Rare histological subtype of invasive micropapillary carcinoma in the ampulla of Vater: A case report

BACKGROUND Carcinoma of the ampulla of Vater is an uncommon ampullo-pancreatobiliary neoplasm,and the most common histological type is adenocarcinoma with a tubular growth pattern.Invasive micropapillary carcinoma(IMPC)is an aggressive variant of adenocarcinoma in several organs that is associated with lymph node metastasis and poor prognosis.IMPC was first described as a histological subtype of breast cancer;however,IMPC of the ampulla of Vater is extremely rare,with only three articles reported in the English literature.CASE SUMMARY We have reported a case of IMPC of the ampulla of Vater in an 80-year-old man.Microscopically,the surface area of the carcinoma was composed of tubulopapillary structures mimicking intra-ampullary papillary-tubular neoplasm,and the deep invasive front area exhibited a pattern of IMPC.The carcinoma showed lymphatic invasion and extensive lymph node metastasis.The immunohistochemical study revealed mixed intestinal and gastric/pancreatobiliary phenotypes.CONCLUSION This rare subtype tumor in the ampulla of Vater showed a histologically mixed phenotype and exhibited aggressive behavior.

Clinical Value Analysis of Ultrasonography and MRI in Diagnosis of Invasive Micropapillary Carcinoma of Breast

Objective:To investigate the diagnostic value of invasive micropapillary carcinoma(IMPC)by ultrasonography and MRI.Method:63 female patients with IMPC were selected,all of which were confirmed by pathological examination,and were assigned to the IMPC group.In the same period,40 patients with invasive ductal carcinoma(IDC group)were selected for diagnostic efficacy control.The efficacy indexes of accuracy,sensitivity,specificity,positive prediction rate and negative prediction rate were 73.0%,65.9%,89.5%,93.5%,46.9%,respectively.The efficiency indexes of accuracy,sensitivity,specificity,positive prediction rate and negative prediction rate of ultrasound combined with breast MRI were 93.6%,93.2%,94.7%,97.6%,85.7%.Ultrasonography combined with MRI has more application value in the diagnosis of IMPC.

sLe^(x) expression in invasive micropapillary breast carcinoma is associated with poor prognosis and can be combined with MUC1/EMA as a supplementary diagnostic indicator

Objective: Mucin 1(MUC1/EMA) and sialyl Lewis X(sLe^(x)) indicate polarity reversal in invasive micropapillary carcinoma(IMPC). The purpose of this study was to evaluate the expression of MUC1/EMA and sLe^(x) and to assess their diagnostic and prognostic value in patients with IMPC.Methods: The expression of sLe^(x) and MUC1/EMA in 100 patients with IMPC and a control group of 89 patients with invasive ductal carcinoma not otherwise specified(IDC-NOS) were analyzed with IHC. Fresh tumor tissues were collected from patients with IMPC or IDC-NOS for primary culture and immunofluorescence analysis.Results: The rate of nodal metastasis was higher in patients with IMPC than those with IDC-NOS, and IMPC cells tended to express more sLe^(x) and MUC1/EMA in the cytomembranes(the stroma-facing surfaces of the micropapillary clusters) than IDC-NOS cells. In IMPC, high cytomembrane expression of sLe^(x), but not MUC1/EMA, indicated poor prognosis. In addition, among the 100 patients with IMPC, 10 patients had sLe^(x)+/EMA-expression patterns, and 8 patients had sLe^(x)-/EMA+ expression patterns. The primary IMPC cells were suspended, non-adherent tumor cell clusters, whereas the primary IDC cells were adherent tumor cells. Immunofluorescence analysis showed that MUC1/EMA and sLe^(x) were co-expressed on the cytomembranes in IMPC cell clusters and in the cytoplasm in IDC-NOS cells.Conclusions: sLe^(x) can be used as a prognostic indicator and can be combined with MUC1/EMA as a complementary diagnostic indicator to avoid missed IMPC diagnosis.

Prognosis of lymphotropic invasive micropapillary breast carcinoma analyzed by using data from the National Cancer Database

Background:Invasive micropapillary carcinoma(IMPC)is an uncommon subtype of breast cancer.Previous studies of this subtype demonstrated a higher propensity for lymph node metastases as compared with invasive ductal carci-noma(IDC).The purpose of the present study was to determine the clinical characteristics,outcomes,and propensity for lymph node metastasis of patients with IMPC of the breast recorded in the National Cancer Database(NCDB).Methods:Records of patients with IMPC diagnosed between 2004 and 2014 were retrieved from the NCDB.Log-rank test was performed to evaluate associations of clinical characteristics with overall survival(OS).Cox proportional hazards model was used to determine variables associated with OS.Results:Overall,2660 patients with IMPC met the selection criteria;the 5-year OS rate was 87.5%and 24.9%of patients had nodal involvement at presentation.Patients with≥4 positive lymph nodes had shorter OS than node-negative patients,whereas patients with 1-3 positive nodes had similar OS to node-negative patients.Age<65 years,receipt of radiotherapy,and estrogen receptor positivity were also associated with prolonged OS.The benefit of radiotherapy was limited to IMPC patients undergoing lumpectomy;there was no benefit for the patients undergoing mastectomy(regardless of nodal positivity/negativity).Conclusions:Favorable prognostic factors of IMPC patients included age<65 years,<4 positive lymph nodes,receipt of radiotherapy,and estrogen receptor positivity.The results presented herein suggest a survival benefit asso-ciated with radiotherapy in IMPC treatment,though this may be limited to the patients treated with lumpectomy.

Study on the Influencing Factors of Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

Objective:To investigate the influencing factors of the cervical lymph node metastasis in papillary thyroid microcarcinoma(PTMC)and to provide a theoretical basis for cervical lymph node dissection.Methods:A total of 80 PTMC patients treated in the Department of Breast and Thyroid Surgery of our Hospital from January 2017 to January 2018 were selected in the study.All the patients accepted the first surgical treatment and were confirmed by pathology.The clinical data of all PTMC patients were retrospectively analyzed,and the related factors such as gender,age,number of primary lesions,tumor diameter and extrathyroidal invasions were analyzed.The factors that actually affected the lymph node metastasis of PTMC patients were explored.Results:All patients underwent prophylactic central lymph node dissection.Lymph node metastasis occurred in 26 patients in the central region and in 13 patients in the lateral neck region.The rate of lymph node metastasis in the central region of men was 41.18%,and the rate of lymph node metastasis in the lateral neck region was 23.53%,which were significantly higher than that of women's 30.16%and 14.29%.The differences were statistically significant(P<0.05).The regional metastasis rate of the patients of≤45 years was 45.83%,and the lateral neck region metastasis rate was 20.83%,which were significantly higher than those of patients>45 years old(12.50%,9.38%)and the differences were statistically significant(P<0.05).The lymph node metastasis rate in the central region and in the lateral neck region of tumor diameter<0.5 cm were 27.27%and 9.09%respectively,which were significantly lower than those of the tumor diameter 0.5-1.0 cm(38.89%,25.00%)(P<0.05).The rate of lymph node metastasis in the central region of single focus was 20.37%,which was significantly lower than that of 57.69%in the multifocal lesions;the rate of lymph node metastasis in the cervical region of the single lesion was 11.11%,which was significantly lower than 26.92%in the multifocal area;the differences were statistically significant(P<0.05).The metastasis rate of the patients with extrathyroidal invasions in the central area was 60.00%,which is significantly higher than that without extrathyroidal invasions(30.67%).About the tumor neck invasion of the lateral neck region,the lymph node metastasis rate of the patients with extrathyroidal invasions was 40.00%,which was significantly higher than that without extrathyroidal invasions(14.67%).The differences were statistically significant(P<0.05).Logistic regression analysis showed that gender and tumor size were independent influencing factors of lymph node metastasis in the central and lateral neck regions(P<0.05).Conclusion:Young,male,multifocal,tumor diameter 0.5-1.0 cm and extrathyroidal invasions are risk factors for cervical lymph node metastasis in patients with PTMC.Gender and tumor size are independent factors affecting central/lateral cervical lymph node metastasis in PTMC patients.