Incomplete inside-out growth pattern in invasive breast carcinoma: association with lymph vessel invasion and recurrence-free survival

Kuba, Sayaka; Oda, Hiroshi; Yamaguchi, Junya; Hayashi, Hiroko; Uga, Tatsuya; Kanematsu, Takashi; Shimokawa, Isao

doi:10.1007/s00428-010-1033-2

Cited by 14 publications

(17 citation statements)

References 37 publications

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“…In this study, PRCP correlated, with high significance, with LI. This is in accord with other studies (14,22,23). Kuba et al, 2011 (22) stated that tumor cell clusters with PRCP are not uncommon and are useful tools for predicting LI.…”

Section: Discussionsupporting

confidence: 94%

Histolopathologic approach to direct the management of the axilla in early breast cancer patients

Farid

Ahmed

2014

APMIS

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Screening mammography improved early detection of breast cancer and since then, the percentage of patients with node involvement is declining. Sentinel lymph node biopsy (SLNB), although helpful in the diagnostic armamentarium of these patients, has consequential limitations. In these patients, moreover, lymphatic invasion (LI) is of utmost importance to determine the risk of local recurrence. To find an adjuvant histologic approach to assist in pre-operative analysis of the patient's risk for having LI and thus sentinel ± non-sentinel axillary lymph node metastasis, one hundred and twenty patients with early invasive duct carcinoma without axillary lymph node metastasis were evaluated. Logistic regression predictive models were built from 80 patients and validated in the remaining 40 patients. The final stepwise multi-regression analysis identified four sensitive models. In the validation group, model 1 [applicable to tumors grade 3 having micropapillary differentiation (MPD)] correctly identified 92.31% of patients with LI and confirmed LI [positive predictive value (PPV) = 83%], but with moderate sensitivity. Model 2 [applicable to tumors without MPD], model 3 [applicable to tumors grade 1/2], and model 4 [applicable to tumors grade 1/2 having no MPD] all had moderate PPV and a high negative predictive value (NPV) rendering these models reliable negative tests. However, as they had high sensitivity, positive results confirm the presence of LI. Patient with tumors grade 3 and MPD might need SLNB and/or axillary lymph node dissection (ALND). Patients having tumors grade 1/2, size <2 cm, and no MPD nor extensive retraction artifact, SLNB and/or ALND could be omitted. In tumors grade 1/2 (model 2) and those without MPD (model 3), the proposed models are reliable negative tests rather than a definitive positive one.

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Section: Discussionsupporting

confidence: 94%

Histolopathologic approach to direct the management of the axilla in early breast cancer patients

Farid

Ahmed

2014

APMIS

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“…7,[14][15][16][17]23,24,[37][38][39][40][41][42][43] One study of 624 patients with IMPC revealed a poor prognosis in the patients who had a tumor lacking in estrogen receptor expression. 7 The status of the HER2/neu protein expression or gene amplification in IMPC is not consistent in literature.…”

Section: Immunophenotypementioning

confidence: 99%

Invasive Micropapillary Carcinoma of the Breast: An Update

Yang¹,

Liu²,

Zhang³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

107

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Context.-Invasive micropapillary carcinoma (IMPC) is a distinct variant of mammary carcinoma in which tumor cells are arranged in morulelike clusters devoid of fibrovascular cores and situated within empty stromal spaces. Identification of IMPC can be achieved by the assessment of morphologic features in conjunction with the characteristic ''inside-out'' staining pattern of epithelial membrane antigen and sialyl Lewis X highlighted by immunohistochemical analysis. Although recognizing micropapillary architecture is often not challenging, the criteria for distinguishing between mixed and pure IMPC remain imprecise. Some mucin-producing carcinomas can also have micropapillary histology, but there is no consensus on whether these tumors are variants of IMPC or mucinous carcinomas. The molecular genetic studies demonstrate that IMPCs have distinct molecular genetic profiles, supporting the theory that they constitute distinct pathologic entities. However, genomic analyses have not identified any specific genomic aberration that may explain the distinctive morphology and clinical behavior of IMPC.Objective.-To provide an overview on the current concepts in the diagnosis and pathogenesis of IMPC of the breast, incorporating recent molecular genetic advances and prognosis-based reclassification.Data Sources.-PubMed search and the cited references were reviewed.Conclusions.-The recent evolution of prognosis-based reclassification and molecular genetic advances has enhanced our knowledge of the pathogenesis of IMPC of the breast. Additional studies might reveal consistent molecular alterations that underlie the formation of the inside-out growth pattern, and they might elucidate the molecular mechanisms responsible for the unfavorable clinical behavior of IMPC.

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“…We identified expression of MUC1 and EMA in the outer surface of papillary clusters like those in AMP of the case 1. This staining pattern is called as an 'inside-out' pattern in the invasive micropapillary carcinoma of breast [7,8] and several organs [9-19]. Therefore, the polarity called as an 'inside-out' pattern of the tumor cells is thought to be a characteristic feature in SMP and AMP of lung adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, the micropapillary pattern is defined as tumor cells growing in papillary tufts, which lack fibrovascular cores surrounded by lacunar spaces and has been reported to be associated with a high incidence of nodal metastasis and poor prognosis [3-6]. This pattern has been described in various organs such as breast [7,8], urinary bladder [9,10], ovary [11,12], salivary gland [13], and is known to behave aggressively. In other organs than the lung, this pattern was observed mainly in stroma as invasive components (stromal micropapillary pattern: SMP) [7-19]; however in lung, MSLA is widely recognized as floating tumor cells within alveolar spaces (aerogenous micropapillary pattern: AMP) [3,4].…”

Section: Introductionmentioning

confidence: 99%

Stromal micropapillary pattern predominant lung adenocarcinoma - a report of two cases

et al. 2011

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Generally, adenocarcinomas with micropapillary pattern, featuring small papillary tufts lacking a central fibrovascular core, are thought to have poor prognosis. This pattern has been described in various organs. However, tumor cells with micropapillary pattern of lung adenocarcinoma are more often seen to float within alveolar spaces (aerogenous micropapillary pattern, AMP) than in fibrotic stroma like other organs (stromal micropapillary pattern, SMP) and SMP predominant lung adenocarcinoma (SMPPLA) has not been well described yet. We presented two cases of SMPPLA which were found in the last four years. Both the cases showed more than 50% of SMP in the tumor area. The majority of the stromal micropapillary clusters expressed MUC1 and epithelial membrane antigen along the outer surface of cell membrane. On the other hand, connective tissues surrounding stromal micropapillary clusters showed no reactivity for epithelial markers (thyroid transcription factor-1 and cytokeratin) or endothelial marker (D2-40 and CD34). It means clusters of SMP do not exist within air space or lymphatic or vessel lumens. The tumors with SMP often presented lymphatic permeation and vessel invasion, and intriguingly, one of the two cases showed metastasis to the mediastinal lymph node. Additionally, both the cases showed EGFR point mutations of exon 21. These results suggest that SMPPLA might be associated with poor prognosis and effective for EGFR tyrosine kinase inhibitors.

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Incomplete inside-out growth pattern in invasive breast carcinoma: association with lymph vessel invasion and recurrence-free survival

Cited by 14 publications

References 37 publications

Histolopathologic approach to direct the management of the axilla in early breast cancer patients

Histolopathologic approach to direct the management of the axilla in early breast cancer patients

Invasive Micropapillary Carcinoma of the Breast: An Update

Stromal micropapillary pattern predominant lung adenocarcinoma - a report of two cases

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