Invasive Ductal Carcinomas of the Breast Showing Partial Reversed Cell Polarity are Associated With Lymphatic Tumor Spread and may Represent Part of a Spectrum of Invasive Micropapillary Carcinoma

Ács, Géza; Esposito, Nicole N.; Rákosy, Zsuzsa; Laronga, Christine; Zhang, Paul J.

doi:10.1097/pas.0b013e3181f5539c

Cited by 44 publications

(38 citation statements)

References 31 publications

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“…Cell membranes at the periphery of tumorous cell clusters were characteristically positive for EMA, indicating an inside-out pattern of reactivity. This distinctive finding is critical for identifying the MPC as confirmed previously [13,14]. MPC showed immunohistochemical findings similar to the immunohistological findings of the same tumor type without MPC.…”

Section: Discussionsupporting

confidence: 49%

Micropapillary component in gastric adenocarcinoma: an aggressive variant associated with poor prognosis

et al. 2014

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Background Adenocarcinomas with a micropapillary component (MPC) have been described as an unusual morphological variant in various organs. However, few reports have described MPCs in gastric carcinomas, and the clinicopathological features of MPC are unclear. Methods Immunohistochemistry was used to detect the expression of epithelial membrane antigen, CK7, CK20, p53, epidermal growth factor receptor, b-catenin, c-erbB-2, and Ki-67. Correlation of the MPC to tumor stage, lymph node metastasis, and lymphovascular invasion was performed using Fisher's exact test. Kaplan-Meier estimates were used to analyze overall survival. Results Immunohistochemical staining demonstrated that micropapillary and conventional gastric carcinomas showed similar positivity rates for all markers. However, aberrant expression of E-cadherin was detected in the tumors with MPCs without immunoreactivity in the stroma face. Epithelial membrane antigen showed the characteristic inside-out staining pattern of MPCs. Lymphatic invasion (P = 0.003), venous invasion (P = 0.017), lymph node metastasis (P = 0.014), and tumor stage (P = 0.022) were significantly increased in patients with MPCs when compared with conventional adenocarcinomas. MPC subtype II had a significantly higher frequency of lymph node metastasis than subtype I (P = 0.014). However, the proportion of MPC was not associated with lymph node metastases (P = 0.136). Overall survival of patients with an MPC was significantly shorter than that of patients with conventional adenocarcinomas (P = 0.031). In addition, overall survival was significantly lower in patients with a subtype II MPC growth pattern than in those with subtype I MPC in gastric carcinomas (P = 0.040). Conclusion Gastric adenocarcinomas with MPC appear to be an aggressive variant associated with a poor prognosis. MPCs occurring in gastric adenocarcinomas should be included in surgical pathology reports, even if the proportion of MPC in the lesions is very low in the lesion.

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Section: Discussionsupporting

confidence: 49%

Micropapillary component in gastric adenocarcinoma: an aggressive variant associated with poor prognosis

et al. 2014

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“…Ide et al 23 revealed 8.4% of invasive breast cancer contained the IMPC component in their cohort of 486 patients, and noted that the presence of the IMPC component alone was a significant predictive factor for LNM, even if it was detected in only a small proportion of the tumor. The study results from Acs et al 24 suggested that breast carcinomas with partial reservation of the cell polarity may have the same implications as micropapillary differentiation, and these tumors may represent parts of a spectrum of IMPCs. Complete or partial reversal of cell polarity may have a significant role in lymphatic tumor spread.…”

Section: Microscopic Pathologymentioning

confidence: 84%

“…7 The status of the HER2/neu protein expression or gene amplification in IMPC is not consistent in literature. Some studies showed HER2/ neu þ rates between approximately 10% and 30%, [14][15][16]23,24 whereas others reported between approximately 50% and 80%. 34,38,41,44 Regarding the molecular classification, more cases of IMPC fall into the luminal A and luminal B subtypes than they do with IDC-NOS.…”

Section: Immunophenotypementioning

confidence: 99%

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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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“…The incidence of IMPC ranges from 3 to 6% [4] of all primary breast cancers. Compared to invasive ductal breast carcinoma (IDC), IMPC is characterized by cells arranged in pseudopapillary structures and surrounded by clear empty spaces lined by delicate strands of fibrocollagenous stroma [5], [6] [shown in Figure 1]. …”

Section: Introductionmentioning

confidence: 99%

Similar Prognoses for Invasive Micropapillary Breast Carcinoma and Pure Invasive Ductal Carcinoma: A Retrospectively Matched Cohort Study in China

Liu

Huang

et al. 2014

PLoS ONE

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PurposeInvasive 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.Methods51 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.ResultsMore 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).ConclusionAlthough 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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Invasive Ductal Carcinomas of the Breast Showing Partial Reversed Cell Polarity are Associated With Lymphatic Tumor Spread and may Represent Part of a Spectrum of Invasive Micropapillary Carcinoma

Cited by 44 publications

References 31 publications

Micropapillary component in gastric adenocarcinoma: an aggressive variant associated with poor prognosis

Micropapillary component in gastric adenocarcinoma: an aggressive variant associated with poor prognosis

Invasive Micropapillary Carcinoma of the Breast: An Update

Similar Prognoses for Invasive Micropapillary Breast Carcinoma and Pure Invasive Ductal Carcinoma: A Retrospectively Matched Cohort Study in China

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