Invasive Micropapillary Carcinoma of the Breast : Association of Pathologic Features With Lymph Node Metastasis

Department of Breast Cancer Pathology and Research Laboratory, State Key Laboratory of Breast Cancer Research, Cancer Hospital of Tianjin Medical University, Tianjin, China.
American Journal of Clinical Pathology (Impact Factor: 3.01). 12/2006; 126(5):740-6. DOI: 10.1309/AXYY-4AJT-MNW6-FRMW
Source: PubMed

ABSTRACT Invasive micropapillary carcinoma (IMPC) of the breast is characterized by a high incidence of axillary lymph node metastasis. To investigate the relationship between pathologic features and lymph node metastasis, 51 cases of breast carcinoma with IMPC components were studied. Immunohistochemical analysis for vascular endothelial growth factor (VEGF)-C and VEGF receptor (VEGFR)-3 was performed, and lymphatic vessel density was measured. The main findings included a significantly increased number of positive lymph nodes and/or an increased rate of lymph node metastasis in IMPC with a higher histologic grade, prominent stromal infiltration of lymphocytes, and higher VEGF-C expression and lymphatic vessel density. The percentage of IMPC component in the tumor was not associated with the incidence of lymph node metastasis. The results suggest that the histologic grade, lymphatic vessel density, and lymphocyte infiltration of IMPC are the key factors that influence lymph node metastasis. Further studies are required to elucidate the mechanisms underlying the lymphotropism of this distinct variant of breast carcinoma.

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    • "Ren et al. [24] Cohort 5625 86 NA Chen et al. [8] [9] b Cohort 297,735 636 NA Guo et al. [16] "
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    ABSTRACT: Invasive micropapillary carcinoma (IMPC) of the breast is a rare and aggressive variant of invasive ductal carcinoma. IMPC has been reported to account for 3–6% of all breast cancers, and these tumors have been associated with a strong tendency to invade lymphatics with early spread to regional lymph nodes.
    12/2014; 189. DOI:10.1016/j.ctrc.2014.12.001
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    • "It has a high tendency for lymphatic invasion and lymph nodes metastasis, resulting in worse prognosis [5]. No percentage of the IMPC component within the tumor was proposed as a criterion for diagnosis [7] [8]. Indeed, there is agreement that, regardless of the extent of the micropapillary component, invasive ductal carcinoma with any amount of IMPC have a more aggressive clinical behavior and poorer prognosis with a high degree of lymph node involvement [1,7–11]. "
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    ABSTRACT: Purpose Describe mammographic, sonographic and MRI findings of invasive micropapillary carcinoma (IMPC) of the breast. Materials and Methods Review of the pathology database identified 43 patients (mean age, 59.3 years) with the diagnosis of breast IMPC. Three patients had no available imaging studies. Mammograms (40), breast ultrasounds (33) and MRIs (8) were retrospectively evaluated by two radiologists in consensus following the BI-RADS Lexicon. Clinical, histopathologic features, as well as hormone status were recorded. Results Twenty patients presented with palpable abnormality (20/40, 50%). Thirty-five patients had an abnormal mammogram (87.5%, 35/40) showing 39 lesions, 29 corresponding to masses (29/39, 74.4%), 11 associated with microcalcifications and two associated with architectural distortion. Sonography identified 41 masses (in 33 patients) displaying an irregular shape (30/41, 73.2%), appearing hypoechoic (39/41, 95%), with spiculated or angular margins (26/41, 63.4%), non-parallel orientation (26/41, 63.4%) and combined acoustic posterior pattern (18/41, 44%). MRI identified 13 lesions (in eight patients), 12 as masses (12/13, 92.3%) with irregular or spiculated margins (12/12, 100%), eight displaying an irregular or lobulated shape (8/12, 66.7%), six a homogenous (6/12, 50%) internal enhancement and eight a type 3 enhancement curve (8/12, 61.5%). Associated non-mass like enhancement was noted in two patients. Twenty-nine patients had associated lymphovascular invasion (29/40, 72.5%) and axillary lymph node metastases were present in 22 of the 39 patients (22/39, 56%). Conclusion Invasive ductal carcinoma with IMPC features display imaging findings highly suspicious of malignant lesions. They are associated with high lymphovascular invasion and lymph node metastases rates.
    European Journal of Radiology 08/2014; 83(8). DOI:10.1016/j.ejrad.2014.05.003 · 2.16 Impact Factor
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    • "The incidence of axillary node metastasis in IMPC is reported to be 67–90% [2] [3] [4] [5], and 64% of patients with lymph node metastasis have more than 3 lymph nodes [5]. IMPC is also associated with a high rate of local recurrence. "
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    ABSTRACT: We report a rare case of invasive micropapillary carcinoma in the male breast. A 63-year-old man was referred to our hospital for investigation of a left breast tumor, which could be palpated in the upper lateral quadrant of the left nipple-areola complex. The tumor invaded the areola skin. Ultrasonography showed a 14.8×15.0×12.4mm low echoic mass, with an irregular lobulated border. Core needle biopsy indicated invasive ductal carcinoma, but the subtype could not be accurately determined. Mastectomy with axillary lymph node dissection was performed. Pathological examination indicated invasive micropapillary carcinoma, no lymph node metastasis, and a nuclear grade of 2. Immunohistochemical examination showed positive staining for estrogen and progesterone receptors, but negative staining for HER2. The Ki67 index was 5%. Tamoxifen was administered, and recurrence has not been noted for 1 year. Women's IMPC generally shows a high HER2 positivity rate. However, HER2 positivity was noted in only 1 male patient with IMPC (14%) according to our literature review. Furthermore, in all cases of the mixed type that were reviewed, IMPC was associated with papillotubular carcinoma. These findings may be specific to IMPC in male patients. IMPC is associated with a high rate of lymph node metastasis or recurrence and advanced vessel invasion, aggressive adjuvant chemotherapy following surgical resection should be selected for patients with IMPC.
    09/2013; 4(11):988-991. DOI:10.1016/j.ijscr.2013.09.001
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