (OS). Results Of the 881 study patients, 444 (50.4%) and 437 (49.6%) underwent breast-conserving surgery (BCS) and mastectomy (MAST), respectively, of whom 357 (80.4%) and 153 (35.0%) underwent PORT, respectively. Patients with young age, large tumor size, or advanced nodal stage were more likely to undergo MAST and PORT compared with MAST alone. Patients with progesterone receptor-positive disease were more likely to receive BCS and PORT compared with BCS alone. The 5-year BCSS and OS were 95.7% and 90.9%, respectively. On multivariate analyses, tumor size, histological grade, and estrogen receptor status were independent predictors of BCSS and OS. The types of surgical procedures (MAST vs. BCS) were not an independent predictor of survival outcomes. Patients who underwent MAST with or without PORT had similar BCSS and OS in the multivariate analyses. Those who underwent BCS plus PORT did not have better BCSS and OS than those who underwent BCS alone. In the low-, intermediate-, and high-risk groups, PORT was not associated with better BCSS and OS than non-PORT groups in patients who received BCS or MAST. Conclusion IMPC has favorable BCSS and OS. Regardless of the types of surgical procedures (MAST or BCS), PORT groups were not inferior to non-PORT groups on BCSS and OS.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Yong-Xiong Chen
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Medical College, Xiamen University, Xiamen, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
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22
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Kim HJ, Park K, Kim JY, Kang G, Gwak G, Park I. Prognostic Significance of a Micropapillary Pattern in Pure Mucinous Carcinoma of the Breast: Comparative Analysis with Micropapillary Carcinoma. J Pathol Transl Med 2017; 51:403-409. [PMID: 28597867 PMCID: PMC5525037 DOI: 10.4132/jptm.2017.03.18] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/27/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mucinous carcinoma of the breast is an indolent tumors with a favorable prognosis; however, micropapillary features tend to lead to aggressive behavior. Thus, mucinous carcinoma and micropapillary carcinoma exhibit contrasting biologic behaviors. Here, we review invasive mucinous carcinoma with a focus on micropapillary features and correlations with clinicopathological factors. METHODS A total of 64 patients with invasive breast cancer with mucinous or micropapillary features were enrolled in the study. Of 36 pure mucinous carcinomas, 17 (47.2%) had micropapillary features and were termed mucinous carcinoma with micropapillary features (MUMPC), and 19 (52.8%) had no micropapillary features and were termed mucinous carcinoma without micropapillary features. MUMPC were compared with 15 invasive micropapillary carcinomas (IMPC) and 13 invasive ductal and micropapillary carcinomas (IDMPC). RESULTS The clinicopathological factors of pure mucinous carcinoma and MUMPC were not significantly different. In contrast to IMPC and IDMPC, MUMPC had a low nuclear grade, lower mitotic rate, higher expression of hormone receptors, negative human epidermal growth factor receptor 2 (HER2) status, lower Ki-67 proliferating index, and less frequent lymph node metastasis (p < .05). According to univariate analyses, progesterone receptor, HER2, T-stage, and lymph node metastasis were significant risk factors for overall survival; however, only T-stage remained significant in a multivariate analysis (p < .05). CONCLUSIONS In contrast to IMPC and IDMPC, the micropapillary pattern in mucinous carcinoma does not contribute to aggressive behavior. However, further analysis of a larger series of patients is required to clarify the prognostic significance of micropapillary patterns in mucinous carcinoma of the breast.
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Affiliation(s)
- Hyun-Jung Kim
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Kyeongmee Park
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jung Yeon Kim
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Guhyun Kang
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Geumhee Gwak
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Inseok Park
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
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23
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de Oliveira Gamba C, Scaratti D, de Andrade VP, Estrela-Lima A, Ferreira E, Cassali GD. Invasive micropapillary carcinoma of the mammary gland in humans and canines: Clinicopathological, immunophenotypical and survival approaches. Res Vet Sci 2017; 115:189-194. [PMID: 28475997 DOI: 10.1016/j.rvsc.2017.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 02/02/2023]
Abstract
Invasive micropapillary carcinoma (IMPC) is a breast cancer with a proclivity for lymph node metastasis that affects women. In canines, this carcinoma has only recently been reported and appears to have similar histological aspects as its human counterpart. Thus, the aim of the present study was to compare clinicopathological, immunohistochemical and prognostic characteristics of mammary IMPC between humans and canines. In canines, regional metastasis was more frequently observed. Histopathologically, humans and canines predominantly showed a moderate histological grade. The pure subtype and neoplastic emboli were more frequently observed in canines. Regarding immunohistochemical evaluation, most canine and human IMPCs were positive for the estrogen and progesterone receptors. A reversed pattern of epithelial membrane antigen expression and a high proliferation index predominated in both species. The mortality due to the neoplastic disease was more frequently observed in canines (94%) than in humans (4%). Thus, canine IMPCs show a larger tumor size and higher rates of the pure subtype, regional metastasis and mortality than their human counterparts and appear to provide a good spontaneous model for achieving a better understanding of the biological behavior of human IMPCs.
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Affiliation(s)
- Conrado de Oliveira Gamba
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Dirceu Scaratti
- Departamento de Ciências Exatas e da Terra, Universidade do Oeste de Santa Catarina (UNOESC), Rua Paese 198, Videira, Santa Catarina 89560-000, Brazil
| | - Victor Piana de Andrade
- Departamento de Patologia, A.C. Camargo Cancer Center, Rua Taguá 440, São Paulo, São Paulo 01508-010, Brazil
| | - Alessandra Estrela-Lima
- Departamento de Patologia e Clínicas, Escola de Medicina Veterinária, Universidade Federal da Bahia, Av. Adhemar de Barros, 500, Ondina, Salvador, Bahia 40170-110, Brazil
| | - Enio Ferreira
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Geovanni Dantas Cassali
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais 31270-901, Brazil.
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24
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Invasive Micropapillary Carcinoma of the Breast: Immunophenotypic Analysis and Role of Cell Adhesion Molecules (CD44 and E-Cadherin) in Nodal Metastasis. Appl Immunohistochem Mol Morphol 2016. [PMID: 26200840 DOI: 10.1097/pai.0000000000000167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Invasive micropapillary carcinoma is a morphologically distinct subtype of breast carcinoma with high frequency of lymph node metastasis. In this study, we analyzed clinicopathologic features, immunophenotype, and expression of adhesion molecules [CD44 and E-cadherin (E-Cad)] in pure invasive micropapillary carcinoma of the breast. All cases had diffuse micropapillary pattern and were grade II tumors. Lymphovascular emboli were present in 80% and lymph node tumor deposits were seen in 69.2% cases. The cases were classified as; luminal A (11 cases), luminal B (8 cases), Her-2-neu overexpressing (4 cases), and triple negative (2 cases). All cases were positive for luminal cytokeratin (CK)CK8/18, and 2 cases showed <10% positivity for CK5/6. Eighteen cases showed loss of CD44 expression and 7 cases showed only weak positivity. Seven cases with lymph node metastasis showed reexpression of CD44 at metastatic site. Strong to moderate expression of E-Cad was observed in all cases and the corresponding nodal metastasis. To conclude, the loss of the CD44 expression plays role in lymphovascular permeation and metastasis and it can be hypothesized that its reexpression at metastatic site may play a role in homing of tumor cells. However, intact E-Cad expression could be because of the fact that tumour cells travel as clusters and retain their expression of E-Cad.
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25
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Li G, Yang S, Yao J, Wang Z, Yao G, Liu M, Ye C. Invasive micropapillary carcinoma of the breast had poor clinical characteristics but showed no difference in prognosis compared with invasive ductal carcinoma. World J Surg Oncol 2016; 14:207. [PMID: 27492008 PMCID: PMC4974796 DOI: 10.1186/s12957-016-0960-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/23/2016] [Indexed: 12/19/2022] Open
Abstract
Background It is controversial for prognosis of invasive micropapillary carcinoma (IMPC) compared with invasive ductal carcinoma (IDC) of the breast. To better understand the difference between IMPC and IDC prognoses, we conducted this retrospective study. Methods Data from 33 patients with IMPC were retrospectively reviewed, and the clinicopathologic characteristics and survival status were compared with those of 347 patients with IDC who were treated during the same period. Results The IMPC cases were of larger tumor size, greater proportion of nodal involvement, and an increased incidence of lymphovascular invasion compared with IDC cases. The overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and failure-free survival (FFS) rates were not significantly different between IMPC and IDC. The 3-year OS rate was 97 vs 94.2 % for the IMPC and IDC patients, respectively. The 3-year FFS rate was 87.9 vs 86.2 % for the IMPC and IDC patients, respectively. For IMPC patients, the 3-year LRFS rate was 93.9 % and in IDC patients was 89.0 %. The 3-year DMFS rates of IMPC patients was 90.9 % and IDC patients was 89 %. Conclusions IMPC had poor clinical characteristics, but it showed no difference in OS, FFS, LRFS, and DMFS compare with IDC.
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Affiliation(s)
- Guanqiao Li
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China.,Department of Breast Surgery, Hainan Province People's Hospital, Haikou, Hainan, 570311, People's Republic of China
| | - Shiping Yang
- Department of Radiation Oncology, Hainan Province People's Hospital, Haikou, Hainan, People's Republic of China
| | - Jia Yao
- Department of Breast Surgery, Hainan Province People's Hospital, Haikou, Hainan, 570311, People's Republic of China
| | - Zhenping Wang
- Department of Radiology, Hainan Province People's Hospital, Haikou, Hainan, 570311, People's Republic of China
| | - Guangyu Yao
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Mingfeng Liu
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Changsheng Ye
- Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China.
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26
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Kuroda N, Sugimoto T, Takahashi T, Moriki T, Toi M, Miyazaki E, Hiroi M, Enzan H. Invasive Micropapillary Carcinoma of the Breast: An Immunohistochemical Study of Neoplastic and Stromal Cells. Int J Surg Pathol 2016; 13:51-5. [PMID: 15735855 DOI: 10.1177/106689690501300107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 59-year-old woman complained of a palpable mass in the right breast, and a needle biopsy disclosed small clusters of neoplastic cells in the fibrous stroma. The small clusters did not contain fibrovascular cores but exhibited micropapillary configuration. Epithelial membrane antigen (EMA) immunohistochemistry confirmed the reverse polarity of the neoplastic cells. Additionally, the plasma membrane of many neoplastic cells stained with E-cadherin and f-catenin. Myofibroblasts, which were positive for alpha smooth muscle actin (ASMA) and negative for cytokeratin 14, were abundant in the neoplastic stroma, but no CD34-positive stromal cells were observed in the neoplastic stroma. For comparison, 3 additional cases of invasive micropapillary carcinoma (IMC) and 4 cases of invasive ductal carcinoma (IDC) were studied. Similar results for stromal cells were obtained in all cases. Our results from this preliminary investigation suggest that CD34-positive stromal cells may disappear from the stroma of IMC as well as IDC.
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Affiliation(s)
- Naoto Kuroda
- Department of Pathology, Kochi Medical School, Kochi, Japan
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27
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Chen HL, Ding A. Comparison of invasive micropapillary and triple negative invasive ductal carcinoma of the breast. Breast 2015; 24:723-31. [PMID: 26392199 DOI: 10.1016/j.breast.2015.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/15/2015] [Accepted: 09/01/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Invasive micropapillary carcinoma (IMPC) of the breast and triple negative breast cancer (TNBC) are both aggressive subtypes, but little information is available on their comparison. PATIENTS AND METHODS Retrospective analysis of 95 IMPC and 200 TNBC-IDC (invasive ductal carcinoma) was conducted to compare the clinicopathologic characteristics and survivals. RESULTS For IMPC, pN was the independent prognostic factor of local-regional recurrence free survival (LRRFS) (P = 0.045) and metastasis free survival (MFS) (P = 0.048), but not of overall survival (OS) (P = 0.165). For TNBC, pT and lymphovascular invasion (LVI) were both independent prognostic factors of MFS (pT: P = 0.006, LVI: P = 0.010) and OS (pT: P = 0.006, LVI: P = 0.001), but not for LRRFS (pT: P = 0.060, LVI: P = 0.503). IMPC exhibited more aggressive features than TNBC, including larger tumor size, a greater proportion of nodal involvement, and an increased incidence of LVI. After a median follow-up duration of 61 months, 5y-LRRFS rate was lower in IMPC than in TNBC, in entire cohort (71.4 ± 4.8% vs. 89.8 ± 2.2%, P < 0.001) and in node positive cases (64.2 ± 5.9% vs. 81.7 ± 4.4%, P = 0.048). A tendency of lower 5y-MFS rate was observed in TNBC compared with in IMPC, in node positive cases (63.8 ± 5.5% vs. 74.8 ± 5.5%, P = 0.053) and in node negative cases (80.1 ± 3.6% vs. 96.2 ± 3.8%, P = 0.052), but it did not reach significance. 5y-OS was similar between IMPC and TNBC (81.9 ± 4.7% vs. 79.8 ± 3.1%, P = 0.475). CONCLUSIONS IMPC is featured with high rate of lymph node involvement which is strongly associated with high rate of LRR. TNBC is featured with high rate of early distant metastasis without increase of nodal metastases. The survival is still relatively poor even in node negative cases.
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Affiliation(s)
- Hong-liang Chen
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai 200011, China
| | - Ang Ding
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Huangpu District, Shanghai 200011, China.
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28
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Yoo SH, Park IA, Chung YR, Kim H, Lee K, Noh DY, Im SA, Han W, Moon HG, Lee KH, Ryu HS. A histomorphologic predictive model for axillary lymph node metastasis in preoperative breast cancer core needle biopsy according to intrinsic subtypes. Hum Pathol 2014; 46:246-54. [PMID: 25496835 DOI: 10.1016/j.humpath.2014.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/06/2014] [Accepted: 10/31/2014] [Indexed: 01/08/2023]
Abstract
The aim of this study is construction of a pathologic nomogram that can predict axillary lymph node metastasis (LNM) for each intrinsic subtype of breast cancer with regard to histologic characteristics in breast core needle biopsy (CNB) for use in routine practice. A total of 534 CNBs with invasive ductal carcinoma classified into 5 intrinsic subtypes were enrolled. Eighteen clinicopathological characteristics and 8 molecular markers used in CNB were evaluated for construction of the best predictive model of LNM. In addition to conventional parameters including tumor multiplicity (P < .001), tumor size (P < .001), high histologic grade (P = .035), and lymphatic invasion (P = .017), micropapillary structure (P < .001), the presence of small cell-like crush artifact (P = .001), and overexpression of HER2 (P = .090) and p53 (P = .087) were proven to be independent predictive factors for LNM. A combination of 8 statistically independent parameters yielded the strongest predictive performance with an area under the curve of 0.760 for LNM. A combination of 6 independent variables, including tumor number, tumor size, histologic grade, lymphatic invasion, micropapillary structure, and small cell-like crush artifact produced the best predictive performance for LNM in luminal A intrinsic subtype (area under the curve, 0.791). Thus, adding these combinations of clinical and morphologic parameters in preoperative CNB is expected to enhance the accuracy of prediction of LNM in breast cancer, which might serve as another valuable tool in determining optimal surgical strategies for breast cancer patients.
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Affiliation(s)
- Su Hyun Yoo
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - In Ae Park
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yul Ri Chung
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keehwan Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.
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Liu Y, Huang X, Bi R, Yang W, Shao Z. Similar prognoses for invasive micropapillary breast carcinoma and pure invasive ductal carcinoma: a retrospectively matched cohort study in China. PLoS One 2014; 9:e106564. [PMID: 25188383 PMCID: PMC4154720 DOI: 10.1371/journal.pone.0106564] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 08/01/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Invasive micropapillary breast carcinoma (IMPC) is a rare pathological finding. Few studies have compared IMPC with invasive ductal breast carcinoma (IDC) according to matched nodal status and age. To better illustrate the difference between IMPC and IDC prognoses, we conducted this cohort study. METHODS 51 mixed or pure IMPC patients and 102 pure IDC patients were matched for nodal status and age. Clinical and biological features as well as disease-free survival (DFS) were compared between groups. RESULTS More than one-half of IMPC consisted of mostly or exclusively IMPC component (meaning greater than 75%) and these tumors significantly correlated with a higher histologic grade (P = 0.016) and LVI positivity (P = 0.036) compared with mixed IMPC. IMPC displayed a significantly higher rate of estrogen receptor (ER) positivity and lymphovascular invasion (LVI) compared to matched IDC. Women diagnosed with IMPC had a slight, but not significant, reduced frequency for recurrence and metastasis compared to women with IDC (15.7% vs. 21.6%, P = 0.518). In the subgroup analysis, IMPC patients demonstrated significantly reduced survival (P = 0.018) compared to IDC patients in the T1N2-3 subpopulation, whereas IDC patients demonstrated significantly increased recurrence and metastasis (P = 0.024) compared to IMPC patients in the T2N2-3 subgroup. No difference was observed in patients with 3 or less positive lymph nodes (LNs). CONCLUSION Although no difference in DFS was observed between IMPC and LN-matched IDC patients, IMPC patients demonstrated a significantly poorer outcome compared to IDC patients with smaller tumors and 4 or more positive LNs. The opposite results were observed in larger tumors and patients with 4 or more positive LNs. Therefore, we might advise more proactive treatment for IMPC patients with a smaller tumor size and extensive LN involvement. Furthermore, correlative IMPC studies should focus on this subset of patients to elucidate the genetic and/or biologic differences that contribute to metastatic potential.
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Affiliation(s)
- Yin Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Xiaoyan Huang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Rui Bi
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
- Department of Pathology, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, People’s Republic of China
| | - Wentao Yang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
- Department of Pathology, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, People’s Republic of China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
- Institutes of Biomedical Science, Fudan University, Shanghai, People’s Republic of China
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Clinico-pathological features and prognosis of invasive micropapillary carcinoma compared to invasive ductal carcinoma: a population-based study from China. PLoS One 2014; 9:e101390. [PMID: 24977705 PMCID: PMC4076314 DOI: 10.1371/journal.pone.0101390] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/06/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Invasive micropapillary carcinoma (IMPC) of the breast is a rare subtype of breast cancer that is associated with a high incidence of regional lymph node metastases and a poor clinical outcome. However, the clinico-pathological features and prognostic factors of IMPC are not well understood. PATIENTS AND METHODS A total of 188 IMPC cases and 1,289 invasive ductal carcinoma (IDC) cases were included. The clinical features, breast cancer-specific survival (BCSS) and recurrence/metastasis-free survival (RFS) of the patients were compared between these two groups. RESULTS The IMPC patients exhibited more features of aggressive carcinoma than the IDC patients, including larger tumor size, higher tumor stage, a greater proportion of nodal involvement and an increased incidence of lymphovascular invasion. Patients with IMPC had lower 5-year BCSS and RFS rates (75.9% and 67.1%, respectively) than patients with IDC (89.5% and 84.5%, respectively). Compared to IDC patients, the patients with IMPC had a significantly higher percentage of stage III breast cancer (51.3% versus 21.7%). In a stage-matched Kaplan-Meier analysis, the patients with stage III IMPC had lower 5-year BCSS and RFS rates than patients with stage III IDC (BCSS, P = 0.004; RFS, P = 0.034). A multivariate analysis revealed that TNM stage was an independent prognostic factor for patients with IMPC. The proportion of cancers with a luminal-like subtype was significantly higher in IMPC than in IDC (P<0.001). However, after matching by molecular subtype, the patients with IMPC had significantly worse clinical outcomes than patients with IDC. CONCLUSIONS In Chinese women, IMPCs displayed more aggressive behaviors than IDCs, resulting in poorer clinical outcomes for patients with IMPC, regardless of a favorable molecular subtype. Our findings illustrate that the poorer survival of patients with IMPC might be due to an increased incidence and aggressiveness of tumors in TNM stage III.
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Alsharif S, Daghistani R, Kamberoğlu EA, Omeroglu A, Meterissian S, Mesurolle B. Mammographic, sonographic and MR imaging features of invasive micropapillary breast cancer. Eur J Radiol 2014; 83:1375-80. [PMID: 24913934 DOI: 10.1016/j.ejrad.2014.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/03/2014] [Accepted: 05/07/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Describe mammographic, sonographic and MRI findings of invasive micropapillary carcinoma (IMPC) of the breast. MATERIALS AND METHODS Review of the pathology database identified 43 patients (mean age, 59.3 years) with the diagnosis of breast IMPC. Three patients had no available imaging studies. Mammograms (40), breast ultrasounds (33) and MRIs (8) were retrospectively evaluated by two radiologists in consensus following the BI-RADS Lexicon. Clinical, histopathologic features, as well as hormone status were recorded. RESULTS Twenty patients presented with palpable abnormality (20/40, 50%). Thirty-five patients had an abnormal mammogram (87.5%, 35/40) showing 39 lesions, 29 corresponding to masses (29/39, 74.4%), 11 associated with microcalcifications and two associated with architectural distortion. Sonography identified 41 masses (in 33 patients) displaying an irregular shape (30/41, 73.2%), appearing hypoechoic (39/41, 95%), with spiculated or angular margins (26/41, 63.4%), non-parallel orientation (26/41, 63.4%) and combined acoustic posterior pattern (18/41, 44%). MRI identified 13 lesions (in eight patients), 12 as masses (12/13, 92.3%) with irregular or spiculated margins (12/12, 100%), eight displaying an irregular or lobulated shape (8/12, 66.7%), six with homogeneous internal enhancement (6/12, 50%) and eight with type 3 enhancement curve (8/12, 61.5%). Associated non-mass like enhancement was noted in two patients. Twenty-nine patients had associated lymphovascular invasion (29/40, 72.5%) and axillary lymph node metastases were present in 22 of the 39 patients (22/39, 56%). CONCLUSION Invasive ductal carcinoma with IMPC features display imaging findings highly suspicious of malignant lesions. They are associated with high lymphovascular invasion and lymph node metastases rates.
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Affiliation(s)
- Shaza Alsharif
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ H3H 1A1, Canada
| | - Razan Daghistani
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ H3H 1A1, Canada
| | - Elif Aşik Kamberoğlu
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ H3H 1A1, Canada
| | - Atilla Omeroglu
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ H3H 1A1, Canada
| | - Sarkis Meterissian
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ H3H 1A1, Canada
| | - Benoît Mesurolle
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ H3H 1A1, Canada.
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Chen AC, Paulino AC, Schwartz MR, Rodriguez AA, Bass BL, Chang JC, Teh BS. Prognostic Markers for Invasive Micropapillary Carcinoma of the Breast: A Population-Based Analysis. Clin Breast Cancer 2013; 13:133-9. [DOI: 10.1016/j.clbc.2012.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 01/29/2023]
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Flatley E, Ang D, Warrick A, Beadling C, Corless CL, Troxell ML. PIK3CA-AKT pathway mutations in micropapillary breast carcinoma. Hum Pathol 2013; 44:1320-7. [PMID: 23352210 DOI: 10.1016/j.humpath.2012.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 10/24/2012] [Accepted: 10/26/2012] [Indexed: 12/20/2022]
Abstract
Micropapillary carcinoma of the breast is associated with increased rates of lymph node metastasis and lymphovascular invasion. While activating point mutations in PIK3CA (encoding phosphatidylinositol-3-kinase catalytic subunit) or AKT1 are found in 25% to 30% of invasive ductal carcinomas, the mutational profile of invasive micropapillary carcinomas has not been characterized in detail. Micropapillary carcinomas, concurrent metastatic and precursor breast lesions from 19 patients were identified. Lesional tissue was punched from paraffin-tissue blocks, and genomic DNA was extracted and screened for a large panel of known hotspot mutations using multiplex polymerase chain reaction and mass-spectroscopy analysis (643 mutations in 53 genes). Hotspot point mutations were identified in 35% (7/20) of micropapillary breast carcinomas, including PIK3CA exons 7, 9 and 20 hotspots, as well as the AKT1 plekstrin homology domain mutation (E17K); mutations in TP53 and KRAS were each found in a single patient. In 6 patients, micropapillary and non-micropapillary components of the same tumor were separately tested, yielding concordant results in five; one had a wild type micropapillary component, but a PIK3CA mutation in the invasive ductal component. Concurrent lymph node metastases were mostly wild type (2/8 mutant). Accompanying ductal carcinoma in situ had point mutations in 45% (5/11), mostly concordant with invasive carcinoma; however, mutational status of other breast proliferative lesions was generally discordant with accompanying carcinoma. The rate of PIK3CA mutations in this series of micropapillary carcinomas is similar to invasive ductal carcinomas; however, there may be an enrichment of AKT1 mutations (10%). The non-micropapillary components and precursor lesions occasionally had different mutations.
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Affiliation(s)
- Ellen Flatley
- Department of Pathology, Oregon Health & Science University, Portland, OR 97239, USA
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Histopathological and immunohistochemical assessment of invasive micropapillary mammary carcinoma in dogs: a retrospective study. Vet J 2012; 196:241-6. [PMID: 23031308 DOI: 10.1016/j.tvjl.2012.08.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 08/03/2012] [Accepted: 08/30/2012] [Indexed: 11/23/2022]
Abstract
Invasive micropapillary carcinoma (IMPC) of the mammary gland, despite its rare occurrence in humans and dogs, is an important neoplasm due to its aggressive behaviour. The aim of this study was to evaluate the clinicopathological and immunophenotypical characteristics of IMPC and to determine the overall survival of dogs with this tumour. Of the selected cases, the majority had >3 cm neoplasms (15/19, 78.95%) and lymph node metastases (16/16, 100%), but only two cases (2/9, 22.2%) had distant metastases. The IMPCs were classified as either pure (15/22, 68.18%) or mixed (7/22, 31.82%) types. There was a predominance of moderate histological grade tumours (16 grade II) and the average overall survival was 120 days. Positive immunohistochemical staining for epithelial membrane antigen and negative staining for CD-31, p63 and cytokeratin (CK) AE1AE3 in cystic formations confirmed the micropapillary nature of these neoplasms. A proportion of cases exhibited positive epithelial staining for p63 (4/20, 20%) and CK34βE12 (20/22, 90.9%). Most cases were positive for oestrogen (19/20, 95%) and progesterone (19/20, 95%) receptors, but lacked HER-2 (16/22, 72.72%) and epidermal growth factor receptor (15/22, 68.18%) over-expression. The mean proliferation index was 14.8%. The findings demonstrate that, similar to humans, canine IMPCs behave aggressively with high rates of metastasis to regional lymph nodes and short overall survival times.
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Fujita T, Gotohda N, Kato Y, Kinoshita T, Takahashi S, Konishi M, Daiko H, Nishimura M, Kuwata T, Ochiai A, Kinoshita T. Clinicopathological features of stomach cancer with invasive micropapillary component. Gastric Cancer 2012; 15:179-87. [PMID: 21987353 DOI: 10.1007/s10120-011-0094-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 08/28/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Invasive micropapillary carcinoma has been recognized as a rare disease entity with aggressive tumor behavior. However, few reports have described invasive micropapillary carcinoma in the gastrointestinal tract, particularly its involvement in gastric cancer. METHODS We retrospectively analyzed 930 patients diagnosed with gastric cancer who underwent gastrectomy, and we then histopathologically evaluated the existence of a regional invasive micropapillary component. Clinicopathological features were investigated in patients with an invasive micropapillary component and compared with such features in 100 patients with gastric adenocarcinoma, selected as stage-matched controls, who underwent gastrectomy during the same period. RESULTS Of the 930 patients, 14 were histopathologically diagnosed with gastric cancer with a regional invasive micropapillary component. There were no significant differences in age, gender, tumor location, macroscopic type, or type of surgery between patients with an invasive micropapillary component and the pT-matched controls. Histopathologically, significant differences were observed in lymphatic infiltration, venous invasion, the percentage of cases with lymph node metastasis, and the median number of metastatic lymph nodes. The three-year disease-free and overall survival rates of patients with an invasive micropapillary component were 40.5 and 59.3%, respectively, compared with those for the stage-matched controls, which were 72.6 and 80.6%, respectively (p = 0.02 and 0.07). CONCLUSIONS Patients with gastric cancer with a regional invasive micropapillary component showed marked cancer infiltration in the lymphatic pathway and poor prognosis after gastrectomy.
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Affiliation(s)
- Takeo Fujita
- Division of Digestive Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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Gamba CO, Araújo MR, Palhares MS, Garbin LC, Maranhão RPA, Cassali GD, Ecco R. Invasive micropapillary carcinoma of the mammary glands in a mare. Vet Q 2011; 31:207-10. [PMID: 22151006 DOI: 10.1080/01652176.2011.642618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- C O Gamba
- Laboratorio de Patologia Comparada, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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37
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Ide Y, Horii R, Osako T, Ogura K, Yoshida R, Iwase T, Akiyama F. Clinicopathological significance of invasive micropapillary carcinoma component in invasive breast carcinoma. Pathol Int 2011; 61:731-6. [DOI: 10.1111/j.1440-1827.2011.02735.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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38
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Ishii S, Ohbu M, Toomine Y, Nishimura Y, Hattori M, Yokoyama M, Toyonaga M, Kakinuma H, Matsumoto K. Immunohistochemical, molecular, and clinicopathological analyses of urothelial carcinoma, micropapillary variant. Pathol Int 2011; 61:723-30. [DOI: 10.1111/j.1440-1827.2011.02731.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Machida Y, Yoshimura H, Nakahira R, Michishita M, Ohkusu-Tsukada K, Takahashi K. Cutaneous invasive micropapillary carcinoma of probable apocrine sweat gland origin in a cat. J Vet Diagn Invest 2011; 23:840-4. [PMID: 21908336 DOI: 10.1177/1040638711407901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An invasive micropapillary carcinoma (IMC) occurred in the buccal skin of an 18-year-old female cat. Histologically, the tumor had a honeycomb pattern characterized by clusters of neoplastic epithelial cells that were surrounded by empty clear spaces and lined with fibrocollagenous stroma. On immunohistochemistry, the neoplastic cells were positive for cytokeratin (clone CAM5.2; pancytokeratin, clone AE1/AE3) and carcinoembryonic antigen (CEA) but negative for cytokeratin 14, vimentin, S100, smooth muscle actin, and p63. The CEA-positive staining reaction was present along the outermost rim of the neoplastic cell clusters consistent with an "inside-out" immunoreactivity pattern. Examination of the tumor cells by electron microscopy revealed microvilli on the outermost rim of neoplastic cells that were directed toward the surrounding vacant space. Based on histomorphological characteristics, the neoplasm was defined as an IMC of "pure-type." The location site and immunohistochemical features suggest the tumor was most likely derived from the apocrine sweat glands in the buccal skin.
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Affiliation(s)
- Yukino Machida
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1, Kyounan-cho, Musashino, Tokyo 180-8602, Japan
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40
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Min SY, Jung EJ, Seol H, Park IA. Cancer Subtypes of Breast Carcinoma with Micropapillary and Mucinous Component Based on Immunohistochemical Profile. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.2.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sun Young Min
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Jung Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyesil Seol
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - In Ae Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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41
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Yu JI, Choi DH, Park W, Huh SJ, Cho EY, Lim YH, Ahn JS, Yang JH, Nam SJ. Differences in prognostic factors and patterns of failure between invasive micropapillary carcinoma and invasive ductal carcinoma of the breast: Matched case–control study. Breast 2010; 19:231-7. [PMID: 20304650 DOI: 10.1016/j.breast.2010.01.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/25/2010] [Accepted: 01/27/2010] [Indexed: 11/28/2022] Open
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A case of HER-2-positive advanced inflammatory breast cancer with invasive micropapillary component showing a clinically complete response to concurrent trastuzumab and paclitaxel treatment. Int J Clin Oncol 2010; 15:615-20. [DOI: 10.1007/s10147-010-0093-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
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43
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Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: a review. Arch Pathol Lab Med 2009; 133:893-907. [PMID: 19492881 DOI: 10.5858/133.6.893] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Interpretation of papillary lesions of the breast remains a challenging task because of the wide morphologic spectrum encountered in the benign, atypical, and malignant subtypes. Data on clinical significance and outcome of papillary lesions, with superimposed atypia or areas similar to ductal carcinoma in situ partially replacing the benign elements, are sparse. Furthermore, complete excision of even a fully developed papillary carcinoma confined to a dilated or cystic duct is associated with an excellent prognosis, whereas a complex papilloma extending into multiple branches of a duct may ultimately recur as a carcinoma because of incomplete excision of microscopic foci. This makes an outcome-based classification difficult. OBJECTIVE An arbitrary yet practical approach to classification is outlined, with discussion of methods to circumvent the various diagnostic difficulties. The limitations in precise diagnosis of papillary lesions in aspirates are addressed, and the implications of finding papillary lesions in core biopsies are discussed. Although the focus is on intraductal lesions, associated invasive carcinomas and invasive micropapillary carcinoma are also presented. DATA SOURCES The literature on papillary lesions and invasive micropapillary carcinoma is reviewed. CONCLUSIONS It would be prudent to completely excise any papillary lesion that has not been entirely removed by the initial core biopsy. The optimal management of localized papillary lesions is complete excision with a small rim of uninvolved breast tissue without any prior needle instrumentation if and when the papillary nature can be determined by imaging. Thus managed, most of these lesions behave indolently, and outcome is usually excellent.
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Affiliation(s)
- Shir-Hwa Ueng
- Department of Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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The presence of micropapillary features and retraction artifact in core needle biopsy material predicts lymph node metastasis in breast carcinoma. Am J Surg Pathol 2009; 33:202-10. [PMID: 18987549 DOI: 10.1097/pas.0b013e318185e171] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Retraction artifact around tumor cell nests is a characteristic feature of invasive micropapillary carcinoma (IMPC), a special type of breast cancer commonly associated with nodal metastasis. We have recently reported that the extent of retraction artifact in usual invasive ductal carcinomas (IDC) is also a strong predictor of nodal metastasis. We examined whether the presence and extent of micropapillary features and retraction artifact in core needle biopsy of breast cancers can predict nodal metastasis in a prospective series of 47 IMPC and 424 IDC. Micropapillary features were present on core needle biopsy in 28 of 47 IMPC cases. Nodal metastases were found in 21 of 28 and 14 of 19 IMPC cases with and without micropapillary features present on core needle biopsy, respectively. Lymph node metastasis was significantly associated with the presence of micropapillary features, but not with its extent within these tumors. The presence of extensive retraction artifact in core needle biopsy samples of IDC also showed a significant association with nodal metastasis. Our results indicate that the presence of micropapillary features or extensive retraction artifact on core needle biopsy of breast carcinoma can predict nodal metastasis. Our results support the notion that the characteristic clear spaces separating the tumor cells from the stroma in IMPC and IDC of the breast are not a random artifactual phenomenon simply resulting from tissue fixation and processing, but rather they are likely related to altered tumor-stromal interactions, which might have an important role in lymphatic tumor spread.
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45
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Kikuchi T, Kumabe T, Higano S, Watanabe M, Tominaga T. Minimum apparent diffusion coefficient for the differential diagnosis of ganglioglioma. Neurol Res 2009; 31:1102-7. [PMID: 19138470 DOI: 10.1179/174313209x382539] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The utility of apparent diffusion coefficient (ADC) values was evaluated for the differential diagnosis of ganglioglioma. METHODS Ten consecutive patients, five men and five women, aged from 14 to 67 years, with histologically proven supratentorial gangliogliomas, underwent diffusion-weighted magnetic resonance imaging with echo planar imaging technique. The minimum ADC (minADC) of each tumor was pre-operatively determined from several regions of interest. The minADC of ganglioglioma was compared with that of low- or high-grade astrocytomas (astrocytoma, anaplastic astrocytoma and glioblastoma). Tumor cellularity of gangliogliomas was compared with the minADC. RESULTS The mean minADC of the gangliogliomas (1.45 +/- 0.20 x 10(-3) mm(2)/s) was significantly higher than that of the low- or high-grade astrocytomas. Tumor cellularity of ganglioglioma was inversely correlated with the minADC value. DISCUSSION The minADC value reflects in the low tumor cellularity of gangliogliomas and may provide a method for the differential diagnosis of ganglioglioma.
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Affiliation(s)
- Toshio Kikuchi
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
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46
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Moriya T, Kozuka Y, Kanomata N, Tse GM, Tan PH. The role of immunohistochemistry in the differential diagnosis of breast lesions. Pathology 2009; 41:68-76. [DOI: 10.1080/00313020802563544] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shimoda M, Okada Y, Hayashi Y, Hatano S, Kawakubo H, Omori T, Ishii S, Sugiura H. Primary invasive micropapillary carcinoma of the stomach. Pathol Int 2008; 58:513-7. [PMID: 18705772 DOI: 10.1111/j.1440-1827.2008.02265.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Reported herein is the case of a 74-year-old man with an unusual gastric carcinoma that developed at the lesser curvature of the stomach. The tumor consisted of small clusters of carcinoma cells surrounded by clear spaces, with histopathology similar to invasive micropapillary carcinoma (IMPC) of the breast. The carcinoma cells, which had downregulation of E-cadherin expression, invaded the subserous tissue and metastasized to the perigastric lymph nodes. IMPC, an unusual subtype of invasive breast carcinoma, is known to have frequent lymph node metastases, resulting in a poor clinical outcome. Although IMPC has been reported in breast, urinary bladder, ureter, lung, salivary gland and colon, to the best of the authors' knowledge this is the first report of IMPC arising in the stomach. Presented here are the clinicopathological features of primary IMPC of the stomach.
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Affiliation(s)
- Masayuki Shimoda
- Department of Pathology, School of Medicine, Keio University, Tokyo, Japan
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48
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Prognostic Significance of Micropapillary Pattern in Pure Mucinous Carcinoma of the Breast. Int J Surg Pathol 2008; 16:251-6. [DOI: 10.1177/1066896908314784] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Breast carcinoma with micropapillary architecture is associated with aggressive behavior. Similar micropapillary pattern in pure mucinous carcinoma has been noticed and has been shown to convey poor prognosis. In this study 17 cases of pure mucinous carcinoma of the breast seen during a 10-year period have been reviewed, with special reference to micropapillary pattern. Diffuse micropapillary pattern was seen in 6 of 17 cases of mucinous carcinoma of the breast and demonstrated reverse polarity immunostaining pattern with “Epithelial Membrane Antigen.” In all cases, the tumor cells showed grade I morphology, and no lymph node metastases were noticed. All the tumors except 1 expressed strong estrogen and progesterone receptor expression, however, all the cases were negative for Her-2/neu expression. In this present study, mucinous carcinomas with micropapillary pattern showed a low nuclear grade, higher incidence of hormone receptor positivity, and lower incidence of Her-2/neu similar to mucinous carcinomas without micropapillary pattern, thus explaining their indolent behavior.
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Ling Chen, Yu Fan, Lang RG, Guo XJ, Sun YL, Cui LF, Liu FF, Jia Wei, Zhang XM, Li Fu. Breast Carcinoma With Micropapillary Features: Clinicopathologic Study and Long-Term Follow-Up of 100 Cases. Int J Surg Pathol 2008; 16:155-63. [PMID: 18417672 DOI: 10.1177/1066896907307047] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To study the clinicopathologic characteristics and prognosis of invasive micropapillary carcinoma of breast (IMPC), 100 cases of invasive breast carcinoma with an IMPC component were reviewed. Compared with invasive ductal carcinoma, not otherwise specified, with similar histologic grades, carcinomas with IMPC were larger sized, had a higher lymph node metastasis rate with more nodes involved per case, and exhibited increased lymphovascular invasion. The presence of IMPC strongly correlated with the more aggressive behavior. No significant association was established between the proportion of the IMPC component and overall tumor size, histologic grade, lymph node metastasis rate, and distant metastasis, but a trend was noted. Long-term follow-up demonstrated a poorer 5-year and 10-year survival rate for patients with breast carcinoma containing an IMPC component. Breast carcinomas with micropapillary features are more aggressive tumors with a poorer prognosis. This specific structure should be carefully evaluated in the surgical pathology examination of breast carcinoma specimens.
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Affiliation(s)
- Ling Chen
- Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China
| | - Yu Fan
- Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China
| | - Rong-gang Lang
- Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China
| | - Xiao-jing Guo
- Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China
| | - Yu-lan Sun
- Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China
| | - Li-fang Cui
- Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China
| | - Fang-fang Liu
- Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China
| | - Jia Wei
- Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China
| | - Xin-min Zhang
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Li Fu
- Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China
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Tanaka Y, Morishima I, Kikuchi K. Invasive micropapillary carcinomas arising 42 years after augmentation mammoplasty: a case report and literature review. World J Surg Oncol 2008; 6:33. [PMID: 18341700 PMCID: PMC2292720 DOI: 10.1186/1477-7819-6-33] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 03/14/2008] [Indexed: 11/10/2022] Open
Abstract
Background There has been no definitive consensus regarding the causal relationships between foreign bodies in the breast and carcinogenesis. This report describes the first case of invasive micropapillary carcinomas after augmentation mammoplasty. Multiple tumors located in immediate contact with the siliconomas suggested a causal link between the siliconomas and carcinomas. Case presentation This report presents the case of a 64-year-old female who underwent liquid silicone injections for augmentation mammoplasty 42 years previously. Eight years before admission, siliconomas of the left breast were removed due to pain and discomfort. The patient visited the hospital for further treatment of newly diagnosed carcinoma of the left breast. Images showed multiple tumors located in various areas of the left breast. The pathological findings of the left breast showed each tumor to be solitary and not continuous with the others. The tumors were diagnosed to be invasive micropapillary carcinomas, and they all came into immediate contact with the residual siliconomas. The siliconomas were therefore suspected to have played a causative role in the development of the breast cancer. Conclusion This rare case of multiple invasive micropapillary carcinomas following augmentation mammoplasty provides evidence that siliconomas may lead to carcinomas. Although a causal relationship was not established unequivocally, we review evidence that suggest silicone gel may cause cell damage responsible for carcinoma development.
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Affiliation(s)
- Yuko Tanaka
- Department of Breast and Thyroid Surgery Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba-city, Ibaraki, 305-0005, Japan.
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