Micropapillary lung adenocarcinoma: a distinctive histologic subtype with prognostic significance. Case series

Department of Pathology, Hospital General Universitary Gregrorio, Marañón, Spain.
Human Pathlogy (Impact Factor: 2.81). 04/2008; 39(3):324-30. DOI: 10.1016/j.humpath.2007.05.029
Source: PubMed

ABSTRACT The aims of the present work were to evaluate the prognostic significance of the micropapillary pattern of lung adenocarcinoma and determine whether there are differences in the behavior of this type of tumor according to its immunohistochemical profile. A series of 191 consecutively resected pulmonary adenocarcinomas were divided into those with (n = 62) and those without (n = 129) micropapillary components. The disease was stage I in 38 and 54 patients, respectively. The 5-year survival rates of patients with and without micropapillary components were 54% and 77%, respectively (log rank P = .03). In multivariate survival analysis, the micropapillary component proved to be an independent prognostic factor (hazard ratio, 3.2). Five autopsy cases were used to investigate the immunohistochemical profile. The percentages of cases positive for various markers were 56.7 for p53, 94 for Ki67, 85.1 for c-myc, 2.9 for Bcl-2, 35.8 for epidermal growth factor receptor, 43.3 for cyclin D1, and 46.3 for Bax. The prognostic value was evaluated according to the expression of the different markers in micropapillary carcinomas in stage I. In univariate analysis, only cyclin D1 expression and Bax expression were associated with significantly worse survival (log rank P = .03 and P = .02, respectively). We conclude that it is important to recognize the micropapillary growth pattern in lung adenocarcinoma. Moreover, cyclin D1 and Bax seem to be markers of a poor prognosis.

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    ABSTRACT: In 2011, a new histologic classification of lung adenocarcinomas was proposed from a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS), based on the recommendation of an international and multidisciplinary panel. This classification proposed a method of comprehensive histologic subtyping (lepidic, acinar, papillary, micropapillary, and solid pattern) based on semi-quantitative assessment of histologic patterns (in 5% increments) with the ultimate goal of choosing a single, predominant pattern. Prognostic subsets could then be described for the classification. Patients with completely resected adenocarcinomas in situ (AIS) and minimally invasive adenocarcinomas (MIA) experienced low risk of recurrence. Patients with micropapillary or solid predominant tumors have a high risk for recurrence or cancer-related death. Patients with acinar and papillary predominant tumors comprise an intermediate-risk group. Herein, we review the outline of the proposed IASLC/ATS/ERS classification, a summary of published validation studies of this new classification and then discuss surgical key issues; we mainly focused on limited resection as an adequate treatment for early-stage lung adenocarcinomas as well as pre- and intraoperative diagnoses. We also review the published studies that identified the importance of histological subtypes in predicting recurrence, both rates and patterns, in early-stage lung adenocarcinomas. This new classification for the most common type of lung cancer is useful for surgeons, as its implementation would require only hematoxylin and eosin (H&E) histology slides, which is the common type of stain used in hospitals. It can be implemented with routine pathology evaluation and with no additional costs.
    Seminars in Thoracic and Cardiovascular Surgery 01/2014; DOI:10.1053/j.semtcvs.2014.09.002
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    ABSTRACT: Micropapillary (MIP) histologic subtype included in the classification of lung adenocarcinomas (ADCs) is associated with both size- and stage-independent poor prognoses. MIP pattern in lung ADCs, even at small, early stages, correlates with high lymphovascular invasion, visceral pleural invasion and lymph node metastases. Recently, we reported that patients with a MIP component are at a higher risk of locoregional recurrence after limited resection. Identification of a MIP pattern is only possible with permanent pathologic sections; preoperative imaging, cytology or intraoperative frozen section specimens remain unreliable. The intermixed, heterogenous morphology of lung ADC presents a technical challenge in investigating the molecular biology of cells with MIP morphology. A comprehensive understanding of the biology of MIP morphology is vital for therapeutic interventions.
    06/2014; 3(3):245-253. DOI:10.2217/lmt.14.15
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    Histopathology 10/2014; 66(5). DOI:10.1111/his.12586 · 3.30 Impact Factor