Gastrointestinal Carcinoma with Plasmacytoid Morphology: Positivity for c-MET, Arylsulfatase, and Markers of Epithelial-Mesenchymal Transition, as Indicators of Aggressivity

Abstract

Background. Plasmacytoid urothelial carcinoma is a rare and aggressive histologic variant of high-grade carcinoma of the urinary bladder. Few than 250 cases have been reported in the urinary bladder till January 2019. In this paper, a case series of unusual gastrointestinal carcinomas with plasmacytoid morphology was included. Only one similar case of the stomach was previously published and no such cases were found in colon. Methods. We present the complex immunoprofile, using a panel of 39 biomarkers, of the largest group of primary gastrointestinal carcinomas with plasmacytoid morphology reported in literature (one from upper rectum and six from stomach). Results. All of the seven cases showed lymph node metastases and only one survived over 25 weeks after surgical excision. The indicators of aggressivity were age (over 60), advanced stage (from IIIA to IV), E-cadherin negativity, and vimentin positivity. The immunoprofile indicated unfavorable prognosis for mesenchymal-type carcinomas (negativity for E-cadherin and positivity for vimentin, with membrane to nuclear translocation or negativity of β-catenin). The survivor showed an “epithelial-type adenocarcinoma with plasmacytoid dedifferentiation”, with membrane positivity for E-cadherin and β-catenin and vimentin negativity. All of the cases expressed c-MET and were negative for HER-2. Conclusions. Primary carcinoma with plasmacytoid morphology is a dedifferentiated variant of adenocarcinoma or poorly cohesive carcinomas. Vimentin positive dedifferentiated-poorly cohesive carcinomas should be considered as mesenchymal-type highly malignant carcinomas. This rare histologic variant of gastrointestinal cancer might respond to anti-c-MET tyrosine kinases.

Chylous Ascites, Unusual Association with Ductal Pancreatic Adenocarcinoma with Plasmacytoid Morphology: A Case Report and Literature Review

“…Only 10 cases of gastrointestinal carcinomas with plasmacytoid appearance were reported till 2020: seven of the stomach, two of the ampulla of Vater, and one in the rectum. 7,16 In pancreas, plasmacytoid morphology was described in cytologic specimens, in "lipid-rich variant of pancreatic endocrine tumors" 18 , fine needle aspirations of serous cystadenomas, 19 and clear cell variant of solid pseudopapillary neoplasms (SPN). 20,21 To our knowledge, no cases of PDAC with plasmacytoid features and chylous ascites were described yet.…”

“…Although rare, gastroenteropancreatic plasmacytoid carcinomas are considered high grade tumors, which aggressivity seems to be induced by the epithelial mesenchymal transition (EMT) phenomenon revealed by loss of E-cadherin and nuclear translocation of β-catenin due to alteration of the Wnt/β-catenin pathway. 7 16 17 It was recommended to call these tumors as “mesenchymal-type poorly cohesive carcinomas” 7 . Only 10 cases of gastrointestinal carcinomas with plasmacytoid appearance were reported till 2020: seven of the stomach, two of the ampulla of Vater, and one in the rectum.…”

“…Only 10 cases of gastrointestinal carcinomas with plasmacytoid appearance were reported till 2020: seven of the stomach, two of the ampulla of Vater, and one in the rectum. 7 16 …”

“…The metastatic discohesive cells showed plasmacytoid morphology, with eccentrically located nuclei, indistinct nucleoli, and eosinophilic cytoplasm. 7 The microscopic features, correlated with the immunoprofile of the tumor cells and clnicopathological characteristics, allowed the diagnosis of a pathologic tumor-node stage III (pT4N2) poorly differentiated PDAC with lymhangiosis carcinomatosa (carcinomatosis of lymph vessels) and chyloperitoneum.…”

“…The metastatic discohesive cells showed plasmacytoid morphology, with eccentrically located nuclei, indistinct nucleoli, and eosinophilic cytoplasm. 7 …”