Invasive micropapillary carcinoma of the breast: high incidence of lymph node metastasis with extranodal extension and its immunohistochemical profile compared with invasive ductal carcinoma

Abstract

Invasive micropapillary carcinoma of the breast: high incidence of lymph node metastasis with extranodal extension and its immunohistochemical profile compared with invasive ductal carcinoma Aims: Invasive micropapillary carcinoma of the breast is an aggressive and distinctive variant of breast cancer. These tumours have a characteristic histological appearance and have been associated with a high incidence of axillary lymph node metastases and a poor clinical outcome. The aims of this study were to investigate the immunohistochemical profile of invasive micropapillary carcinoma of the breast, to compare it with invasive ductal carcinoma, and to identify the morphological parameters which predict its poor outcome. Methods and results: Fifty-three (2.6%) invasive micropapillary carcinomas of the breast from 2022 cases of infiltrating breast carcinomas were identified by retrospective review. The patient age at presentation ranged from 33 to 78 years (mean 52.5 years). The tumour size ranged from 5 to 70 mm (mean 27 mm). Eightytwo percent (43 of 53) were of high histological grade; 69% (33 of 48) of cases with axillary lymph node dissections had positive lymph nodes; and 75.5% (40 of 53) had lymphatic invasion: 46% (22 of 48) of cases had extranodal extension. Of lymph node-positive cases, 61% had four or more metastatic lymph nodes. Of tumours with tumour size >10 mm, 77% had positive lymph nodes. The percentages of cases positive for oestrogen receptor (ER) and progesterone receptor (PR) were 68% and 61%, respectively. These values were significantly higher than the values for invasive ductal carcinomas. p53 and c-erbB-2 were detected in 48% and 54% of cases, respectively. The mean value of Ki67 was 26%. Follow-up was available in 36 patients. Eight patients had local recurrences, nine patients had distant metastases, and 10 patients died of disease within a follow-up period of 9 years. Conclusion: Lymphotropism and an unfavourable prognosis are the hallmarks of this distinct entity. Prognostic markers such as ER, PR, p53, and c-erbB-2 failed to provide new criteria to allow discrimination of these tumours from other breast cancers.

Clinicopathological and molecular characterization of colorectal micropapillary carcinoma

“…The tumor cells show eosinophilic cytoplasm, pleomorphic, hyperchromatic nuclei and a peculiar ''inside-out'' pattern of cell arrangement. [1][2][3][4][5][6][7] Clinicopathological features, summarized in Table 1, include the following parameters: gender and age of the patient, tumor location (proximal or distal to the splenic flexure), macroscopic type (ulcerated/stenosing or polypoid/exophytic), microscopic type (conventional adenocarcinomas or mucinous, when more than 50% of the tumor has an extra-or intracellular mucoid component) 16 and histological grade defined by the ratio of glandular to solid pattern, following the WHO classification 16 and categorizing mucinous adenocarcinoma as grade 3. The extent of tumor invasion and lymph node involvement was assigned according to the TNM system (sixth edition), 17 and the presence or absence of metastasis and peritoneal invasion is reported.…”

“…It was described first in the breast and ovary, and subsequently in other organs, including the bladder, lung, pancreas and salivary glands. [1][2][3][4][5][6][7] Previously published work found that the proportion of micropapillary carcinoma to the entire tumor ranged from 5 to 80% but was usually less than 30% of the entire lesion, with no pure cases of micropapillary carcinoma reported. Most cases were located in the sigmoid colon and the rectum.…”

Pure Micropapillary Rectal Carcinoma with CK7 and CK20 Coexpression and Loss of CDX2 Reactivity

“…Except for the ovary, micropapillary carcinoma arising in many organs seems to pursue an aggressive clinical course because of frequent invasion into lymphatic spaces, metastasis into lymph nodes, or systemic metastasis (Verdú et al;Amin et al, 2002;Amin et al, 1994;Nassar;Nassar et al;Paterakos et al;Siriaunkgul & Tavassoli;Zekioglu et al;Haupt et al;Kim et al;Kuroda et al;Sakamoto et al;Wen et al;Xu et al). Micropapillary carcinoma of the colon macroscopically seems to be indistinguishable from conventional adenocarcinoma.…”

“…The micropapillary carcinoma is regarded as an aggressive variant of adenocarcinoma in any location described, namely bladder, lung, pancreas, salivary glands and recently colon, rectum and stomach (Verdú et al, 2011;Amin et al, 2002;Amin et al, 1994;Nassar, 2004;Nassar et al, 2001;Paterakos et al, 1999;Siriaunkgul & Tavassoli, 1993;Zekioglu et al, 2004). Histologically is characterized by papillary cell clusters surrounded by clear spaces.…”

Micropapillary carcinoma: pathogenesis, histological and clinical features

“…Mikropapiller karsinom komponentinin nükleer özellikleri genellikle eşlik eden duktal komponente benzer ve yüksek derecelidir (6)(7)(8)(9)(10)(11). Duktal karsinoma in situ (DKİS) %53-80 oranında görülmekte olup çoğunlukla mikropapiller, kribriform veya papiller tiptedir (1,7,8,18,20).…”