Invasive micropapillary carcinoma of the breast. A prognostic Study

Department of Pathology, Evanston Northwestern Healthcare and Northwestern University Medical School, IL 60201, USA.
Human Pathlogy (Impact Factor: 2.77). 12/1999; 30(12):1459-63. DOI: 10.1016/S0046-8177(99)90168-5
Source: PubMed


Invasive micropapillary carcinoma (IMC) of the breast is a rare variant of infiltrating ductal carcinoma that has been associated with an extremely high incidence of lymph node metastases. Follow-up studies on patients with pure IMC breast cancer histology have been limited by low patient numbers, short duration of follow-up, and a lack of multivariate analyses. Using invasive breast cancers from 1,287 patients (median follow-up, 13.8 years), histological review showed 21 cases (1.7%) with pure IMC histology. Pure IMC histology was associated with high-grade histology (P = .04), metastases to regional lymph nodes (P < .001), a high mitotic index (P = .02), and erbB-2 immunopositivity (P = .007). Univariate analyses showed a strong association between IMC histology and shortened survival (disease-free survival [DFS], P = .0052; median, 44 months for IMC and 63 months for non-IMC; disease-specific survival [DSS], P = .014; medians, 71 and 78 for IMC and non-IMC, respectively) only in an analysis of all patients. Because only 1 case of node-negative IMC histology was available, univariate analysis of IMC histology was performed only on node-positive patients without significance. Multivariate analyses comparing IMC histology with either node-positive or all other breast cancers failed to show independent prognostic significance. In summary, breast cancer patients with pure IMC histology showed survival rates similar to those of other patients with equivalent numbers of lymph node metastases.

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Available from: Ann Denise Thor, Jun 03, 2014
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    • "This carcinoma has been reported to exhibit lymphovascular invasion, lymph node metastasis, local recurrence and distant metastasis at relatively high frequencies, thus exhibiting a more aggressive behavior than invasive ductal carcinoma (IDC) [2], [3]. The rate of incidence of IMPC of the breast has been reported to range from 1.0–8.4% [4], [5], [6], [7], [8], [9], [10]. Due to the low incidence of this breast cancer variant, most studies examining IMPC have small sample sizes; the clinico-pathological characteristics and the clinical prognostic factors of invasive micropapillary carcinoma are therefore not well understood. "
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    ABSTRACT: Background Invasive micropapillary carcinoma (IMPC) of the breast is a rare subtype of breast cancer that is associated with a high incidence of regional lymph node metastases and a poor clinical outcome. However, the clinico-pathological features and prognostic factors of IMPC are not well understood. Patients and Methods A total of 188 IMPC cases and 1,289 invasive ductal carcinoma (IDC) cases were included. The clinical features, breast cancer-specific survival (BCSS) and recurrence/metastasis-free survival (RFS) of the patients were compared between these two groups. Results The IMPC patients exhibited more features of aggressive carcinoma than the IDC patients, including larger tumor size, higher tumor stage, a greater proportion of nodal involvement and an increased incidence of lymphovascular invasion. Patients with IMPC had lower 5-year BCSS and RFS rates (75.9% and 67.1%, respectively) than patients with IDC (89.5% and 84.5%, respectively). Compared to IDC patients, the patients with IMPC had a significantly higher percentage of stage III breast cancer (51.3% versus 21.7%). In a stage-matched Kaplan-Meier analysis, the patients with stage III IMPC had lower 5-year BCSS and RFS rates than patients with stage III IDC (BCSS, P = 0.004; RFS, P = 0.034). A multivariate analysis revealed that TNM stage was an independent prognostic factor for patients with IMPC. The proportion of cancers with a luminal-like subtype was significantly higher in IMPC than in IDC (P<0.001). However, after matching by molecular subtype, the patients with IMPC had significantly worse clinical outcomes than patients with IDC. Conclusions In Chinese women, IMPCs displayed more aggressive behaviors than IDCs, resulting in poorer clinical outcomes for patients with IMPC, regardless of a favorable molecular subtype. Our findings illustrate that the poorer survival of patients with IMPC might be due to an increased incidence and aggressiveness of tumors in TNM stage III.
    PLoS ONE 06/2014; 9(6):e101390. DOI:10.1371/journal.pone.0101390 · 3.23 Impact Factor
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    • "IMPC was first reported by Siriaunkgul and Tavassoli in 1993 as a rare subtype of epithelial tumor of the breast [3]. The percentage of IMPC in all breast cancers is estimated to be 1.7% to 2.7% [4,5]. IMPC is characterized by an inside-out growth pattern forming a micropapillary or tubular-alveolar arrangement [3], invasion to the lymphatic or vascular space and a high frequency of lymph node metastasis [4,6-8]. "
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    ABSTRACT: We herein report a case of invasive micropapillary carcinoma (IMPC) involving extensive lymph node metastasis with no recurrence for over 7 years. A 41-year-old female presented with pain and a swelling mass in the left axillary region, which had been present for several months. The tumor measured 1.6 cm in diameter in the middle of upper area of the left breast. Based on the findings of a core needle biopsy the pathological diagnosis was IMPC or mucinous carcinoma. The cytology of the left axillary lymph node was positive for metastatic carcinoma. The patient underwent a left mastectomy and a left axillary dissection (level I to III). The postoperative pathological diagnosis was IMPC with mucin production, and the number of metastatic lymph nodes was 59. The patient was given adjuvant chemotherapy (four courses of 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and four courses of docetaxel), radiation for the left chest wall, supraclavicular and internal thoracic area, and then received tamoxifen for 5 years. The patient has remained recurrence-free for over 7 years. IMPC is known to be an aggressive histological type associated with a high incidence of lymph node metastasis and a poor prognosis. It seems that long-term survival was obtained by performing sufficient medical treatment. Prognostic factors other than the number of lymph node metastases may also exist.
    World Journal of Surgical Oncology 04/2014; 12(1):84. DOI:10.1186/1477-7819-12-84 · 1.41 Impact Factor
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    • "Invasive micropapillary carcinoma (IMPC) was first reported as a rare subtype of invasive ductal carcinoma of the breast, defined as a carcinoma composed of small clusters of tumor cells lying within clear spaces simulating vascular channels [1]. IMPC has been described as a histological indicator for lymphatic invasion and nodal metastasis, resulting in poor prognosis [2]. After initially being reported as a histological variant of breast cancer [1], IPMC of the urinary bladder [3], ovary [4], colon [5], and ampulla of Vater [6] was also reported. "
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    ABSTRACT: Invasive micropapillary carcinoma (IMPC) of the breast, urinary bladder, ovary, and colon has been reported. However, few reports have described IMPC of the stomach. In addition, IMPC has been described as a histological indicator for lymphatic invasion and nodal metastasis, resulting in poor prognosis. We report a case of 5-year survival after surgery for IPMC of the stomach. A 69-year-old woman was admitted to our hospital with symptoms of upper abdominal pain. Upper gastrointestinal endoscopy revealed a tumor at the antrum of the stomach. Histological examination of the biopsy specimen indicated poorly differentiated adenocarcinoma. The patient underwent distal gastrectomy with lymph node dissection. Microscopic examination of the specimen revealed that the tumor consisted of an invasive micropapillary component. Carcinoma cell clusters were floating in the clear spaces. The patient recovered uneventfully and remains alive without recurrence 5 years after surgery.
    03/2013; 2013:560712. DOI:10.1155/2013/560712
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