Article

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: 2.81). 12/1999; 30(12):1459-63. DOI: 10.1016/S0046-8177(99)90168-5
Source: PubMed

ABSTRACT 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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    ABSTRACT: Invasive micropapillary carcinoma is a unique variant of invasive ductalcarcinoma (I DC). Characteristicaly tumor cells are arreged in small clusters with a central lumen usually present, image of micropapillaewithin clear spaces. In addition, immunohistochemical studies have demonstrated the highly malignant potential of this type of tumor. In our last study we have observed significant clinicopathological and immunohistochemical differences between IMPCa and IDC. Therefore, our aim is to study the molecular background of IMPCa through the analysis of gene expression profile. A total of 24 frozen tissue samples (IDC 15 and IMPCa 12) from the Tohoku University hospital were selected and total RNA was isolated and hybridized with Agilent Human I A micro array. Images are scanned and fluorescence intensities on scanned images were quantified, and the values were corrected for the background level and normalized. Analysis was performed using GeneSpring 6.2 software. In our results approximately 305 genes revealed to have significant difference in expression between IMPCa And IDC. And we could recognized 150 genes upregulated in IMPCa. We predict that difference in the expression profiles among the two tumor types will provide an important interpretation of this unique variant of invasive ductal carcinoma.
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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.
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