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Guo Z, Yang Z, Li D, Tang J, Xu J, Shen H, Yuan Y. Colorectal cancer with invasive micropapillary components (IMPCs) shows high lymph node metastasis and a poor prognosis: A retrospective clinical study. Medicine (Baltimore) 2020; 99:e20238. [PMID: 32481300 PMCID: PMC7249862 DOI: 10.1097/md.0000000000020238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTS The present study aimed to identify the clinicopathological characteristics of colorectal cancer (CRC) with invasive micropapillary components (IMPCs) and the relationship between different amounts of micropapillary components and lymph node metastasis. METHODS A cohort of 363 patients with CRC who underwent surgical treatment in the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2013 and December 2016 were retrospectively reviewed. We compared the clinicopathological characteristics, including survival outcomes and immunohistochemical profiles (EMA, MUC1, MLH1, MSH2, MSH6, and PMS2), between CRC with IMPCs and those with conventional adenocarcinoma (named non-IMPCs in this study). Logistic regression was used to identify the association between IMPCs and lymph node invasion. A multivariate analysis was performed using the Cox proportional hazard model to evaluate significant survival predictors. RESULTS Among 363 patients, 76 cases had IMPCs, including 22 cases with a lower proportion of IMPCs (≤5%, IMPCs-L) and 54 cases with a higher proportion (>5%, IMPCs-H). Compared to the non-IMPC group, the IMPC group (including both IMPC-L and IMPC-H) had a lower degree of tumor differentiation (P = .000), a higher N-classification (P = .000), more venous invasion (P = .019), more perineural invasion (P = .025) and a later tumor node metastasis (TNM) stage (P = .000). Only tumor differentiation (P = .031) and tumor size (P = .022) were different between IMPCs-L and IMPCs-H. EMA/MUC1 enhanced the characteristic inside-out staining pattern of IMPCs, whereas non-IMPCs showed luminal staining patterns. The percentage of mismatch repair deficiency (dMMR) in the non-IMPC group was much higher than that in the IMPC group (14.7% vs 4.7%). The overall survival time of patients with IMPCs was significantly less than that of patients with non-IMPCs (P = .002), then that of IMPCs-H was lower than that of IMPCs-L (P = .030). Logistic regression revealed that patients with IMPCs were associated with lymph metastasis, regardless of the proportion of IMPCs. Multivariate analysis demonstrated both IMPCs-L and IMPCs-H as negative prognostic factors. CONCLUSIONS IMPCs are significantly associated with lymph node metastasis and poor outcome, and even a minor component (≤5%) may render significant information and should therefore be part of the pathology report.
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Affiliation(s)
- Zeying Guo
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine
- Department of Medical Oncology, Zhuji People's Hospital of Zhejiang Province, Zhuji
| | - Ziru Yang
- Department of Radiation Oncology, the Lihuili Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Dan Li
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine
- Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, the Second Affiliated Hospital of Zhejiang University School of Medicine
| | - Jinlong Tang
- Department of Pathology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Jinghong Xu
- Department of Pathology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Hong Shen
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine
| | - Ying Yuan
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine
- Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, the Second Affiliated Hospital of Zhejiang University School of Medicine
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Remo A, Fassan M, Vanoli A, Bonetti LR, Barresi V, Tatangelo F, Gafà R, Giordano G, Pancione M, Grillo F, Mastracci L. Morphology and Molecular Features of Rare Colorectal Carcinoma Histotypes. Cancers (Basel) 2019; 11:cancers11071036. [PMID: 31340478 PMCID: PMC6678907 DOI: 10.3390/cancers11071036] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 02/05/2023] Open
Abstract
Several histopathological variants of colorectal carcinoma can be distinguished, some associated with specific molecular profiles. However, in routine practice, ninety/ninety-five percent of all large bowel tumors are diagnosed as conventional adenocarcinoma, even though they are a heterogeneous group including rare histotypes, which are often under-recognized. Indeed, colorectal cancer exhibits differences in incidence, location of tumor, pathogenesis, molecular pathways and outcome depending on histotype. The aim is therefore to review the morphological and molecular features of these rare variants of intestinal carcinomas which may hold the key to differences in prognosis and treatment.
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Affiliation(s)
- Andrea Remo
- Pathology Unit, Services Department, ULSS9 "Scaligera", 37122 Verona, Italy.
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, 35100 Padua, Italy
| | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Luca Reggiani Bonetti
- Department of Diagnostic, Clinic and Public Health Medicine, Anatomic Pathology, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Valeria Barresi
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy
| | - Fabiana Tatangelo
- Department of Pathology, Istituto Nazionale Tumori Fondazione G. Pascale, IRCCS, 80131 Naples, Italy
| | - Roberta Gafà
- Section of Anatomic Pathology, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and S. Anna University Hospital, 44121 Ferrara, Italy
| | - Guido Giordano
- U.O.C. Oncologia Medica, Ospedali Riuniti Azienda Ospedaliera Universitaria, 71122 Foggia, Italy
| | - Massimo Pancione
- Department of Sciences and Technologies, University of Sannio, 82100 Benevento, Italy
| | - Federica Grillo
- Anatomic Pathology, Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa and Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Luca Mastracci
- Anatomic Pathology, Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa and Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Snover DC. Diagnostic and reporting issues of preneoplastic polyps of the large intestine with early carcinoma. Ann Diagn Pathol 2018; 39:1-14. [PMID: 30597401 DOI: 10.1016/j.anndiagpath.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
Premalignant polyps of the large intestine are common specimens in surgical pathology. They consist of several different subtypes identifiable by histological criteria that are associated with different molecular characteristics and with the development of different types of colorectal carcinoma. The most common of these is the conventional adenoma, which most commonly leads to carcinomas with a low degree of methylation (CIMP-L) that are microsatellite stable. In Lynch syndrome patients these polyps lead to CIMP-L carcinomas that are microsatellite instable. The second most common is the sessile serrated adenoma, which leads to carcinomas with a high degree of methylation (CIMP-H) that may be either microsatellite stable or instable. The least common premalignant polyp is the traditional serrated adenoma, which can lead to either CIMP-L or CIMP-H carcinomas, most often microsatellite stable. This paper will review the histological features of these lesions, discuss problems in diagnosis and discuss the role of histology in management.
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Affiliation(s)
- Dale C Snover
- The University of Minnesota Medical School, Department of Laboratory Medicine and Pathology, 240 Delaware St SE, Minneapolis, MN 55455, USA.
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Ciocalteu A, Gheonea DI, Saftoiu A, Streba L, Dragoescu NA, Tenea-Cojan TS. Current strategies for malignant pedunculated colorectal polyps. World J Gastrointest Oncol 2018; 10:465-475. [PMID: 30595800 PMCID: PMC6304302 DOI: 10.4251/wjgo.v10.i12.465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate staging remain the main factors that lead to a decrease in the cost and invasiveness of the curative techniques, significantly improving the outcome. However, the diagnosis of pedunculated early colorectal malignancy remains a current challenge. Data on the management of pedunculated cancer precursors, apart from data on nonpolypoid lesions, are still limited. An adequate technique for complete resection, which provides the best long-term outcome, is mandatory for curative intent. In this context, a discussion regarding the diagnosis of malignancy of pedunculated polyps, separate from non-pedunculated variants, is necessary. The purpose of this review is to provide a critical review of the most recent literature reporting the different features of malignant pedunculated colorectal polyps, including diagnosis and management strategies.
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Affiliation(s)
- Adriana Ciocalteu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Dan Ionut Gheonea
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Liliana Streba
- Department of Oncology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Nicoleta Alice Dragoescu
- Department of Anesthesiology and Intensive Care, Emergency County Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Tiberiu Stefanita Tenea-Cojan
- Department of General Surgery, C.F. Clinical Hospital, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
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Pyo JS, Park MJ, Kang DW. The clinicopathological significance of micropapillary pattern in colorectal cancers. Hum Pathol 2018; 77:159-165. [PMID: 29634975 DOI: 10.1016/j.humpath.2018.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 01/11/2023]
Abstract
The aim of the present study is to elucidate the clinicopathological significance and prognostic role of micropapillary pattern (MPP) in colorectal cancer (CRC). We investigated the correlation between the presence of MPP and clinicopathological characteristics and prognosis in 266 CRCs. In addition, the clinicopathological significance of MPP in mucin pools was investigated and compared to pure MPP, which is not associated with mucin pools. MPP, regardless of its proportion in the overall tumor, was found in 74 of 266 CRCs (27.8%). The rate of MPP in proportions ≥5% was 9.4% (25 of 266 cases). CRC with MPP showed higher rates of vascular and lymphatic invasion, higher metastatic lymph node ratio, and higher pT stage compared to CRC without MPP. In addition, increasing proportion of MPP in overall tumor showed more frequent vascular and lymphatic invasions (P = .002 and P = .008, respectively). Among 74 CRCs with MPP, 25 CRCs were found in mucin pools (33.8%). These cases were more right-sided and poorly differentiated with less frequent lymphatic invasion and lymph node metastasis, compared to CRCs with pure MPP. The presence of MPP significantly correlated with worse overall survival (P = .010). In 74 CRCs with MPP, overall survival significantly differed between pure MPP and MPP in mucin pools (P = .003). Taken together, our data suggest that the presence of MPP significantly correlated with aggressive tumor behavior and worse survival in CRC. In addition, the clinicopathological significance of MPP in mucin pools differed from CRC with pure MPP.
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Affiliation(s)
- Jung-Soo Pyo
- Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Mee Ja Park
- Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea.
| | - Dong-Wook Kang
- Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea
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Gonzalez RS, Huh WJ, Cates JM, Washington K, Beauchamp RD, Coffey RJ, Shi C. Micropapillary colorectal carcinoma: clinical, pathological and molecular properties, including evidence of epithelial-mesenchymal transition. Histopathology 2017; 70:223-231. [PMID: 27560620 PMCID: PMC5921077 DOI: 10.1111/his.13068] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/24/2016] [Indexed: 02/03/2023]
Abstract
AIMS Colorectal carcinoma (CRC) with micropapillary (MP) features has only been described recently and is still being characterized. METHODS AND RESULTS We reviewed the clinicopathological and molecular features of 42 CRC with MP features. Twenty-nine cases were also evaluated for immunohistochemical evidence of epithelial-mesenchymal transition (EMT). The extent of MP features within our cohort ranged from 5% (13 cases) to 100% (one case). Twenty-seven cases featured prominent cribriforming with dirty necrosis in the non-MP component; nine displayed mucinous features. Twenty-four of 29 cases (83%) demonstrated evidence of EMT. Thirty-six cases (86%) showed advanced T-category (pT3 or pT4), 31 (74%) had lymph node metastases and 23 (55%) had distant metastases. Median overall follow-up was 36 months. Seventeen patients (40%) died of disease, with median survival of 23 months. Mutations were seen in 17 of 31 tested cases (55%), including 11 KRAS mutations and four BRAF V600E mutations. Microsatellite instability testing was performed on 21 cases; all were microsatellite-stable. Compared to a cohort of 972 conventional CRC, MP CRC was more likely to present as stage IV disease (P < 0.001), but patients with MP CRC showed no significant differences in overall survival after adjusting for stage. CONCLUSIONS Micropapillary features in CRC portend a high likelihood of advanced local disease and distant metastases. MP CRC is often associated with a cribriform pattern elsewhere in the tumour and cystic nodal metastases with prominent necrosis. They also show frequent mutations in KRAS and BRAF. Immunohistochemical evidence of EMT is common in MP CRC.
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Affiliation(s)
- Raul S. Gonzalez
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Won Jae Huh
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Justin M.M. Cates
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Kay Washington
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - R. Daniel Beauchamp
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN
| | - Robert J. Coffey
- Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Chanjuan Shi
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
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Reversed polarity of the glandular epithelial cells in micropapillary carcinoma of the large intestine and the EMA/MUC1 immunostain. Pathology 2016; 46:527-32. [PMID: 25158820 DOI: 10.1097/pat.0000000000000144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Micropapillary carcinoma of the colon and rectum is associated with an adverse prognosis. This tumour type displays reverse polarity of the tumour cells and is stated to be characterised by an inside-out epithelial membrane antigen (EMA)/MUC1 staining. Nine cases of primary colorectal carcinoma and one omental metastasis were studied by means of immunohistochemistry, using antibodies to detect EMA, MUC1, MUC2, MUC3, MUC5AC, MUC6, CD10, CA125, carcinoembryonic antigen (CEA). The inside-out pattern staining with EMA/MUC1 ranged from diffuse circumferential through focal and partial to negative, but in some cases CEA, MUC3 and CD10 also showed this pattern staining, sometimes more clearly than did EMA or MUC1. The reverse polarity of colorectal micropapillary carcinomas is sometimes better visualised by immunostains other than EMA/MUC1.
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Miyaoka Y, Fujiwara A, Kotani S, Tsukano K, Ogawa S, Yamanouchi S, Kusunoki R, Fujishiro H, Kohge N, Yamamoto T, Amano Y. Primary micropapillary carcinoma of the colon with submucosal invasion: A case report. Endosc Int Open 2016; 4:E744-7. [PMID: 27556088 PMCID: PMC4993887 DOI: 10.1055/s-0042-106721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/11/2016] [Indexed: 12/27/2022] Open
Abstract
We present a case of invasive micropapillary carcinoma (IMPC) of the colon treated by endoscopic resection following magnifying endoscopy. A 47-year-old woman visited our hospital for follow-up of a positive fecal occult blood test. Colonoscopy revealed a semi-pedunculated reddish polyp, the surface of which showed gentle irregularity, and mild tension in the sigmoid colon. Magnifying colonoscopy with narrow band imaging revealed an irregular surface pattern with heterogeneity in vascular diameter and distribution. Magnifying endoscopic findings using crystal violet staining showed an irregular pit pattern with an expansion of stromal areas. Endoscopic resection of the sigmoid colon tumor was performed, and the histology of the resected specimen primarily revealed a micropapillary component with a small moderately differentiated adenocarcinoma component that massively invaded into the submucosal layer, accompanied by lymphatic invasion, although the tumor was very small (7 mm in diameter, smaller than any in previous reports). Laparoscopy-assisted sigmoidectomy and regional lymph node resection were performed; neither cancer nor lymph node metastases were present. This is the first report of a case with early-stage colonic IMPC observed with magnifying colonoscopy.
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Affiliation(s)
- Youichi Miyaoka
- Division of Endoscopy, Shimane Prefectural Central Hospital, Shimane, Japan ,Corresponding author Yoichi Miyaoka, MD, PhD Division of Endoscopy, Shimane Prefectural Central Hospital4-1-1 Himebara, Izumo 693-8555, ShimaneJapan+81-0853-22-5111+81-0853-21-2197
| | - Aya Fujiwara
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Satoshi Kotani
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Kosuke Tsukano
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Sayaka Ogawa
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Satoshi Yamanouchi
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Ryusaku Kusunoki
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Hirofumi Fujishiro
- Division of Endoscopy, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Naruaki Kohge
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Tomohiko Yamamoto
- Division of Pathology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Yuji Amano
- Division of Endoscopy, Kaken Hospital, International University of Health and Welfare, Chiba, Japan
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Jakubowska K, Guzińska-Ustymowicz K, Pryczynicz A. Invasive micropapillary component and its clinico-histopathological significance in patients with colorectal cancer. Oncol Lett 2016; 12:1154-1158. [PMID: 27446411 DOI: 10.3892/ol.2016.4717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/29/2016] [Indexed: 12/27/2022] Open
Abstract
Micropapillary components are located in distinct, empty spaces resembling lymphatic vessels and consist of clusters of cancer cells that adhere tightly to one another. These structures do not have a fibrovascular core. Invasive micropapillary components (IMPCs) exhibit reverse polarity, which results in a characteristic 'inside-out' structure. The aim of the present study was to examine the histological significance of the micropapillary component in colorectal carcinoma compared with conventional colorectal adenocarcinoma. Among 115 patients, 5 (4.3%) were diagnosed with a micropapillary colorectal component based on hematoxylin and eosin staining and immunohistochemical analysis. To exclude identification of poorly-differentiated clusters of adenocarcinoma cells in the lymphatic vessels, immunohistochemical analysis with D2-40 was performed, and epithelial membrane antigen was used to confirm the specific 'inside-out' structure of IMPCs. IMPCs were observed to positively correlate with histopathological type (P=0.001) and tumor invasion in venous vessels (P=0.033). Furthermore, the presence and number of lymph node metastases was greater in IMPC cases compared with conventional carcinoma cases; however, these differences were not statistically significant (P=0.087 and P=0.094, respectively). In addition, IMPC cases were not significantly associated with the presence of inflammatory infiltrate in the invasive front of the tumor (P=0.098). Therefore, the present study indicates that the IMPC serves a histopathological and prognostic role in the diagnosis of colorectal cancer due to its aggressive and invasive behavior. IMPC is rare in cases of colorectal cancer and remains a great diagnostic challenge in pathomorphology with further detailed investigation required in the future.
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Affiliation(s)
- Katarzyna Jakubowska
- Department of General Pathomorphology, Medical University of Białystok, Białystok, 15-269 Podlaskie, Poland
| | | | - Anna Pryczynicz
- Department of General Pathomorphology, Medical University of Białystok, Białystok, 15-269 Podlaskie, Poland
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Guzińska-Ustymowicz K, Niewiarowska K, Pryczynicz A. Invasive micropapillary carcinoma: A distinct type of adenocarcinomas in the gastrointestinal tract. World J Gastroenterol 2014; 20:4597-4606. [PMID: 24782612 PMCID: PMC4000496 DOI: 10.3748/wjg.v20.i16.4597] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 03/19/2014] [Indexed: 02/06/2023] Open
Abstract
Invasive micropapillary carcinoma (IMPC) is a rare histological type of tumor, first described in invasive ductal breast cancer, than in malignancies in other organs such as lungs, urinary bladder, ovaries or salivary glands. Recent literature data shows that this histological lesion has also been found in cancers of the gastrointestinal system. The micropapillary components are clusters of neoplastic cells that closely adhere to each other and are located in distinct empty spaces. Moreover, clusters of neoplastic cells do not have a fibrous-vascular core. The IMPC cells show reverse polarity resulting in typical ‘’inside-out’’ structures that determines secretary properties, disturbs adhesion and conditions grade of malignancy in gastrointestinal (GI) tract. Invasive micropapillary carcinoma in this location is associated with metastases to local lymph nodes and lymphovascular invasion. IMPC can be a prognostic factor for patients with cancers of the stomach, pancreas and with colorectal cancer since it is related with disease-free and overall survival. The purpose of this review is to present the characterization of invasive micropapillary carcinoma in colon, rectum, stomach and others site of GI tract, and to determine the immunohistological indentification of IMPC in those localization.
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Mukai S, Takakura Y, Egi H, Hinoi T, Saito Y, Tanimine N, Miguchi M, Adachi T, Shimomura M, Ohdan H. Submucosal invasive micropapillary carcinoma of the colon with massive lymph node metastases: a case report. Case Rep Oncol 2012; 5:608-15. [PMID: 23275774 PMCID: PMC3531951 DOI: 10.1159/000345566] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Micropapillary carcinoma was originally reported to be an aggressive variant of breast carcinoma, and it is associated with frequent lymphovascular invasion and a dismal clinical outcome. It has subsequently been found in other organs; however, at present, only a limited number of cases of colorectal micropapillary carcinoma have been reported. We present a case of early colon cancer with extensive nodal metastases in a Japanese patient. An 82-year-old man was found by colonoscopy to have a 20-mm pedunculated polyp in his sigmoid colon. Endoscopic resection of the sigmoid colon tumor was performed, and pathological examination of the resected specimen revealed a poorly differentiated adenocarcinoma component and a micropapillary component. Despite the tumor being confined within the submucosa, massive lymphatic invasion was noted. Thereafter, the patient underwent laparoscopic sigmoidectomy with lymph node dissection, and multiple lymph node metastases were observed. Our case suggests that when a micropapillary component is identified in a pre-operative biopsy specimen, even for early colorectal cancer, surgical resection with adequate lymph node dissection would be required because of the high potential for nodal metastases.
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Affiliation(s)
- Shoichiro Mukai
- Department of Gastroenterological Surgery, Hiroshima University Hospital, Hiroshima, Japan
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12
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Lino-Silva LS, Salcedo-Hernández RA, Caro-Sánchez CH. Colonic micropapillary carcinoma, a recently recognized subtype associated with histological adverse factors: clinicopathological analysis of 15 cases. Colorectal Dis 2012; 14:e567-72. [PMID: 22390187 DOI: 10.1111/j.1463-1318.2012.03013.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM Micropapillary carcinoma (MPC) is regarded as an aggressive variant of adenocarcinoma in any location. The reported proportion of a micropapillary carcinoma component in an entire tumour ranges from 5 to 95% and only one case of pure MPC has been reported. To date, approximately 130 cases of MPC in the colorectum have been reported, but it is likely that this small number is to some extent due to under-reporting because this pattern is not well recognized by the general pathologist. All previous studies have combined colonic and rectal primary tumours and most have only analysed patients with clinical Stages I or II. METHOD We analysed 15 cases of MPC of the colon alone, diagnosed in our institution, and compared them with 105 conventional carcinomas of the colon. RESULTS An MPC component was present in 10% of all colonic carcinomas. These tumours presented at a median age of 56 years, and all were of American Joint Committee on Cancer Stages III and IV. Subserosal tissue invasion was present in every case, 60% had more than four positive lymph nodes, 60% were accompanied by poorly differentiated conventional carcinoma, 40% had had an incomplete resection and a third demonstrated lymphovascular invasion. Despite these adverse prognostic factors, tumours containing MPC showed the same survival, stage by stage, as conventional adenocarcinoma in multivariate analysis, although 3-year survival (81.7%vs 87.3%, P=0.035) was worse on univariate analysis. CONCLUSION The histopathologist should be aware of the possibility of MPC. Three-year survival is worse than in patients with conventional colonic carcinomas in Stage III.
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Affiliation(s)
- L S Lino-Silva
- Department of Gastrointestinal Pathology, Instituto Nacional de Cancerología, México City, México.
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13
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Invasive micropapillary carcinoma of the ascending colon--a report of a case. Int Surg 2011; 96:82-6. [PMID: 21675626 DOI: 10.9738/1355.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Micropapillary carcinoma (MC) has been recently recognized to be a rare but distinctive variant of adenocarcinoma. At present, only a limited number of colorectal MC cases have been reported. We present a case of MC of the ascending colon with distant metastasis. A 61-year-old female patient was hospitalized with a complaint of abdominal pain. A diagnostic work-up revealed cancer of the ascending colon with multiple lung metastases. The patient underwent a right hemicolectomy with lymph node dissection. A peritoneal nodule was observed in the abdominal cavity during surgery, and this nodule was also resected. The pathologic findings of the colon tumor revealed components of conventional tubular adenocarcinoma and micropapillary carcinoma. Lymph nodes and a peritoneal nodule revealed tubular adenocarcinoma. MC is a rare disease but has high malignant potential. In the present case the tumor was small in size, but the patient had a peritoneal and multiple lung metastases.
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Clinicopathological and molecular characterization of colorectal micropapillary carcinoma. Mod Pathol 2011; 24:729-38. [PMID: 21336262 DOI: 10.1038/modpathol.2011.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Invasive micropapillary carcinoma is associated with frequent lymph node metastasis and adverse clinical outcome. Initially described as a variant of breast and ovarian carcinoma, it has subsequently been found in other organs, most recently the colon. Reports of colorectal micropapillary carcinoma to date are limited in number, and their molecular profile has not been established. The aims of the present study were to analyze their clinicopathological features and molecular profile, and compare them with those of conventional adenocarcinoma. Clinicopathological features of a cohort of 379 patients with primary colorectal cancer were retrospectively reviewed for the presence of the pattern characteristic of micropapillary carcinoma. We also assessed the expression of KRT7, KRT20, CEACAM5, MUC1 (EMA, clone E29), MUC1 (clone MA695), MLH1, MSH2, MSH6 and TP53 by immunohistochemistry. Genetic assessments of microsatellite instability, chromosomes 17p and 18q, and mutations in TP53, BRAF and KRAS were performed using DNA extracted from formalin-fixed, paraffin-embedded sections. In all, 60 of the reviewed cases (16%) had a micropapillary component that ranged from 5 to 95% of the tumor, characterized by a higher frequency of an infiltrative pattern, lymphovascular and perineural invasion, a higher depth of invasion and more positive lymph nodes than conventional adenocarcinoma. Immunohistochemistry for MUC1 (clone MA695) and MUC1 (EMA, clone E29) enhanced the characteristic inside-out staining pattern of the micropapillary carcinoma component, whereas the rest of the tumor showed luminal staining patterns. KRT7 expression was slightly increased in micropapillary carcinoma, but did not reach significance (17-3%, P=0.1967). The molecular parameters showed a higher frequency of TP53 alterations and a low incidence of microsatellite instability and RER phenotype (loss of mismatch repair protein) in micropapillary carcinoma. With regard to the histological parameters, micropapillary carcinoma appears to be more aggressive than conventional colorectal adenocarcinoma. The molecular profile supports the hypothesis that micropapillary carcinoma carcinogenesis develops through the classical chromosomal instability pathway.
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Primary micropapillary carcinoma of the colon: a case report and literature review. Clin J Gastroenterol 2011; 4:99-103. [DOI: 10.1007/s12328-011-0211-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
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Otsubo K, Kubo N, Nakashima N, Izumi M, Nakamori M, Koto H. A juvenile case of pulmonary lymphangitic carcinomatosis caused by sigmoid colon cancer with a component of micropapillary carcinoma. Intern Med 2011; 50:2361-5. [PMID: 22001466 DOI: 10.2169/internalmedicine.50.5170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Micropapillary carcinoma is known to be associated with a poor prognosis and high propensity for lymphovascular invasion and lymph node metastasis. Case reports on colorectal micropapillary carcinoma are relatively rare. We report here a 26-year-old woman who had sigmoid colon cancer with a micropapillary component. We made the diagnosis of pulmonary lymphangitic carcinomatosis but could not identify the primary lesion. We gave her chemotherapy as an occult primary cancer. But her respiratory condition did not improve and she died of respiratory failure. Autopsy was performed after her death. The final diagnosis was pulmonary lymphangitic carcinomatosis and multiple lymph node metastases of sigmoid colon cancer with a component of micropapillary carcinoma.
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Affiliation(s)
- Kohei Otsubo
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Japan.
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