Skin metastases revealing a bilateral ovarian invasive micropapillary serous carcinoma

Skin involvement is a late complication that rarely occurs in ovarian cancer patients. This event invariably carries a bad prognosis in the course of an advanced stage ovarian carcinoma which is usually of the conventional serous type. Micropapillary serous carcinoma (MPSC) was recently recognized as a distinct neoplasm that seems to be less aggressive than conventional serous ovarian carcinoma. Indeed, a few cases of stage IV MPSC have been reported. Herein, we describe an unusual case of ovarian invasive MPSC occurring in a young woman, particularly by its mode of presentation as multiple subcutaneous nodules that were subsequently diagnosed as metastatic lesions. This case demonstrates the potential of MPSC for aggressive clinical behaviour.     

Clinicopathologic analysis of 10 cases of pulmonary colloid adenocarcinoma and prognostic implication of invasive micropapillary component

Background

We aimed to investigate the clinicopathologic and histopathologic characteristics of colloid adenocarcinoma of the lung.

膀胱微乳头变异型尿路上皮癌临床病理分析

目的探讨膀胱微乳头变异型尿路上皮癌的临床病理特征。方法收集解放军总医院1999—2011年间经病理诊断的膀胱微乳头变异型尿路上皮癌患者,复习其临床及病理学资料并进行随访,结合文献对其临床及病理学特征加以分析。结果 12年中诊断膀胱癌患者4 325例,其中微乳头变异型尿路上皮癌4例(0.09%),均为男性,年龄45～68岁,临床上均表现为肉眼血尿。行膀胱全切术。4例外观各不相同,表现为平坦浸润型、乳头状、息肉样及溃疡型。组织学上3例为单纯性微乳头型尿路上皮癌,多个脉管内可见癌栓,其中2例伴神经侵犯及多处淋巴结转移;另1例为经典型尿路上皮癌,仅局灶见微乳头变异型成分;诊断时4例中2例为pT4期,1例为pT3期,1例为pT2期。免疫组化染色显示,4例肿瘤细胞HER-2均呈强阳(+)。结论膀胱微乳头变异型尿路上皮癌是一种具有特殊形态学特征的高级别癌,具有高侵袭性的生物学行为,易发生淋巴、血管转移,预后差。HER-2蛋白强(+)可能与膀胱微乳头变异型尿路上皮癌侵袭性生物学行为有关。     

乳腺浸润性微乳头状癌的临床病理学观察及相关免疫组化研究

目的探讨乳腺浸润性微乳头状癌(IMPC)的临床病理特征、免疫组化表达、诊断和鉴别诊断。方法采用光学显微镜对24例IMPC进行观察,应用免疫组化方法分析其激素受体、Cerbb-2和细胞增殖表达。结果 24例IMPC光镜下特征性表现为肿瘤细胞呈微乳头状或小腺管状排列,细胞团外缘毛糙呈锯齿状,表面细胞质微绒毛样改变,缺乏纤维血管轴心,胞质伊红染,胞核圆形或卵圆形,染色较深,不同程度异型。免疫组化ER、PR、CerbB-2阳性率分别为75%、62.5%、54.2%;Ki-67阳性率70.8%,生长指数10%～80%,平均30%。结论 IMPC是一种具有独特的病理形态学表现的少见乳腺癌类型,易转移,高淋巴结侵袭性。     

Micropapillary lung adenocarcinoma: a distinctive histologic subtype with prognostic significance. Case series

The aims of the present work were to evaluate the prognostic significance of the micropapillary pattern of lung adenocarcinoma and determine whether there are differences in the behavior of this type of tumor according to its immunohistochemical profile. A series of 191 consecutively resected pulmonary adenocarcinomas were divided into those with (n = 62) and those without (n = 129) micropapillary components. The disease was stage I in 38 and 54 patients, respectively. The 5-year survival rates of patients with and without micropapillary components were 54% and 77%, respectively (log rank P = .03). In multivariate survival analysis, the micropapillary component proved to be an independent prognostic factor (hazard ratio, 3.2). Five autopsy cases were used to investigate the immunohistochemical profile. The percentages of cases positive for various markers were 56.7 for p53, 94 for Ki67, 85.1 for c-myc, 2.9 for Bcl-2, 35.8 for epidermal growth factor receptor, 43.3 for cyclin D1, and 46.3 for Bax. The prognostic value was evaluated according to the expression of the different markers in micropapillary carcinomas in stage I. In univariate analysis, only cyclin D1 expression and Bax expression were associated with significantly worse survival (log rank P = .03 and P = .02, respectively). We conclude that it is important to recognize the micropapillary growth pattern in lung adenocarcinoma. Moreover, cyclin D1 and Bax seem to be markers of a poor prognosis.     

High-risk-pattern lung adenocarcinoma with epidermal growth factor receptor mutation is associated with distant metastasis risk and may benefit from adjuvant targeted therapy

 Open in a separate windowOBJECTIVESThis study aimed to evaluate the value of the high-risk-pattern histology (micropapillary and solid components) for predicting distant metastasis in lung adenocarcinoma and to determine the survival benefit with adjuvant targeted therapy for resected non-small cell lung cancer with high-risk-pattern histology.METHODSPatients receiving surgery for non-small cell lung cancer were included in this retrospective study. Histological classification was performed according to 2015 World Health Organization classification. Tumours with micropapillary and solid components were defined as high-risk-pattern tumours. Univariable and multivariable Cox regression analyses were used for survival analysis. Adjuvant targeted therapy was alternative for patients with epidermal growth factor receptor (EGFR)-mutation and refusing adjuvant chemotherapy, and outcome was evaluated between 2 groups.RESULTSThe 514 patients (78 in high-risk group and 436 in low-risk group) were followed up for a median of 64 months. High-risk-pattern adenocarcinoma was significantly more common in male patients (P < 0.001) and in smokers (P < 0.001). Among patients with EGFR mutation (n = 164), the high-risk pattern was significantly associated with distant metastasis (P = 0.028) including brain metastasis (P = 0.022). In the 42 patients with high-risk pattern plus EGFR mutation, survival was significantly better after treatment with adjuvant targeted therapy than with chemotherapy (5-year overall survival: 56.4 ± 2.6 vs 44.7 ± 3.7 months, P = 0.011; 5-year disease-free survival: 54.0 ± 3.3 vs 41.9 ± 4.5 months, P = 0.006).CONCLUSIONSHigh-risk pattern is associated with distant metastasis in non-small cell lung cancer after surgery. Adjuvant targeted therapy may be superior to chemotherapy for treatment of patients with high-risk pattern and EGFR mutation.     

Imaging Phenotyping Using Radiomics to Predict Micropapillary Pattern within Lung Adenocarcinoma

IntroductionLung adenocarcinomas (ADCs) with a micropapillary pattern have been reported to have a poor prognosis. However, few studies have reported on the imaging-based identification of a micropapillary component, and all of them have been subjective studies dealing with qualitative computed tomography variables. We aimed to explore imaging phenotyping using a radiomics approach for predicting a micropapillary pattern within lung ADC.MethodsWe enrolled 339 patients who underwent complete resection for lung ADC. Histologic subtypes and grades of the ADC were classified. The amount of micropapillary component was determined. Clinical features and conventional imaging variables such as tumor disappearance rate and maximum standardized uptake value on positron emission tomography were assessed. Quantitative computed tomography analysis was performed on the basis of histogram, size and shape, Gray level co-occurrence matrix–based features, and intensity variance and size zone variance–based features.ResultsHigher tumor stage (OR = 3.270, 95% confidence interval [CI]: 1.483–7.212), intermediate grade (OR = 2.977, 95% CI: 1.066–8.316), lower value of the minimum of the whole pixel value (OR = 0.725, 95% CI: 0.527–0.98800), and lower value of the variance of the positive pixel value (OR = 0.961, 95% CI: 0.927–0.997) were identified as being predictive of a micropapillary component within lung ADC. On the other hand, maximum standardized uptake value and tumor disappearance rate were not significantly different in groups with a micropapillary pattern constituting at least 5% or less than 5% of the entire tumor.ConclusionA radiomics approach can be used to interrogate an entire tumor in a noninvasive manner. Combining imaging parameters with clinical features can provide added diagnostic value to identify the presence of a micropapillary component and thus, can influence proper treatment planning.