Clinical and Pathological Characteristics of Micropapillary Transitional Cell Carcinoma: A Highly Aggressive Variant

Maranchie, Jodi K.; Bouyounes, Boutros T.; Zhang, Ping L.; O’Donnell, Michael A.; Summerhayes, Ian C.; Wolf, W. Clark

doi:10.1016/s0022-5347(05)67796-8

Cited by 92 publications

(80 citation statements)

References 10 publications

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“…Of the three, one micropapillary carcinoma had an abnormal cytoplasmic distribution, despite normal membrane-bound staining of the adjacent micropapillary urothelial carcinoma. 63 In another case report, E-cadherin staining was lost in the peripheral portions of cell clusters. 64 In all eight of our cases of micropapillary urothelial carcinoma, E-cadherin expression was homogenously present in the membrane of the invasive component.…”

Section: Discussionmentioning

confidence: 94%

E-cadherin expression in plasmacytoid, signet ring cell and micropapillary variants of urothelial carcinoma: comparison with usual-type high-grade urothelial carcinoma

et al. 2011

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Loss of E-cadherin expression has been linked to the invasive phenotypes of a variety of neoplasms, including lobular breast cancer. The expression of E-cadherin in variants of urothelial carcinoma relative to usual-type urothelial carcinoma, maximum depth of invasion and angiolymphatic invasion has not been well characterized. A total of eight cases of micropapillary urothelial carcinoma, four cases of plasmacytoid urothelial carcinoma, two cases of urothelial carcinoma with signet ring cell differentiation and two cases of urothelial carcinoma with mixed plasmacytoid and signet ring cell differentiation, all obtained from cystectomy/cystoprostatectomy cases, were identified. In all nine cases of usual-type invasive and noninvasive high-grade urothelial carcinoma were also included in the study. Immunohistochemical staining of E-cadherin was performed in all cases. Pathological parameters including depth of invasion and presence of angiolymphatic invasion were documented. Maximum depth of invasion: In micropapillary urothelial carcinoma, extravesical extension was seen in three of eight cases; muscularis propria invasion in four of eight cases; and lamina propria invasion in one of eight cases. In plasmacytoid urothelial carcinoma, extravesical extension was observed in two of four cases, and muscularis propria invasion and lamina propria invasion in one of four cases each. In urothelial carcinoma with signet ring cell differentiation, extravesical extension and muscularis propria invasion was seen in one of two cases each. In urothelial carcinoma with mixed plasmacytoid and signet ring cell differentiation, muscularis propria invasion and lamina propria invasion was observed in one of two cases each. In usual-type high-grade urothelial carcinoma, extravesical extension was seen in six of nine cases and noninvasive in three of nine cases. In angiolymphatic invasion, micropapillary urothelial carcinoma was observed in eight of eight cases; plasmacytoid urothelial carcinoma in two of four cases; urothelial carcinoma with signet ring cell differentiation in one of two cases; and urothelial carcinoma with mixed plasmacytoid and signet ring cell differentiation in one of two cases. Usual-type high-grade urothelial carcinoma was seen in six of nine cases. E-cadherin expression: All eight cases of micropapillary urothelial carcinoma were positive for E-cadherin in the micropapillary component and adjacent usual-type urothelial carcinoma. The four cases of plasmacytoid urothelial carcinoma, two cases of urothelial carcinoma with signet ring cell differentiation and two cases of urothelial carcinoma with mixed plasmacytoid and signet ring cell differentiation were all negative for E-cadherin. All nine additional cases of usual-type high-grade urothelial carcinoma were diffusely positive for E-cadherin. E-cadherin is diffusely positive in usual-type urothelial carcinoma and micropapillary urothelial carcinoma, irrespective of pathological stage and angiolymphatic invasion. Loss of E-cadherin expression may be a marker of...

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Section: Discussionmentioning

confidence: 94%

E-cadherin expression in plasmacytoid, signet ring cell and micropapillary variants of urothelial carcinoma: comparison with usual-type high-grade urothelial carcinoma

et al. 2011

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“…1,[7][8][9][10] Taken together, 33 cases have been examined by using factor VIII, Ulex europaeus, CD31, and CD34, and 23 (70%) of these cases were positive for focal vascular invasion (summarized in Table 1). To date, no study has investigated lymphovascular invasion in MPUC by using an immunohistochemical marker specific for lymphatic endothelium.…”

Section: Immunohistochemical Findingsmentioning

confidence: 99%

Lymphovascular Invasion in Micropapillary Urothelial Carcinoma: A Study of 22 Cases

McQuitty¹,

Ro²,

Truong³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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is a known aggressive variant of urothelial carcinoma. However, the reasons for its aggressiveness remain unclear.Objective.-To investigate the frequency of lymphovascular invasion in 22 cases of MPUC.Design.-Consecutive tissue sections were stained with D2-40 and CD34 to highlight lymphovascular channels associated with MPUC. Spaces containing tumor cells were scored as positive for lymphovascular invasion if the staining pattern on immunohistochemistry was distinct and circumferential.Results.-Of 22 cases, 21 (95%) had lymphovascular invasion on immunohistochemical staining, with 91% lymphatic invasion and 4% vascular invasion. Interestingly, 8 cases were originally signed out as negative for lymphovascular invasion on the basis of hematoxylineosin-stained sections; of these, 7 (88%) had focal lymphovascular invasion evident on immunohistochemical staining.Conclusions.-Our results confirm that micropapillary lacunae are not lymphovascular channels. However, nearly all MPUC tumors (95% in this series) have evidence of lymphovascular invasion by immunohistochemical analysis. Our data support the use of micropapillary features as a morphologic marker for lymphovascular invasion and MPUC as an adverse histologic type of urothelial carcinoma.(Arch Pathol Lab Med. 2012;136:635-639; doi: 10.5858/ arpa.2011-0463-OA) M icropapillary urothelial carcinoma (MPUC) is a rare, clinically aggressive histologic variant of urothelial carcinoma (UC). It was first described by Amin et al 1 in 1994 and is characterized by small, infiltrating clusters of neoplastic cells that appear to float within clear lacunar spaces and that lack a fibrovascular core (Figure 1). Micropapillary urothelial carcinoma occurs almost exclusively in the setting of conventional UC, 2,3 and the proportion of MPUC predicts high pathologic stage and lymph node metastasis. 4,5 The overall prognosis is poor; the 5-year and 10-year survival in the largest study were 51% and 24%, respectively. 6Multiple investigators have examined vascular invasion in MPUC by using immunohistochemistry for factor VIII, Ulex europaeus, CD31, and CD34, 1,7-10 as summarized in Table 1. Together, these studies demonstrate vascular invasion in 23 of 33 cases (70%). But these studies are hampered by exclusive use of vascular endothelial markers, and the rate of lymphovascular invasion in MPUC may be even higher.

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“…In the organs in which it is best characterized, invasive micropapillary carcinoma has been shown to have a highly infiltrative nature, often presenting at advanced stages, and showing high degrees of lymphotrophism. 8,9 To our knowledge, invasive micropapillary carcinoma has not yet been reported in the ampullo-pancreatobiliary region. In this study, carcinomas of this region resected at the authors' institution were reviewed to identify those with micropapillary pattern, determine their relative frequency, and document their clinicopathologic features.…”

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confidence: 91%

Invasive micropapillary carcinomas of the ampullo-pancreatobiliary region and their association with tumor-infiltrating neutrophils

2005

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Invasive micropapillary carcinoma, originally described as a distinctive type of invasive carcinoma in the breast, is being increasingly recognized as a separate entity in many other organs; however, it has not yet been documented in the pancreas or periampullary region. In this study, 313 pancreatic and 73 periampullary carcinomas were reviewed to investigate the micropapillary pattern in this location. Eight periampullary and eight pancreatic cases (4%) were composed at least focally (420%) of invasive micropapillary carcinoma. The patients were 10 males and six females, mean age 69 years. The mean tumor size was 3.2 cm. Lymph node metastasis was detected in 11/15 cases. The median survival was 8 months (all were resected). Invasive micropapillary carcinoma was characterized by small, closely packed micropapillary clusters (without fibrovascular cores) lying within clefts. The cells had moderate degree of nuclear atypia. In nine cases, there was abundant inflammation composed of neutrophils concentrating around the tumor cells, both intraepithelial ('cannibalism') and stromal. Molecules implicated in abnormalities of tumor cell-stroma adhesion, galectin-3 and E-cadherin were expressed in the cytoplasm of 11/11 and 9/11 cases, respectively. Reversal of cell polarity was observed by MUC 1 in all 11 cases tested, which showed labeling in the stroma-facing surfaces of the micropapillary clusters, also confirming that the clefts are not merely a processing artifact, but indeed a true biologic alteration. In conclusion, invasive micropapillary carcinoma constitutes 4% of carcinomas in the pancreatic/periampullary region and is commonly associated with abundant neutrophilic infiltrates.Invasive miropapillary carcinoma appears to be more common in periampullary than in pancreatic invasive micropapillary carcinoma would qualify as poorly differentiated both based on pattern and the median survival (8 months). Modern Pathology (2005) 18, 1504-1511.

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Clinical and Pathological Characteristics of Micropapillary Transitional Cell Carcinoma: A Highly Aggressive Variant

Cited by 92 publications

References 10 publications

E-cadherin expression in plasmacytoid, signet ring cell and micropapillary variants of urothelial carcinoma: comparison with usual-type high-grade urothelial carcinoma

E-cadherin expression in plasmacytoid, signet ring cell and micropapillary variants of urothelial carcinoma: comparison with usual-type high-grade urothelial carcinoma

Lymphovascular Invasion in Micropapillary Urothelial Carcinoma: A Study of 22 Cases

Invasive micropapillary carcinomas of the ampullo-pancreatobiliary region and their association with tumor-infiltrating neutrophils

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