Micropapillary Component in Colorectal Carcinoma is Associated With Lymph Node Metastasis in T1 and T2 Stages and Decreased Survival Time in TNM Stages I and II

Abstract

Colorectal carcinoma with a micropapillary component (MP) is an exceptionally aggressive variant, but has never been investigated in terms of survival analysis. Thirty colorectal carcinomas with a MP were identified from a series of 221 colorectal carcinomas. Carcinomas with and without a MP were compared in terms of histologic and immunohistochemical markers. Colorectal carcinoma with a MP seemed to have a lower differentiation status, increased tumor budding, more frequent lymphovascular and perineural invasion, more frequent lymph node metastasis, higher tumor node metastasis (TNM) stage, and less nuclear beta-catenin staining (P<0.05). Further analysis revealed that the presence of a MP predicted more frequent lymph node metastasis in T1 and T2 stages but not in T3 and T4 stages. Five-year survival rates for patients with a MP and those without were 50% and 73%, respectively. Furthermore, in TNM stages I and II, but not in TNM stages III and IV, a MP was an unfavorable prognostic variable. A MP was demonstrated to be an independent unfavorable prognostic indicator in TNM stages I and II by the multivariate Cox proportional hazard model. Colorectal carcinoma with a MP should be distinguished from colorectal carcinoma of conventional histologic type.

Colorectal micropapillary carcinomas are associated with poor prognosis and enriched in markers of stem cells

“…7 Several studies showed the prevalence of micropapillary carcinoma was 9-19% in colorectal carcinoma, and it was associated with aggressive histological features, including higher levels of lymphovascular invasion and perineural invasion, more frequent lymph node and distant metastases, and higher TNM stages (III/ IV). [8][9][10][11] In concordance with previous studies, we identified 10% of colorectal carcinoma with micropapillary carcinoma component from our cohort (55/561 cases), and micropapillary carcinoma was significantly associated with higher Figure 2 Kaplan-Meier survival analysis (log rank test). (a and b) Non-micropapillary carcinoma patients experience significantly better overall survival rates (Po0.0001, a) and disease-free survival rates (Po0.0001, b) than patients with micropapillary carcinoma.…”

“…10 Xu et al 10 analyzed 30 colorectal carcinomas with micropapillary component from 1990 to 2000. This study revealed the presence of micropapillary components had an independent importance for survival of colorectal cancer patients, especially in TNM stage I and II.…”

“…Previous published studies found that the proportion of micropapillary carcinoma to the entire tumor ranged from 5 to 80%, and defined micropapillary carcinoma as carcinoma with at least 5% of micropapillary components. [8][9][10][11] On the other hand, as the identification of tumorinitiating cells, also referred to as cancer stem cells, in acute myeloid leukemia, their presence has also been identified in a number of solid tumor types, such as breast, lung, ovarian, brain, and colon cancer. [12][13][14][15][16][17] Emerging evidence suggests that stem cells have a crucial role not only in the embryonic development and maintenance of mature normal tissues, but also in the development of malignancies and disease progression associated with poor prognosis.…”

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 reported proportion of micropapillary carcinoma component to the entire tumor ranged from 5 to 80% and no pure cases has been reported. In gastrointestinal tract the most reported location is the sigmoid and rectum (Haupt et al, 2007;Kim et al, 2006;Kuroda et al, 2007;Sakamoto et al, 2005;Wen et al, 2008;Xu et al, 2009). In total, are near of 130 cases reported to date in colorectum.…”