Noninvasive, microinvasive, and invasive mucinous carcinomas of the ovary: a clinicopathologic analysis of 40 cases

BACKGROUND: Whether ovarian mucinous tumors with epithelial stratification of more than three cell layers in the absence of stromal invasion (i.e., carcinomas diagnosed according to the Hart and Norris criteria) should be placed in the same category as mucinous tumors with stromal invasion (i.e., unquestionable carcinomas) remains controversial. Because individual mucinous tumors frequently contain benign, borderline, and malignant components, the adequacy of sampling has been emphasized. METHODS: We examined 21 mucinous carcinomas with no destructive stromal invasion (MCNI), 4 mucinous carcinomas with microinvasion (MCMI) of < 2 mm, and 15 mucinous carcinomas with invasion (MCI) of > or = 2 mm. Tumors were diagnosed as MCNI according to Hart and Norris criteria (12 tumors) or when severe nuclear atypia was present (9 tumors). Cases of MCNI were selected for review if a section had been taken for each 2 cm or less of the tumor's greatest diameter. The International Federation of Gynecology and Obstetrics stage and follow-up data of each case were examined, and differences among MCNI, MCMI, and MCI were analyzed. RESULTS: All 21 patients with MCNI and all 4 patients with MCMI had Stage I disease; there was no recurrence or death in these cases. In contrast, 7 of 15 patients with MCI had Stage II or III disease, and 8 patients died. CONCLUSION: MCNI clearly should be distinguished from MCI and be classified as noninvasive carcinomas after the absence of destructive stromal invasion has been confirmed by examining a sufficient number of sections.     

Mucinous carcinoma of the ovary. Pathologic prognostic factors.

Thirty-four ovarian mucinous carcinomas defined by nuclear stratification in excess of three layers (noninvasive mucinous carcinoma, NIMC) or stromal invasion (invasive mucinous carcinoma, IMC) were examined to define prognostic indicators. Twenty-two patients had NIMC (Stage I, 15; Stage II, 1; Stage III, 5; and Stage IV, 1). Twelve patients had IMC (Stage I, one; Stage II, one; and Stage III, ten). Fifteen patients died, ten with IMC and five with NIMC (mean survival, 16.7 months). Nineteen patients survived, two with IMC and 17 with NIMC (mean follow-up, 12 years). Ten of the 12 patients with IMC who died had Stage III disease. Five of the 22 patients with NIMC who died included four with Stage III and one with Stage I disease. Among patients who died, those with IMC tended to have a shorter mean survival than those with NIMC. No differences among groups were identified with respect to nuclear grade, mitotic activity, percentage of tumor displaying more than three cell layers, or amount of invasion. In ovarian mucinous carcinoma, clinical stage and stromal invasion are the most important prognostic variables, and they are interrelated. Stage I NIMC rarely pursues an aggressive course.     

Diagnosis, pathology, staging, treatment, and outcome of epithelial ovarian neoplasia in patients age < 21 years

BACKGROUND: Epithelial ovarian neoplasms are rare in patients under the age of 21 years. This is a report of a series of such patients documenting their presentation, histologic type, stage of disease, treatment, and outcome. METHODS: Clinical findings, histology, stage, treatment, and outcomes of 19 patients with epithelial ovarian neoplasia are reported. All histology was rereviewed. RESULTS: The median age at the time of diagnosis was 19.7 years (range, 14.1-21.8 years), and the median follow-up was 5.6 years (range, 0.2-19.5 years). The most common presenting symptom was dysmenorrhea (100%) followed by abdominal pain (68%), and the initial diagnosis usually was made ultrasonographically. There were nine (47%) serous tumors, 7 (37%) mucinous tumors, 2 (11%) small cell carcinomas, and 1 (5%) endometrioid carcinoma. Seventy-nine percent of tumors were unilateral, and 84% were low malignant potential or well differentiated tumors. Surgical treatment included unilateral salpingo-oophorectomy in 12 patients (63%), total abdominal hysterectomy and bilateral salpingo-oophorectomy in 6 patients (32%), and ovarian cystectomy in 1 patient (5%). Fifteen patients (79%) had Stage I disease, and 4 patients (21%) had Stage III disease at the time of diagnosis. There were two deaths in this series, and both occurred in patients with small cell anaplastic carcinoma. CONCLUSIONS: Epithelial ovarian neoplasias are rare in patients in this age group but must be included in the differential diagnosis of an ovarian mass. Most patients present with Stage I tumors of low malignant potential. In these patients, good survival is achieved with unilateral salpingo-oophorectomy and preservation of fertility. In contrast, small cell carcinomas are very aggressive, and patients with this variant require intensive therapy.     

Clinicopathologic study of asymptomatic gallbladder carcinoma found at autopsy

Of 3000 autopsy cases, consisting primarily of older patients, asymptomatic gallbladder carcinomas were found in 15 (0.5%); the incidence among all gallbladder carcinomas (80 cases) was 18.8%. In contrast to symptomatic gallbladder carcinomas, all of which were classified as Stage III (9.3%) or Stage IV (90.7%) disease, 80.0% of asymptomatic cases were classified as Stage 0 (13.3%), I (20.0%), or II (46.7%). Histologically, all the symptomatic cases of gallbladder carcinoma had invasion to the serosal or subserosal layer of the gallbladder as well as to the hepatoduodenal ligament. Lymphatic and hematogenous metastases of the symptomatic carcinomas were found in 94.4% and 64.8%, respectively. On the other hand, the carcinoma in the asymptomatic group was retained in the mucosal layer (M) in four cases, in the muscular layer (MUS) in one case, in the subserosal layer (SS) in nine cases (INF beta in seven cases and INF r in two in the mode of infiltration), and in the serosa (SE) in one case. However, cancerous invasion to the hepatoduodenal ligament or lymphatic metastasis was found in only two cases, whereas hematogenous metastasis was not found in any of them. Cancerous extension beyond the gallbladder wall was apparently rare in the cases of SS invasion, as well as in those of M or MUS invasion. It was suggested that, for radical resection of gallbladder carcinoma, it is very important to find it in an asymptomatic stage.     

卵巢交界性黏液瘤和黏液癌近期病理学研究

卵巢交界性黏液瘤(mucinousborderline overian tumor,MBT)的病理诊断和生物学行为始终存在较多争论。目前,对于卵巢交界瘤有的仍按低度恶性肿瘤的治疗原则进行处理,结果多数患者接受过分的治疗。近期研究证实,MBT和它伴同的上皮内癌及微浸润癌在排除了腹膜假黏液瘤和转移癌后,预后良好。500例MBT经随访,死亡率为1%。分析死亡原因认为,肿瘤内存在的破坏性浸润未被发现或者将腹膜假黏液瘤及转移癌误诊为MBT,结果出现了死亡病例。MBT伴上皮内癌的诊断标准为腺上皮细胞增生至3~4层以上,胞核明显异形性,其生存率为100%。MBT伴微浸润的诊断标准是肿瘤间质内出现单个或呈巢状排列的癌细胞浸润,癌灶直径3~5mm,经随访无1例复发和死亡。卵巢黏液癌的浸润特点是“融合性和膨胀性浸润”,若出现间质浸润则要考虑为转移癌。卵巢黏液癌内有80%为转移癌。卵巢原发性和转移性癌的病理诊断除根据上述特征外,免疫组织化学染色有助于鉴别。     

Early invasive mucinous carcinoma of the breast

Cases of early invasive mucinous carcinoma of the breast have been reviewed. Microscopically, a typical lesion exhibits leakage of cancerous mucus into the stromal tissue from an intraductal carcinomatous component which were shown to be mucus-producing and to be lower papillary projection. Among 5,360 primary breast cancers that had been mastectomized at the C.I.H., 11 or 0.21% were determined as being "early" cases. All of these cases exhibited "pure type" mucinous carcinomas which were found to be highly mucus. The average age of these patients was 41 years (range: 34-51 yrs.), and no cases showed a nodal involvement. During an average follow-up of 8 years, no recurrent case were found. Thus, we have found that these "early" cases revealed an early invasion of a mucinous carcinoma that is highly mucus-producing but without an invasive ductal carcinomatous pattern.     

Krukenberg tumor of the ovary

Light microscopic, ultrastructural and histochemical observation of 46 cases of ovarian Krukenberg tumors are described. The clinical material is also analysed. The histologic classification of this tumor is suggested to be four types: 1. classical Krukenberg tumor (CKT), 27 cases; 2. tubular Krukenberg tumor (TKT), 9 cases; 3. sclerosing Krukenberg tumor (SKT), 5 cases; and 4. mixed Krukenberg tumor (MKT), 5 cases. In CKT, single signet ring cells predominated over lumen-forming cells and contained ultrastructural and histochemical characteristics similar to cylindral cells of colonic and ovarian mucinous adenocarcinomas. The stroma contained extracellular mucin. In TKT, the lumen was formed by non-secretory and secretory cylindral cells. Some rare argentaffin cells were observed. Steroidgenic stromal lutein cells were identified in one case by electron microscope. Cells in both CKT and TKT produced neutral and sialomucins. Hypertrophic stromal fibroblasts were extremely rich in five SKT with signet ring cells occasionally located inside. It is easy to be misdiagnosed as fibroma or sclerosing stromal tumor. Five cases of MKT showed the mixed features of the above two or three types. Krukenberg tumors are almost always made up of intestinal type cells basing on cell differentiation. The TKT is better differentiated than CKT and SKT. Hypertrophy and hyperplasia of ovarian stromal cells may occur in response to malignant growth or the extracellular mucinous products of malignant cells. They may play a role in the control of tumor invasion.     

Cytoplasmic and stromal expression of laminin γ 2 chain correlates with infiltrative invasion in ovarian mucinous neoplasms of gastro-intestinal type

Ovarian mucinous neoplasms of gastro-intestinal type (GI-type) are known to be a heterogeneous tumor composed of benign, borderline and non-invasive and invasive malignant lesions. The presence of infiltrative invasion is also known to be an important prognostic factor of this neoplasm. Laminin γ 2 chain, known to stimulate tumor cell invasion and migration, has not been sufficiently investigated in ovarian mucinous neoplasms. The purpose of this study was thus to clarify the role of laminin γ 2 in ovarian mucinous neoplasms of GI-type. We selected each morphological phase of tumor development from 61 cases of mucinous neoplasms of the GI-type: 55 adenoma lesions, 60 borderline lesions, 20 microinvasive lesions, 17 intraepithelial carcinoma lesions, 38 expansile invasive carcinoma lesions, 19 infiltrative invasive carcinoma lesions and 5 mural nodules lesions; and evaluated the localization of laminin γ 2 in the lesions using immunohistochemical method. The staining pattern was classified into i) basement membranous (BM), ii) cytoplasmic (CYT) and iii) stromal (S) pattern. The BM pattern was characteristic in adenoma, borderline, and interaepithelial and expansile invasive carcinoma lesions. The CYT and S patterns were characteristic in infiltrative invasive lesions. The staining pattern of mural nodules was similar to that of infiltrative invasion. The infiltrative invasion of GI-type ovarian mucinous neoplasms may be promoted by cytoplasmic and/or stromal expression of laminin γ 2 chain.     

腮腺原发良、恶性肿瘤CT表现的比较分析

背景与目的:腮腺富含脂肪组织,与周围骨骼肌肉形成天然对比,CT能够较好地评价腮腺病变及其对周围结构的侵犯情况。术前CT对腮腺良恶性肿瘤的准确判断与评估能够有效指导临床诊断与治疗。本研究探讨CT对腮腺原发良、恶性肿瘤的鉴别诊断价值,提高术前定性诊断精确性。方法:回顾性分析了经病理证实的17例腮腺原发良性肿瘤和15例恶性肿瘤的CT表现,并进行统计学处理。32例患者均行CT增强扫描。由两位资深放射科医生进行阅片分析。结果:本组良性肿瘤(14/17)多表现为圆形或类圆形肿块,而恶性肿瘤(9/15)以分叶状或不规则肿块影常见,P=0.027。良性肿瘤(6/17)常出现散在小片状低密度灶,恶性肿瘤组未见散在片状低密度灶,P=0.019。良性肿瘤(13/17)大部分边缘光滑清晰,恶性肿瘤(11/15)多表现为边缘毛糙模糊,P=0.012。个别良性肿瘤(2/17)与胸锁乳突肌分界欠清,恶性肿瘤部分(9/15)侵犯咬肌或胸锁乳突肌,P=0.008。良性肿瘤均未见肿大淋巴结及血管神经侵犯,恶性肿瘤6例(6/15)出现肿大淋巴结,4例(4/15)出现神经血管侵犯,P值分别为0.006和0.038。结论:肿块的形态、边缘、内部低密度灶分布以及与邻近咬肌及胸锁乳突肌分界情况是腮腺良恶性肿瘤的重要鉴别点,淋巴结转移及血管神经侵犯是恶性肿瘤的特异性征象。综合多指标观察分析,CT能对大多数腮腺良、恶性肿瘤做出正确诊断。     

胃肠道间质瘤32例临床分析

目的 :提高对胃肠道间质瘤 (gastrointestinalstromaltumor ,GIST)的认识和诊治水平。方法 :回顾分析总结 32例GIST的临床资料。结果 :患者平均年龄 4 2 .7岁 ,男女比为 17∶15。病灶均为单发 ,部位以胃及小肠最多见 ,分别为 13例 ( 4 0 .6% )和 15例 ( 4 6.9% )。病理诊断良性 2 1例 ( 65.6% )、交界性5例 ( 15.6% )、恶性 6例 ( 18.8% )。结合肿瘤临床生物学行为 ,重新划分为GIST良性 18例 ( 56.3% )、交界性 4例 ( 12 .5% )、恶性 10例 ( 31.3% )。 32例均获手术切除 ,术后复发 2例 ,肝转移 4例 ,死亡 4例。结论 :GIST是一类具有恶性倾向的肿瘤 ,局部切除是足够而有效的治疗。术后应长期严密随访 ,对复发和 /或转移者应持积极态度 ,多次姑息切除 ,辅以TACE可望延长病人生存期。     

Predicting Lympho-Vascular Space Invasion in Endometrial Cancers with Mucinous Carcinomatous Components

Objective: To determine the predictors of lympho-vascular space invasion (LVSI) in endometrial cancerswhich contain mucinous carcinomatous histology. Materials and Methods: Clinical and histopathological dataof endometrial carcinomas with a mucinous carcinomatous component diagnosed between January 2007 andJanuary 2014 at the Gynecologic Oncology Department of Zekai Tahir Burak Women’s Health Education andResearch Hospital were reviewed retrospectively. Results: Twelve patients (25.5%) were positive for LVSI and 35(74.5%) patients were negative. Patients with LVSI were mostly staged higher than 1A. Mean age, BMI and paritywere not significantly different between patient groups. Larger tumor diameter (≥2cm) (p=0.04) and elevatedCa125 and Ca-19.9 (p=0.01) levels were significant for predicting LVSI. We also found >1/2 myometrial invasion(p<0.001), cervical stromal involvement (p=0.002) and higher grade (2-3) (p=0.001) significant for predictingLVSI. In multivariate analysis we found only grade significant for predicting LVSI. Conclusions: Especiallygrade of tumor is a crucial factor for determining LVSI in endometrial cancers with mucinous carcinomatouscomponents.     

Stage I epithelial ovarian tumors of low malignant potential

Clinical and pathological details of 10 patients with stage I low malignant potential tumors of the ovary, between September, 1969, and February, 1988, have been reviewed. The mean age of the patients was 46.6 years. Six patients had serous and four had mucinous tumors. Of the 10 patients, five had a unilateral salpingo-oophorectomy, one had a bilateral salpingo-oophorectomy and four a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The mean duration of follow-up was 12.8 years. All patients have remained alive and disease-free. A recurrence occurred in one patient who has been managed well by additional surgery. Stage I ovarian tumor of low malignant potential appears to carry a favorable prognosis.     

Histologic subtype has minor importance for overall survival in patients with adenocarcinoma of the uterine cervix: a population-based study of prognostic factors in 505 patients with nonsquamous cell carcinomas of the cervix.

BACKGROUND: The incidence of adenocarcinoma of the uterine cervix is increasing. For better prognostic information, the authors studied all nonsquamous cell carcinomas (non-SCCs) in the Norwegian population over a total of 15 years. METHODS: All non-SCCs from three 5-year periods (1966-1970, 1976-1980, and 1986-1990) were reviewed and classified according to the World Health Organization classification system, and histopathologic and clinical parameters were registered. Tissue blocks were available from all patients. RESULTS: Of 505 patients, 417 had tumors classified as adenocarcinoma, and 88 had tumors classified as other non-SCC. The mean ages were 53 years and 52 years for patients with adenocarcinoma and non-SCC, respectively. Sixty-two percent of the staged patients had clinical Stage I disease according to the classification system of the International Federation of Gynecology and Obstetrics (FIGO). In univariate analyses, histology, architectural and nuclear grade, extension to the vagina or corpus uteri, tumor length (> 20 mm) or tumor volume (> 3000 mm(3)), infiltration depth (in thirds of the cervical wall), thickness of the remaining wall (< 3 mm), vascular invasion, lymph node metastases, treatment, and patient age were significant variables in patients with FIGO Stage I disease. Variables with no significance in patients with Stage I disease were number of mitoses, state of resection margins, infiltration to ectocervix, tumor thickness, lymphoid reaction, earlier or concomitant cervical intraepithelial neoplasia, stump carcinoma, DNA ploidy or DNA index, or time period. Multivariate analyses of patients with FIGO Stage I disease identified small cell carcinoma, corpus infiltration, vascular invasion, and positive lymph nodes as independent prognostic factors. CONCLUSIONS: Small cell carcinoma was the only histologic subgroup of independent importance for prognosis in patients with non-SCC of the uterine cervix. No significant difference between major subtypes of adenocarcinoma favored a simplified classification. Extension to the corpus in patients with early-stage disease was of independent significance and should be acknowledged in planning treatment.     

Ovarian epithelial tumors of borderline malignancy. A clinical and pathologic study of 109 cases

One hundred nine cases of ovarian tumors of low malignant potential (borderline tumors) diagnosed at Stanford University Medical Center from 1958 to 1982 were reviewed. The patients ranged in age from 10 to 79 years (mean, 40.5 years). The histologic types and corresponding stages of these neoplasms were 73 serous (Stage IA: 35 patients; Stage IB+C: 16 patients; stage II: 8 patients; Stage III: 14 patients), 30 mucinous (Stage IA: 27 patients; Stage IB+C: 3 patients), and 6 mixed seromucinous (all Stage IA). Borderline endometrioid, clear cell, and Brenner tumors were excluded. Follow-up information from 3 to 27 years from the time of initial diagnosis (mean, 7.6 years; median, 7.1 years) revealed that 89 patients are alive without further evidence of neoplasm, and three patients died of unrelated disease without recurrent tumor. Seventeen patients have developed persistent or recurrent neoplasms in the contralateral ovary (six patients) and/or elsewhere within the peritoneal cavity (15 patients) at 5 to 226 months (mean, 61 months) after the initial excision. All of the second neoplasms were borderline serous or seromucinous tumors histologically identical to the original tumor; none of the borderline mucinous tumors recurred. Patients who initially had Stage III borderline serous tumors developed persistent or recurrent neoplasms more commonly (64%) than did patients with lower stage tumors (12%). No correlation was found between the development of a subsequent serous neoplasm and patient age, the primary tumor size, or any single histologic feature. Following treatment of the subsequent neoplasms, 13 patients are free of neoplasm, one patient is alive with tumor, one patient has died of intercurrent disease with tumor, and two patients have died with widespread abdominal tumor 53 and 232 months after their initial diagnosis. These findings confirm the excellent prognosis for patients with borderline serous tumors, despite involvement of the peritoneal cavity and the development of recrudescent tumor, although long-term follow-up is indicated. Mucinous borderline tumors, as defined by published criteria, almost invariably present as localized (low-stage) tumors and, in our experience, do not recur when confined to the ovary.     

Follicular Hurthle cell tumors of the thyroid gland

A clinicopathologic study of 153 cases of thyroid follicular Hurthle cell tumor (HCT) is presented. Follow-up, available in all cases, ranged from 5 to 26 years (median, 9 years). These neoplasms were divided into three categories on the basis of presence and degree of capsular and vascular invasion, pattern of growth (follicular, trabecular, or solid), nuclear atypia, and necrosis. The categories were benign (90 cases), indeterminate (35 cases), and malignant (28 cases). All the tumors classified histologically as benign or indeterminate behaved in a clinically benign fashion. Of the 28 tumors classified histologically as malignant, 20 had a clinically malignant behavior. At survival analysis, no clinical or pathologic feature among the carcinomas was found to correlate with a fatal outcome. It is concluded that histologic criteria alone can distinguish benign from malignant HCT and that clinical or pathologic feature cannot predict behavior among the malignant tumors.     

Cystic pancreatic tumors (CPT): predictors of malignant behavior

BACKGROUND AND OBJECTIVES: Due to widespread use of imaging studies, increasing cystic pancreatic tumor (CPT) cases are being detected. The diagnosis of malignancy in CPT cases requires pancreatectomy. Clinical and laboratory characteristics of CPT may predict underlying malignancy. METHODS: CPT cases treated between 1994 and 2004 at our institution were included. Pseudocysts were excluded. Serous cystadenoma (SCA), mucinous cystadenoma (MCA), intrapapillary mucinous tumor, cystic endocrine tumor, and lymphoepithelial cysts were classified as benign or pre-malignant. Serous cystadenocarcinoma (SCACA), mucinous cystadenocarcinoma (MCACA), and adenocarcinoma (ACA) were classified as malignant. RESULTS: Thirty-five patients had histological confirmation. Median age was 65 years. Male/female ratio was higher in malignant group (P = 0.0284). Weight loss and abdominal mass were more prevalent in malignant group (P = 0.042 and 0.028, respectively). Malignant lesions were larger, associated with local invasion (superior mesenteric artery (SMA), superior mesenteric vein (SMV), portal vein (PV) complex or celiac encasement) and CA 19-9 elevation. On univariate analyses, local invasion (P = 0.0029), negative surgical intervention (P = 0.0010), presence of ACA (P = 0.0044), or malignant CPT (P = 0.0018) were associated with shorter survival. On a multivariate analysis, local invasion was associated with shorter survival [Hazard ratio (HR) = 4.322, P = 0.0218], while surgical intervention was associated with improved survival (HR = 0.179, P = 0.0124). CONCLUSION: Male sex, abdominal mass, weight loss, larger tumor size, local invasion, and elevated CA 19-9 were associated with malignant CPT.     

Clinicopathological studies and patterns of recurrence of mucinous colorectal carcinoma with curative resection

In 771 cases of Stage II and III colorectal carcinoma with curative resection, clinicopathological characteristics, recurrent rate, patterns of recurrence, and prognosis of 24 cases (3%) of mucinous carcinoma were compared with those of 725 cases (94%) of well-moderately differentiated adenocarcinoma. Compared with well-moderately differentiated adenocarcinoma, mucinous carcinoma was found to be larger in tumor size, more severe lymphatic invasion, and a greater likelihood of Stage IIIb. Mucinous carcinoma had a highly recurrent rate and poorer prognosis than well-moderately differentiated adenocarcinoma. About the patterns of recurrence, mucinous carcinoma was found to be more significantly often as lymph node recurrences, but there was no liver metastasis in mucinous carcinoma. As for mucinous colorectal carcinoma, we should consider other different therapeutic strategies and surveillance.     

Expression of p53 protein in invasive colorectal carcinomas of different histologic types.

BACKGROUND. This study was performed to determine whether morphologic differences of colonic cancer types can be related to different genotypes of these tumors. METHODS. Paraffin sections of 76 human invasive colorectal carcinomas were examined for the overexpression of p53 oncoprotein with the avidin-biotin complex-peroxidase staining procedure and CM-1 antiserum, which detects p53 protein in paraffin-embedded material. The tumors were categorized as mucinous (22 cases), most of which originated from adenomas, and nonmucinous, which were subdivided into carcinomas originating from adenoma-carcinoma sequence (ACS) (29 cases) and de novo (DN) carcinomas (25 cases). RESULTS. Nineteen DN carcinomas (76%), 21 ACS carcinomas (72%), and 8 mucinous carcinomas (36%) exhibited detectable amounts of p53 protein in the tumor cell nuclei. Strong overexpression of p53 protein coincided with a high percentage (> 40%) of stained nuclei in 40% of ACS and 48% of DN carcinomas versus 9% of mucinous tumors. The percentage of stained nuclei, intensity of staining, and distribution of the stained areas did not correlate with the grade of differentiation or the invasive edge of the tumors. Along with nuclear staining of the tumor area, a distinct perinuclear staining of normal epithelial cells adjacent to the tumor was observed in 48% of DN, 7% of ACS, and 9% of mucinous carcinomas. CONCLUSIONS. The current results, in combination with the recently published data on Ki-ras and c-myc alterations, indicate that mucinous carcinomas differ from nonmucinous colorectal carcinomas in their genetic lesions.     

Increased expression of laminin-5 and its prognostic significance in lung adenocarcinomas of small size. An immunohistochemical analysis of 102 cases

BACKGROUND: Laminin-5 plays an important role in cell migration during tissue remodeling and tumor invasion. METHODS: The authors studied the expression of laminin-5 immunohistochemically in 102 cases of small-sized lung adenocarcinoma (maximum dimension < or = 2 cm) using a monoclonal antibody against the laminin gamma2 chain, and they also investigated the associations of laminin-5 with clinicopathologic characteristics. Prognostic significance of increased laminin-5 expression was evaluated using the Kaplan-Meier method and the Cox proportional hazard model. RESULTS: Overall, laminin-5 expression was observed in 82 cases (80.4%): 7 of 18 (38.9%) bronchioloalveolar carcinomas and 75 of 84 (89.3%) invasive adenocarcinomas. Laminin-5 was preferentially localized in the cytoplasm of tumor cells at the tumor-stromal interface, where budding or dissociation of cancer cells was frequently observed. Overexpression of laminin-5 (24 cases, 23.5%) was associated with vascular invasion (P = 0.021) and stromal fibroblastic reaction (P = 0.005) but not with nodal involvement, lymphatic invasion, or pleural invasion. Survival analysis revealed that overexpression of laminin-5 was associated with shorter patient survival (P = 0.0027 by log rank test). On multivariate analysis, overexpression of laminin-5 was an independent prognostic factor (P = 0.030), as were nodal involvement (P < 0.0001), vascular invasion (P = 0.047), and lymphatic invasion (P = 0.0047) in a whole cohort of patients. Moreover, when patients with Stage I (International Union Against Cancer [UICC] staging system) disease were considered in multivariate analysis, overexpression of laminin-5 was the only significant prognostic factor (P = 0.022), whereas vascular invasion had a marginally significant impact (P = 0.07) on patient survival. CONCLUSIONS: The authors' results showed that laminin-5 is frequently expressed by cancer cells at the invasive front of lung adenocarcinoma. The study concluded that overexpression of laminin-5 may be a useful prognostic factor in patients with small-sized lung adenocarcinoma, especially in Stage I cases.