Journal of Pathology and Translational Medicine

Original Articles

Prognostic Significance of a Micropapillary Pattern in Pure Mucinous Carcinoma of the Breast: Comparative Analysis with Micropapillary Carcinoma: Hyun-Jung Kim, Kyeongmee Park, Jung Yeon Kim, Guhyun Kang, Geumhee Gwak, Inseok Park; J Pathol Transl Med. 2017;51(4):403-409. Published online June 9, 2017; DOI: https://doi.org/10.4132/jptm.2017.03.18

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Background
Mucinous carcinoma of the breast is an indolent tumors with a favorable prognosis; however, micropapillary features tend to lead to aggressive behavior. Thus, mucinous carcinoma and micropapillary carcinoma exhibit contrasting biologic behaviors. Here, we review invasive mucinous carcinoma with a focus on micropapillary features and correlations with clinicopathological factors.
Methods
A total of 64 patients with invasive breast cancer with mucinous or micropapillary features were enrolled in the study. Of 36 pure mucinous carcinomas, 17 (47.2%) had micropapillary features and were termed mucinous carcinoma with micropapillary features (MUMPC), and 19 (52.8%) had no micropapillary features and were termed mucinous carcinoma without micropapillary features. MUMPC were compared with 15 invasive micropapillary carcinomas (IMPC) and 13 invasive ductal and micropapillary carcinomas (IDMPC).
Results
The clinicopathological factors of pure mucinous carcinoma and MUMPC were not significantly different. In contrast to IMPC and IDMPC, MUMPC had a low nuclear grade, lower mitotic rate, higher expression of hormone receptors, negative human epidermal growth factor receptor 2 (HER2) status, lower Ki-67 proliferating index, and less frequent lymph node metastasis (p < .05). According to univariate analyses, progesterone receptor, HER2, T-stage, and lymph node metastasis were significant risk factors for overall survival; however, only T-stage remained significant in a multivariate analysis (p < .05).
Conclusions
In contrast to IMPC and IDMPC, the micropapillary pattern in mucinous carcinoma does not contribute to aggressive behavior. However, further analysis of a larger series of patients is required to clarify the prognostic significance of micropapillary patterns in mucinous carcinoma of the breast.

Citations

Citations to this article as recorded by

Pure mucinous adenocarcinoma of the breast with the rare lymphoplasmacytic infiltration: A case report with review of literature
Yash Hasmukhbhai Prajapati, Vishal Bhabhor, Kahan Samirkumar Mehta, Mithoon Barot, Husen Boriwala, Mohamed Omar
Clinical Case Reports.2024;[Epub] CrossRef
Expression of autocrine motility factor receptor (AMFR) in human breast and lung invasive micropapillary carcinomas
Jing Xu, Hongfei Ma, Qi Wang, Hui Zhang
International Journal of Experimental Pathology.2023; 104(1): 43. CrossRef
The Spectrum of Mucinous Lesions of the Breast
Upasana Joneja, Juan Palazzo
Archives of Pathology & Laboratory Medicine.2023; 147(1): 19. CrossRef
Pure Mucinous Carcinoma of the Breast: Radiologic-Pathologic Correlation
Cherie M Kuzmiak, Benjamin C Calhoun
Journal of Breast Imaging.2023; 5(2): 180. CrossRef
On Ultrasonographic Features of Mucinous Carcinoma with Micropapillary Pattern
Wei-Sen Yang, Yang Li, Ya Gao
Breast Cancer: Targets and Therapy.2023; Volume 15: 473. CrossRef
Micropapillary Breast Carcinoma: From Molecular Pathogenesis to Prognosis
Georgios-Ioannis Verras, Levan Tchabashvili, Francesk Mulita, Ioanna Maria Grypari, Sofia Sourouni, Evangelia Panagodimou, Maria-Ioanna Argentou
Breast Cancer: Targets and Therapy.2022; Volume 14: 41. CrossRef
Mucinous carcinoma of the breast: distinctive histopathologic and genetic characteristics
Minjung Jung
Kosin Medical Journal.2022; 37(3): 176. CrossRef
Triple-Positive Breast Carcinoma: Histopathologic Features and Response to Neoadjuvant Chemotherapy
Jennifer Zeng, Marcia Edelweiss, Dara S. Ross, Bin Xu, Tracy-Ann Moo, Edi Brogi, Timothy M. D'Alfonso
Archives of Pathology & Laboratory Medicine.2021; 145(6): 728. CrossRef
HER2 positive mucinous carcinoma of breast with micropapillary features: Report of a case and review of literature
Dinesh Chandra Doval, Rupal Tripathi, Sunil Pasricha, Pankaj Goyal, Chaturbhuj Agrawal, Anurag Mehta
Human Pathology: Case Reports.2021; 25: 200531. CrossRef
Sonographic Features of Pure Mucinous Breast Carcinoma With Micropapillary Pattern
Wu Zhou, Yong-Zhong Li, Li-Min Gao, Di-Ming Cai
Frontiers in Oncology.2021;[Epub] CrossRef
Clinicopathologic characteristics of HER2-positive pure mucinous carcinoma of the breast
Yunjeong Jang, Hera Jung, Han-Na Kim, Youjeong Seo, Emad Alsharif, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, Yeon Hee Park, Eun Yoon Cho, Soo Youn Cho
Journal of Pathology and Translational Medicine.2020; 54(1): 95. CrossRef
Mucinous carcinoma with micropapillary features is morphologically, clinically and genetically distinct from pure mucinous carcinoma of breast
Peng Sun, Zaixuan Zhong, Qianyi Lu, Mei Li, Xue Chao, Dan Chen, Wenyan Hu, Rongzhen Luo, Jiehua He
Modern Pathology.2020; 33(10): 1945. CrossRef
Micropapillary pattern in pure mucinous carcinoma of the breast – does it matter or not?
Xiaoli Xu, Rui Bi, Ruohong Shui, Baohua Yu, Yufan Cheng, Xiaoyu Tu, Wentao Yang
Histopathology.2019; 74(2): 248. CrossRef
An Update of Mucinous Lesions of the Breast
Beth T. Harrison, Deborah A. Dillon
Surgical Pathology Clinics.2018; 11(1): 61. CrossRef
The clinicopathological significance of micropapillary pattern in colorectal cancers
Jung-Soo Pyo, Mee Ja Park, Dong-Wook Kang
Human Pathology.2018; 77: 159. CrossRef
The sonographic findings of micropapillary pattern in pure mucinous carcinoma of the breast
Heqing Zhang, Li Qiu, Yulan Peng
World Journal of Surgical Oncology.2018;[Epub] CrossRef
Diagnostic dilemma of micropapillary variant of mucinous breast cancer
Geok Hoon Lim, Zhiyan Yan, Mihir Gudi
BMJ Case Reports.2018; : bcr-2018-225775. CrossRef

Cytological Findings of the Micropapillary Variant of Urothelial Carcinoma: A Comparison with Typical High-Grade Urothelial Carcinoma: Kyu-Ho Kim, Chang-Hwan Choi, Jee-Young Han, Lucia Kim, Suk-Jin Choi, In-Suh Park, Joon-Mee Kim, Young-Chae Chu; Korean J Pathol. 2013;47(4):365-371. Published online August 26, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.4.365

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Abstract PDF

Background

Micropapillary variant of urothelial carcinoma (MPUC) showed distinct pathologic features and aggressive behavior. The cytologic findings of MPUC are still indistinct. In this study, we evaluated the cytological findings of MPUC compared with those of high-grade urothelial carcinoma (HGUC).

Methods

The voided urine cytology of 8 cases of MPUC and 8 cases of HGUC was reviewed. Following cytological parameters were evaluated: cellularity, background, number of small, tight papillary clusters, small acinar structure, scattered single cells, cytoplasmic features, nuclear-to-cytoplasmic ratio, nuclear pleomorphism, nuclear membrane irregularity, hyperchromasia, chromatin pattern and nucleoli.

Results

Compared to that of HGUC, cytology of MPUC showed large numbers of small, tight papillary clusters, small acinar structure, few numbers of single cells, and hyperchromatic nuclei. Other parameters were similar between the two groups; both groups showed similar cellularity, dense or vacuolated cytoplasm, moderate to severe nuclear pleomorphism, irregular nuclear membrane, coarse granular chromatin, and small and prominent nucleoli.

Conclusions

The urine cytology of MPUCs showed smaller and tighter papillary cell clusters, more small acinar structures, fewer numbers of scattered single cells, and more hyperchromatic nuclei than that of HGUC. These features can help to distinguish MPUC and HGUC and offer an early cytological diagnosis of MPUC.

Citations

Citations to this article as recorded by

Cytologic features of micropapillary variant urothelial carcinoma in urinary tract cytology: Case series and review of literature
Nancy Y. Greenland, Yue Peng, Poonam Vohra, Z. Laura Tabatabai
Diagnostic Cytopathology.2022;[Epub] CrossRef
Cyto-histo correlations of plasmacytoid and micropapillary variants of high-grade urothelial carcinoma: do they fit well in The Paris System for reporting urinary cytology?
Liye Suo, Ivonne Vega, Michael Thrall
Journal of the American Society of Cytopathology.2021; 10(1): 20. CrossRef
A case report of urothelial carcinoma with combined micropapillary and plasmacytoid morphology in the urinary bladder
Sanghui Park, Min‐Sun Cho, Kwang Hyun Kim
Diagnostic Cytopathology.2016; 44(2): 124. CrossRef
Two cases with the micropapillary variant of urothelial carcinoma of the urinary bladder
Akiko KAGOTANI, Mitsuaki ISHIDA, Muneo IWAI, Nozomi IWAMOTO, Nozomi KASUGA, Yuji HAYASHI, Yoshimitsu MIYAHIRA, Ryoji KUSHIMA
The Journal of the Japanese Society of Clinical Cytology.2016; 55(3): 165. CrossRef

Cancer Subtypes of Breast Carcinoma with Micropapillary and Mucinous Component Based on Immunohistochemical Profile.: Sun Young Min, Eun Jung Jung, Hyesil Seol, In Ae Park; Korean J Pathol. 2011;45(2):125-131.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.2.125

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Abstract PDF

BACKGROUND
Micropapillary carcinoma (MPC) is known to have a worse prognosis than the other subtypes of breast cancer. Occasionally, MPC is observed in association with invasive ductal carcinoma not otherwise specified (IDC NOS), as well as mucinous carcinoma.
METHODS
We examined the immunohistochemical expression of an estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) in 127 cases of surgically resected MPC or IDC NOS with MPC. Further, we classified these cases based on their immunohistochemical profile.
RESULTS
Among the IDC NOS with MPC cases, 47 were luminal A (62.7%), 10 were luminal B (13.3%), and 9 were HER2 (12.0%). The MPC cases included 4 luminal A (50.0%), 2 luminal B (25.0%) and 1 HER2 (12.5%) subtypes. Of the mucinous carcinomas with MPC, 4 were grouped as luminal A (57.1%), 1 as luminal B (14.3%), and 2 as HER2 (28.6%) subtypes. However, among the mucinous carcinomas, 33 were categorized as luminal A (89.2%), 3 as luminal B (8.1%), and 1 as HER2 (2.7%) subtype, indicating a low incidence of HER2 subtype as compared to the other subtypes.
CONCLUSIONS
The luminal B and HER2 subtypes were prevalent in carcinomas with MPC. This result explains the poor prognosis of breast carcinomas with an MPC pattern.

Citations

Citations to this article as recorded by

Investigation of Clinical Histopathologic Features and Metabolic Parameters of ¹⁸F-FDG PET/CT in Invasive Breast Carcinoma with a Micropapillary Component
Elife Akgün, Göksel Alçın, Esra Canan Kelten Talu, Tevfik Fikret Çermik, Tuçe Söylemez Akkurt, Ebru Şen, Esra Arslan
Molecular Imaging and Radionuclide Therapy.2023; 32(3): 221. CrossRef
Micropapillary Breast Carcinoma: From Molecular Pathogenesis to Prognosis
Georgios-Ioannis Verras, Levan Tchabashvili, Francesk Mulita, Ioanna Maria Grypari, Sofia Sourouni, Evangelia Panagodimou, Maria-Ioanna Argentou
Breast Cancer: Targets and Therapy.2022; Volume 14: 41. CrossRef
Micropapillary variant of mucinous breast carcinoma: A distinct subtype
Katrina Collins, Andrew Ricci
The Breast Journal.2018; 24(3): 339. CrossRef
Prognostic Significance of a Micropapillary Pattern in Pure Mucinous Carcinoma of the Breast: Comparative Analysis with Micropapillary Carcinoma
Hyun-Jung Kim, Kyeongmee Park, Jung Yeon Kim, Guhyun Kang, Geumhee Gwak, Inseok Park
Journal of Pathology and Translational Medicine.2017; 51(4): 403. CrossRef

Case Reports

Pulmonary Adenocarcinoma with a Micropapillary Pattern Detected by Bronchial Washing: A Brief Case Report.: Jae Hong Park, Seung Yeon Ha, Hyun Yee Cho, Dong Hae Chung, Na Rae Kim, Sanghui Park; Korean J Cytopathol. 2008;19(2):206-208.; DOI: https://doi.org/10.3338/kjc.2008.19.2.206

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Abstract PDF: Adenocarcinomas with micropapillary patterns are generally aggressive and show lymphotropism. Only a few reports on pulmonary adenocarcinoma with micropapillary patterns have described cytologic findings. A 70-year-old Korean woman was admitted to the hospital because of intermittent dry cough and chest pain. Cytology after bronchial washing showed neoplastic cells in small, angulated, cohesive clusters consisting of 3-20 cells without a fibrovascular core. The resected right middle lobe showed a tumor occupying almost the entire lobe. Histologically, about 90% of neoplastic cells proliferated with micropapillary morphology in the background of bronchioloalveolar carcinoma. Cytologic smears of a bronchial washing showing tumor cells in small, cohesive clusters without a fibrovascular core may indicate an adenocarcinoma with micropapillary pattern.

Invasive Micropapillary Carcinoma of the Breast: A clinicopathologic study of 16 cases.: Young Kyung Bae, Dong Sug Kim, Mi Jin Kim, Soo Jung Lee; Korean J Pathol. 1999;33(4):267-273.

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Abstract PDF: Invasive micropapillary carcinoma is a recently defined unusual variant of invasive breast carcinoma characterized by the formation of micropapillae within clear spaces separated by delicate fibrocollagenous stroma. This study was designed to examine clinicopathologic features of invasive micropapillary carcinoma of the breast. Sixteen cases of invasive micropapillary carcinoma were retrieved from the files of the Department of Pathology, Yeungnam University College of Medicine. We evaluated their clinicopathologic findings including patients' age, tumor size, nuclear grade, vascular invasion, axillary lymph node status, presence of extensive intraductal carcinoma, estrogen and progesterone receptors, p53, c-erbB-2, MIB-1 labelling index and follow-up data and compared this results with those of 292 cases of invasive ductal carcinoma, not otherwise specified. The incidence of invasive micropapillary carcinoma was 4.2% of all invasive breast carcinoma, and the mean age of the patients was 46 years. Nine cases were pure form (over 75% of micropapillary growth pattern in the tumor) and seven cases were mixed form. The results of clinicopathologic findings, except vascular invasion and axillary lymph node status, of the 16 cases of invasive micropapillary carcinoma were not different from those of the 292 cases of invasive ductal carcinoma, not otherwise specified (p>0.05). However, the rate of vascular invasion and axillary lymph node metastasis was significantly higher in invasive micropapillary carcinoma (p <0.05). Of 16 cases, five cases had distant metastasis during follow-up period, and one patient died of cancer. Although the mechanism of higher vascular invasion and lymph node metastasis in micropapillary growth pattern could not be determined, we propose that invasive micropapillary carcinoma should be recognized as a separate entity with increased risks of vascular invasion and axillary lymph node metastsis.

Fine Needle Aspiration Cytology of Invasive Micropapillary Carcinoma of the Breast: Report of four Cases.: Sun Young Kwon, Hae Ra Jung, Yu Na Kang, Sang Pyo Kim, Kun Young Kwon, Sang Sook Lee; Korean J Cytopathol. 2004;15(2):106-111.

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Abstract PDF: Invasive micropapillary carcinoma (IMPCa) is a rare variant of invasive ductal carcinoma of the breast. This variant is associated with a set of peculiar cytological findings and aggressive biological behaviors. In most reported cases, IMPCa has involved massive axillary lymph node metastases at the time of diagnosis. We experienced four cases of cytological features of IMPCa, all of which were verified by histological examination. Fine needle aspiration cytology (FNAC) revealed malignant epithelial cells, which formed small, oval to angulated papillary clusters, which lacked central fibrovascular cores. The histological findings of the four cases revealed both pure and mixed forms of IMPCa, composed of cohesive malignant epithelial cells, surrounded by distinctive clear spaces and separated by thin fibrous septa. All patients evidenced axillary lymph node metastases at the time of diagnosis. It is important to identify the peculiar cytological findings which would differentiate IMPCa from other diseases.

Micropapillary Variant of Urothelial Carcinoma of the Urinary Bladder: Report of a Case with Cytologic Diagnosis in Urine Specimen.: Young Seok Lee, Hyunjoo Lee, Jung Woo Choi, Bongkyung Shin, Hankyem Kim, Insun Kim, Aeree Kim; Korean J Cytopathol. 2006;17(1):46-50.

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Abstract PDF: A micropapillary variant of urothelial carcinoma (MPC) is a distinct entity with an aggressive clinical course. It has a micropapillary configuration resembling that of ovarian papillary serous carcinoma. Its cytologic features have rarely been reported. We report a case of MPC detected by urine cytology. A woman aged 93 years presented with a chief complaint of macroscopic hematuria. Cytology of her voided urine showed clusters of malignant cells in a micropapillary configuration. Each tumor cell had a vacuolated cytoplasm, a high nuclear:cytoplasmic ratio, and irregular hyperchromatic nuclei. An ureteroscopic examination revealed exophytic sessile papillary masses extending from the left lateral wall to the anterolateral wall of the urinary bladder. A transurethral resection of the tumor was carried out. The tumor was characterized by delicate papillae with a thin, well-developed fibrovascular stromal core and numerous secondary micropapillae lined with small cuboidal cells containing uniform low- to intermediate-grade nuclei and occasional intracytoplasmic mucinous inclusions. These tumor cells infiltrated the muscle layers of the bladder, and lymphatic tumor emboli were frequently seen. Recognizing that the presence of MPC components in urinary cytology is important for distinguishing this lesion from low-grade papillary lesions and high-grade urothelial carcinomas can result in early detection and earlier treatment for an improved treatment outcome.

Original Articles

Fine Needle Aspiration Cytology of Invasive Micropapillary Carcinoma of the Breast.: Hyun Joo Choi, Ji Han Jung, Jung Ha Shin, Kiouk Min, Jinyoung Yoo, Seok Jin Kang, Kyo Young Lee; Korean J Cytopathol. 2007;18(1):62-68.

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Abstract PDF: Invasive micropapillary carcinoma (IMPC) of the breast is recently described rare variant of invasive ductal carcinoma. This variant has a distinctive histological features and aggressive biological behavior. We reviewed the cytologic features of eight cases of IMPC. The cytologic smears showed moderate to high cellularity and the tumor tissue was composed of atypical, angulated, cohesive clusters of neoplastic cells with a papillary to tubuloalveolar architecture, and a morular growth pattern without fibrovascular cores was seen on the histopathology. IMPC of the breast has distinctive cytologic features and it is important to make an early diagnosis via fine needle aspiration cytology due to this tumor's aggressive behavior.

Clinicopathologic Analysis of the Micropapillary Variant of Urothelial Carcinoma in Urinary.: Kyungji Lee, Ahwon Lee, Yeong Jin Choi, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Pathol. 2006;40(4):263-268.

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Abstract PDF: BACKGROUND
Micropapillary urothelial carcinoma of urinary bladder is a rare and aggressive subtype of urothelial carcinoma (UC).
METHODS
AND RESULTS: Seven UCs with a micropapillary component (MPC) were identified by reviewing 135 cystectomy specimens of UC (5.2% in incidence). MPC was associated with conventional UC in 6 cases and the plasmacytoid variant of UC in 1 case. Lymph node metastasis, that characteristically contained MPC was present in 60% (3 out of 5 cases of regional lymph node dissection). Three patients with extensive MPC showed laminar propria invasion (pT1; 33%) and perivesical fat invasion (pT3; 67%). Two out of 3 patients with extensive MPC showed distant metastasis into the colon after cystectomy. The colonic lesions showed exclusively micropapillary differentiation. Four patients with focal or moderate MPC (pT2, 25%; pT3, 75%) were alive without disease at the time of writing this article. All 3 cases with extensive MPC had surface and/or invasive MPC on the prior TURB specimen. Immunohistochemically, the tumor cells were positive for cytokeratin 7, cytokeratin 20, EMA and E-cadherin and tissue retraction spaces that simulate lymphatic spaces were negative for CD34 in all 7 cases.
CONCLUSIONS
This study suggests that the micropapillary growth pattern in UC is a manifestation of aggressive behavior and UC with MPC must be included as part of the differential diagnosis when dealing with a metastatic lesion with a micropaillary structure.

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