Micropapillary variant of mucinous breast carcinoma: A distinct subtype

Invasive micropapillary carcinoma of the breast is a subtype with high malignant potential characterized by lymphovascular invasion (LVI) and a predilection for axillary lymph node (AXLN) metastases. In contrast, pure mucinous breast carcinoma (MBC) is relatively indolent with low metastatic potential. Recent studies have described a histologic variant of breast cancer that displays combined mucinous and micropapillary patterns, ie, micropapillary variant of mucinous carcinoma (MpVMBC). This underrecognized variant is, as yet, incompletely characterized clinicopathologically. Extant reports suggest a more aggressive lesion than pure MBC with greater propensity for both LVI and AXLN metastases. Here we present our institution's experience with MpVMBCs including clinicopathologic and immunohistochemical (IHC) analyses. Greater awareness and recognition of this variant could positively contribute to patient care by (1) avoiding underestimation of malignant potential for individuals whose tumors may have been diagnosed as simply “MBC, not otherwise specified”, and (2) recommending a postsurgical adjuvant approach emphasizing the hormone receptor targets, even perhaps in younger women presenting with AXLN positive disease.     

Presence of a micropapillary pattern in mucinous carcinomas of the breast and its impact on the clinical behavior

Infiltrating micropapillary carcinomas (IMPC) of breast are highly angioinvasive tumors with poor prognosis. This study is based on the observation that a similar micropapillary pattern is also observed in mucinous carcinomas of breast. About 102 mucinous carcinomas were evaluated for the presence and impact of this micropapillary pattern on the clinical behavior. Of these, 68 were mucinous carcinomas with a micropapillary pattern (MUMPC), 20 had MUMPC mixed with an infiltrating duct carcinoma component, two were solid variants of papillary carcinoma with mucin (SVPCMU), five had collision of the MUMPC and SVPCMU patterns and seven were mucinous carcinomas with signet ring cells (MUS). The factors negatively affecting overall survival (OAS) and disease-free survival (DFS) included the histological type of mucinous carcinoma, nodal metastases, an irregular tumor border, <50% mucin and an IMPC type of local recurrence or metastases. In the multivariate analysis, the histologic type of mucinous carcinoma and an irregular tumor border were most significant for OAS and DFS. Thus, 86% of mucinous carcinomas in this study were mucinous variants of the angioinvasive infiltrating micropapillary carcinomas. These tumors can produce IMPC type of metastases and thus should be treated aggressively.     

两种不同临床类型的肾黏液性小管状和梭形细胞癌

目的:探讨两种不同临床类型肾黏液性小管状和梭形细胞癌的临床特点。方法:报告2例不同临床类型肾黏液性小管状和梭形细胞癌患者的临床资料,进行对比分析,并复习有关文献。结果:例1为体检发现,无局部及远处转移,无病理性核分裂像,异型性小。例2以持续高热就诊,有局部及远处转移,病理性核分裂像常见,异型性明显。2例均行肾癌根治术,例1术后随访未见复发。例2患者于术后3个月死亡,此为国内首例报道因肾黏液性小管状和梭形细胞癌死亡者。结论:肾黏液性小管状和梭形细胞癌有两种不同临床类型,多数为低度恶性,亦存在恶性程度较高的病例,需区别对待。     

Long-term outcomes in patients with mucinous, medullary, tubular, and invasive ductal carcinomas after lumpectomy

BACKGROUND: Mucinous, medullary, and tubular carcinomas are uncommon types of breast cancer whose rarity does not permit large single-institution studies or randomized trials to define optimal treatments. In this study, we evaluated the long-term outcomes of breast-conserving therapy (BCT) for these subtypes of breast cancer and compared them with those for invasive ductal carcinoma. METHODS: In our institutional database of patients who received BCT from 1965 to 1999, 1,643 patients with stage I to II mucinous (61), medullary (37), tubular (60), and invasive ductal (1,485) histologies were identified. The clinical and pathologic features of the 4 groups were evaluated and compared with respect to local-regional recurrence rates, disease-free survival, and overall survival (OS). RESULTS: No statistically significant differences were found in the local-regional failure rate among the 4 groups (10.6-year median follow-up). Only patients with tubular carcinoma had better 5- and 10-year OS rates (P = .013). In multivariable analysis, factors associated with improved OS included age at or below 50 years, negative nodal status, use of chemotherapy or hormonal therapy, and tubular histology. CONCLUSIONS: BCT for mucinous, medullary, or tubular carcinoma resulted in similar local-regional failure rates to that for invasive ductal carcinoma. Tubular carcinoma patients had the most favorable OS. BCT is an appropriate treatment strategy for early-stage mucinous, medullary, and tubular carcinomas.     

A review of mucinous lesions of the breast

Mucinous lesions of the breast include a variety of benign and malignant epithelial processes that display intracytoplasmic or extracellular mucin, including mucocele‐like lesions, mucinous carcinoma, solid papillary carcinoma, and other rare subtypes of mucin‐producing carcinoma. The finding of free‐floating or stromal mucin accumulations is a diagnostic challenge of which the significance depends on the clinical, radiologic, and pathologic context. This article emphasizes the differential diagnosis between benign and malignant mucin‐producing lesions, with a brief consideration of potential mimics, such as biphasic and mesenchymal lesions with associated with mucinous, myxoid, or matrix material.     

The case for the omission of axillary staging in invasive breast carcinoma that exhibits a predominant tubular growth pattern on preoperative biopsy

True invasive tubular breast carcinoma (TBC) is unlikely to metastasize to axillary nodes, yet it is routinely subjected to sentinel lymph node biopsy (SLNB), even if the diagnosis was suspected preoperatively. The positive predictive value (PPV) of core biopsy for TBC and the incidence and predictors of axillary metastasis in invasive breast carcinomas identified as tubular‐rich on core biopsy are unknown. Prospective patient and tumor data regarding postoperatively confirmed TBCs, and tubular‐rich carcinoma identified on preoperative core biopsy between January 2005 and May 2016 was analyzed retrospectively. Axillary metastasis occurred in only 4.2% (4/95) of TBCs, all of which measured >15 mm pathologically. In 11.1% (11/99) of TBCs, the initial core biopsy was either indeterminate/suspicious or ductal carcinoma in situ (DCIS); therefore, their true tubular histotype and size were ascertained following operative excision and before SLNB. Nine were ≤15 mm, and all were node‐negative. Only 63.9% (46/72) of tubular‐rich core biopsies were confirmed as TBCs; the remaining 36.1% (26/72) were well‐differentiated invasive nontubular carcinomas. None of the preoperative patient or tumor features were predictive of true TBC on multivariable analysis; 10.1% (7/69) of carcinomas identified as tubular‐rich on core biopsy (regardless of their true histotypes) were node‐positive; 23.1% (6/26) in nontubular and 2.3% (1/43) in true tubular carcinomas. Preoperative ultrasound size >15 mm was associated with axillary metastasis in 40.0% (4/10) compared to 5.7% (3/53) in those ≤15 mm (OR = 11.11, 95% CI = 1.99‐62.04; multivariable P = .010). Axillary metastasis in TBC is dependent on pathological size; therefore, a case is made for omitting SLNB in small true TBCs confirmed following excision. Preoperative tubular‐rich core biopsy is not adequately diagnostic of TBC; however, it selects carcinomas that are well‐differentiated, small, and unlikely to metastasize to the axilla, thus allowing for the selective omission of SLNB.     

The impact of molecular status on survival outcomes for invasive micropapillary carcinoma of the breast

Invasive micropapillary carcinoma (IMPC) is an uncommon variant of breast cancer. Previous studies demonstrated this subtype is often hormone receptor (HR)‐positive, resulting in survival outcomes similar to invasive ductal carcinoma. However, many of these studies were conducted prior to HER2 testing availability. We aim to determine the impact of molecular marker status (including HER2 status) on IMPC survival outcomes. The National Cancer Data Base (NCDB) was used to retrieve patients with biopsy‐proven IMPC from 2007 to 2012. Only patients with known HR and HER2 status were included. Cox multivariate regression was used to determine prognostic factors. In total, 865 patients were included; median follow‐up was 2.5 years. Overall, 651 patients (75.3%) had HR + HER2? disease, 128 (14.8%) had HR + HER2+ disease, 41 (4.7%) had HR‐HER2 + disease, and 45 (5.2%) had triple negative disease. Patients with triple negative disease were more likely to have poorly differentiated histology (66.7%), lymphovascular invasion (73.3%), stage 3 disease (37.8%), undergone mastectomy (68.9%), and positive surgical margins (15.6%). On Cox multivariate regression, those with triple negative disease had worse overall survival (hazard ratio [HR] 7.28, P < 0.001). Other adverse prognostic factors included African‐American descent (HR 2.24, P = 0.018), comorbidity score of 1 (HR 2.50, P = 0.011), comorbidity score ≥2 (HR 3.27, P = 0.06), and ≥3 positive lymph nodes (HR 3.23, P = 0.007). Similar to invasive ductal carcinoma, triple negative disease in IMPC results in worse survival outcomes. This is the largest and first study to characterize molecular status (including HER2 status) in patients with IMPC and its impact on survival outcomes.     

Outcomes following resection of invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas

BACKGROUND: Since any intraductal papillary mucinous neoplasm (IPMN) is at least premalignant, avoiding conversion to invasion by pancreatic resection should provide a survival advantage-but how much? METHODS: We reviewed 100 cases of IPMN that were resected. Survival was compared between 3 groups: noninvasive IPMN (n = 75), invasive IPMN (n = 25), and invasive ductal adenocarcinoma (n = 24), the latter matched by tumor-node-metastasis (TNM) stage to the IPMN invasive group. RESULTS: The 5-year disease-specific survival was significantly better for the noninvasive IPMN group (100%) than the invasive IPMN group (46%). Tumor recurrence was infrequent with noninvasive IPMNs (1.3% benign IPMN). Recurrence was common in the invasive IPMN group (46%). Even the subgroup with stage 1 disease had a 25% recurrence of malignancy. Survival curves were not different (P = .11) between the cases matched by stage for those with invasive IPMN cases versus cases with ductal adenocarcinoma. CONCLUSION: Patients with the invasive form of IPMN will have a similarly poor survival as those with ductal adenocarcinoma. In patients thought to have a benign IPMN, these lesions should be removed to avoid conversion to invasive cancer and to preserve the opportunity for the more favorable prognosis observed in this study.     

肾黏液性小管状和梭形细胞癌临床病理特点分析

目的:分析肾脏黏液性小管状和梭形细胞癌的临床病理特点,提高对肾黏液性小管状和梭形细胞癌的认识。方法:回顾性分析8例肾黏液性小管状和梭形细胞癌患者的临床资料。女5例,男3例,平均年龄48.4(25～80)岁。肿瘤最大直径平均4.2(2.5～10.0)cm。3例行开放性肾癌根治术,3例行腹腔镜肾癌根治术,2例行腹腔镜肾脏部分切除术。结果:手术顺利,术中术后未出现明显并发症,术后病理检查均诊断为肾黏液性小管状和梭形细胞癌。平均住院7(5～10)天,术后平均随访30(7～45)个月,均未见肿瘤复发及转移。结论:肾黏液性小管状和梭形细胞癌是一种极为罕见的低度恶性的肾脏肿瘤,临床症状、影像学表现与肾癌类似,需依靠病理组织学确诊。早期手术治疗是首选治疗方法,预后良好,需长期密切随访,对最大直径<4.0cm患者,推荐行腹腔镜下保留肾单位手术。     

A case of renal mucinous tubular and spindle cell carcinoma

A 33-year-old man was hospitalized for treatment of a left renal tumor. The radiological findings were consistent with those of a left renal cell carcinoma (RCC). Subsequently, a radical nephrectomy was carried out. Macroscopic examination showed that a well-demarcated tumor measuring 2.9 × 2.6 × 2.5 cm was present in the middle portion of the resected kidney. The cut surface of the tumor was grayish-white in color. Pathological examination of the resected specimen showed a mucinous tubular and spindle cell carcinoma of the kidney (MTSCC-K). MTSCC-K is a low-grade renal epithelial neoplasm that has recently been recognized as a specific entity in the World Health Organization 2004 classification of RCC. To our knowledge, 17 cases of MTSCC-K in Japan have been reported by Japanese investigators. To avoid administration of excessive adjuvant treatment to patients, pathologists and urologists should consider this newly recognized low-grade malignancy when diagnosing renal tumors.     

Pure and Mixed Mucinous Carcinoma of the Breast: A Comparison of Clinical Outcomes and Treatment Results

Mucinous breast carcinoma (MBC) carcinoma represents approximately 1–6% of all malignant breast carcinoma and is divided into pure (PMBC) and mixed (MMBC) subtypes. This study presents the comparison of clinical characteristics and treatment results in 70 patients with PMBC and 40 patients with MMBC, treated at a single institution during 25 years. Performed analyses showed that only nodal status was different in both subtypes. Patients with MMBC showed a significantly higher incidence of axillary nodal metastases in comparison to PMBC (25% versus 10%, respectively). Instead, the 10‐year disease‐free survival rate was significant higher in PMBC than MMBC (85.7% versus 65%, p < 0.02, test log rank). Authors own observations and data from literature proved that MMBC should be considered as subtypes of mucinous breast cancer.     

单纯乳腺粘液癌的临床病理特点及治疗

Objective To explore clinical characteristics,pathology,prognosis and proper treatment of pure mucinous breast carcinoma(PMBC).Methods Retrospective analysis Was carried out on patients with PMBC who were admitted from Jan.2004 to Dec.2010.Results PMBC patients accounted for 2.6%of all the patients with breast cancer treated at the same period.The mean age of PMBC patients was(55.28±15.73)years,ranging from 32 years to 81 years.The tumor diameter was from 1 to 10 cm and axillary lymph node involvement was 0%.Immunohistochemieal detection showed the positive rate of estrogen receptor(ER),progesterone receptor(PR),HER-2 and p53 was 96%,92%,0%and 32%respectively.All patients underwent operation and polychemotherapy(cyclophosphamide+Adriamycin,Paclitaxel+Adriamyein).12 cases received tamoxifen,13 cases received letrozole and 8 cases received postoperative irradiation.All the patients were followed up from 1 month to 6 years and the overall survival rate was 100%.Conclusions PMBC is a favorable histological type of breast carcinoma with good prognosis.Proper surgical and adjuvant therapy is important to improve survival rate and life quality.Molecular biologic parameters should be given enough consideration into prognosis evaluation.     

Excision only for tubular carcinoma of the breast

The purpose of this study was to assess the rationale of excision only (without breast irradiation) in patients with small (< or =3 cm) tubular/well-differentiated breast cancers. A total of 44 patients with pure tubular invasive breast cancer who have undergone complete excision only and have had a minimum 1-year follow-up were identified from the Colorado Cancer Registry and assessed for recurrence rates as well as median local disease-free and overall survival. Treatment dates were October 1972 to April 2001. The median age was 67 years (range 40-96 years). The median tumor size was 6.5 mm (range 2-30 mm). All patients had a complete excision with negative margins. Staging was as follows: T1N0 (11), T1Nx (27), T2N0 (1), T1N1 (3); 2 were unable to be staged accurately. After a median follow-up of 5.4 years (range 1.1-26.3 years) there were only two local recurrences in the ipsilateral breast (at 7.6 and 8.8 years), for a crude local control rate of 96% (2/44). Both patients were salvaged, are alive, and currently have no evidence of disease (NED) at last follow-up of 9 and 13.3 years. Actuarial 5- and 10-year local control rates were 100% and 87%. Actuarial 5- and 10-year overall and disease-free survivals were 80% and 52%, and 100% and 91%. Twenty-five patients had more than 5 years of follow-up. The median follow-up for this group was 9.1 years (range 5.1-26.3 years) and both recurrences were in this group. Although the number of cases in this report is small, it represents the largest total and longest follow-up for tubular breast cancer cases after excision alone. This report suggests that breast irradiation could be omitted after conservative surgery in older patients with smaller (< or =3 cm) tubular/well-differentiated breast cancers. However, due to the retrospective nature of our report, we cannot categorically make this recommendation.     

假体置入联合乳腺瓣固定矫正筒状乳房畸形

目的：介绍采用乳腺底面放射状切开固定,同期在胸大肌后间隙置入硅凝胶假体,矫正伴有乳腺发育不良的筒状乳房畸形的方法和经验。方法：经乳房下皱襞切口,乳腺底面放射状切开,形成4个乳腺瓣,向下固定于胸大肌筋膜上,胸大肌后间隙置入硅凝胶假体。结果：2002年1月～2010年12月采用该方法共治疗3例伴有乳腺发育不良的筒状乳房畸形的患者,无血肿、感染、乳头乳晕坏死等并发症发生。术后随访1～3年,乳房丰满挺拔,畸形得到矫正,乳头乳晕感觉功能正常。结论：该术式在增大乳房体积的同时矫正筒状乳房畸形,对伴有乳腺发育不良的筒状乳房畸形患者可作为一种理想的整形方法。     

结直肠印戒细胞癌及黏液腺癌临床与预后差异分析

目的 探讨结直肠黏液腺癌与印戒细胞癌临床病理特点和预后及其关系。方法 分析中山大学附属第一医院胃肠胰外科1994-2007年收治的2089例原发性结直肠癌中的黏液腺癌144例,印戒细胞癌25例的临床资料,比较结直肠黏液腺癌与印戒细胞癌临床病理特点和预后及其之间的关系。 结果 黏液腺癌占结直肠癌的5.45%,印戒细胞癌占1.19%;黏液腺癌与印戒细胞癌相比, 印戒细胞癌发病年龄更年轻, 女性易发病, 黏液腺癌好发于结肠而印戒细胞癌好发于直肠（P<0.01）;但在肿瘤直径、淋巴结转移和远处转移和浆膜浸润﹑脏器侵犯﹑根治性切除率﹑中晚期比例等方面二者差异无统计学意义（P>0.05）;印戒细胞癌与黏液腺癌总体存活率相比差异有统计学意义（P<0.05）,可根治手术组总体存活率相比差异有统计学意义（P<0.05）。 结论 印戒细胞癌与黏液腺癌是生物学行为相近而且具有独特的癌变机制的肿瘤,结直肠黏液癌尤其是印戒细胞癌是结直肠癌独立的预后危险因素,其预后差的原因可能与其发生部位和独特的病理类型有关。     

Survival patterns of invasive lobular and invasive ductal breast cancer in a large population-based cohort with two decades of follow up

BackgroundInvasive lobular carcinoma (ILC) comprises 8–15 % of all invasive breast cancers and large population-based studies with >10 years of follow-up are rare. Whether ILC has a long-time prognosis different from that of invasive ductal carcinoma, (IDC) remains controversial.PurposeTo investigate the excess mortality rate ratio (EMRR) of patients with ILC and IDC and to correlate survival with clinical parameters in a large population-based cohort.Material and methodsFrom 1989 through 2006, we identified 17,481 patients diagnosed with IDC (n = 14,583) or ILC (n = 2898), younger than 76 years from two Swedish Regional Cancer Registries. Relative survival (RS) during 20 years of follow up was analysed.ResultsILC was significantly associated with older age, larger tumours, ER positivity and well differentiated tumours. We noticed an improved survival for patients with ILC during the first five years, excess mortality rate ratio (EMRR) 0.64 (CI 95 % 0.53–0.77). This was shifted to a significant decreased survival 10–15 years after diagnosis (EMRR 1.49, CI 95 % 1.16–1.93). After 20 years the relative survival rates were similar, 0.72 for ILC and 0.73 for IDC.ConclusionsDuring the first five years after surgery, the EMRR was lower for patients with ILC as compared to patients with IDC, but during the years 10–15 after surgery, we observed an increased EMRR for patients with ILC as compared to IDC. These EMRR between ILC and IDC were statistically significant but the absolute difference in excess mortality between the two groups was small.     

Impact of neoadjuvant and adjuvant chemotherapy on invasive lobular carcinoma: A propensity score‐matched analysis of SEER data

Invasive lobular carcinoma (ILC) has a different treatment response from invasive ductal carcinoma (IDC). We assessed whether perioperative chemotherapy was associated with improved prognosis in patients with ILC. Retrospective data of women who underwent surgery for ILC were extracted from the SEER database. Subjects were divided into non‐chemotherapy and chemotherapy groups. Overall, 10 537 patients were included, and 2107 patients were stratified into each group after propensity score matching. Perioperative chemotherapy significantly improved 10‐year survival rates for ILC, particularly in patients with large tumor size and lymph node metastases. Perioperative chemotherapy is effective for ILC patients with proper selection.     

Gastrointestinal carcinomas occurring in breast cancer patients

Breast cancer patients are reported to have a higher rate of second primary malignancies. We retrospectively reviewed the coexistence of breast and gastrointestinal (GI) tumors in the same patients and the characteristics of the tumors. The charts of all patients more than 35 years of age who were diagnosed with breast cancer and hospitalized for various reasons between 1985 and 2003 were reviewed and those who also had a diagnosis of GI malignancy were then selected. Age and tumor characteristics were evaluated. Out of all the patients, 2,650 had a diagnosis of breast cancer, while 40 (1.5%) also had GI malignancies. Among a comparable group of 70,784 consecutive female patients without breast cancer, 1,292 patients (1.8%) had a diagnosis of GI malignancy. The location of GI tumors in patients with both tumors was as follows: stomach, 6 (15%); right colon, 8 (20%); left colon, 7 (17.5%); sigma, 9 (22.5%); and rectum, 10 (25%). Seventeen of the patients (51.5%) had Dukes C and D tumors, 14 (42.5%) Dukes B, and 2 (6%) Dukes A or in situ. The stage of the others was not identified. The mean age at diagnosis of breast cancer was 68.5 years (range 48-88 years). In 23 (57.5%), GI cancer was diagnosed after breast cancer, in 7 (17.5%) it was diagnosed within 3 months of diagnosing breast cancer, and in 8 (20%) it was diagnosed prior to the diagnosis of breast cancer. Five patients suffered from an additional primary cancer: three endometrial, one lung, one esophageal, and one patient had two additional tumors in the endometrium and thyroid. We conclude that the rate of GI malignancies in breast cancer patients is slightly lower than in comparable patients without breast cancer. GI malignancies tend to be diagnosed later and are found more often in the distal colon.