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Anticancer Research Mar 2021Histological changes induced by neoadjuvant chemotherapy (NAC) have rarely been reported in histological subtypes other than ovarian high-grade serous carcinoma (HGSC).
Prominent Papillary Growth Pattern and Severe Nuclear Pleomorphism Induced by Neoadjuvant Chemotherapy in Ovarian Mucinous Carcinoma: Potential for Misdiagnosis as High-grade Serous Carcinoma.
BACKGROUND/AIM
Histological changes induced by neoadjuvant chemotherapy (NAC) have rarely been reported in histological subtypes other than ovarian high-grade serous carcinoma (HGSC).
CASE REPORT
We report a 49-year-old woman whose tumors in interval debulking surgery (IDS) specimen exhibited prominent papillary growth pattern and severe nuclear pleomorphism due to NAC. In the initial microscopic examination, ovarian HGSC was the most likely candidate; however, immunostaining results were not compatible with HGSC. We detected areas resembling mucinous cystadenoma and borderline tumor, and finally diagnosed this case as ovarian mucinous carcinoma.
CONCLUSION
Although the tumor mimicked histologically HGSC, its clinical features differed from those of advanced-stage HGSC. It is important for pathologists to recognize NAC-induced histological changes, be aware of the diagnostic mimics and pitfalls, and to identify the correct histological subtype by considering the patient's previous history, clinical features, preoperative imaging findings, and histological features.
Topics: Adenocarcinoma, Mucinous; Chemotherapy, Adjuvant; Cystadenocarcinoma, Serous; Diagnostic Errors; Female; Humans; Middle Aged; Neoadjuvant Therapy; Ovarian Neoplasms; WT1 Proteins
PubMed: 33788752
DOI: 10.21873/anticanres.14918 -
The American Journal of Surgical... Oct 2021Mucin-producing salivary adenocarcinomas were historically divided into separate colloid carcinoma, papillary cystadenocarcinoma, and signet ring cell carcinoma...
Salivary Mucinous Adenocarcinoma Is a Histologically Diverse Single Entity With Recurrent AKT1 E17K Mutations: Clinicopathologic and Molecular Characterization With Proposal for a Unified Classification.
Mucin-producing salivary adenocarcinomas were historically divided into separate colloid carcinoma, papillary cystadenocarcinoma, and signet ring cell carcinoma diagnoses based on histologic pattern, but have recently been grouped together in the adenocarcinoma not otherwise specified category. It is currently unclear if these tumors represent 1 or more distinct entities and how they are related to well-circumscribed papillary mucinous lesions with recurrent AKT1 E17K mutations that were recently described as salivary intraductal papillary mucinous neoplasm. Here, we sought to evaluate the clinicopathologic and molecular features of salivary mucinous adenocarcinomas to clarify their classification. We identified 17 invasive mucin-producing salivary adenocarcinomas, 10 with a single histologic pattern, and 7 with mixed patterns. While most tumors demonstrated papillary growth (n=15), it was frequently intermixed with colloid (n=6) and signet ring (n=3) architecture with obvious transitions between patterns. All were cytokeratin 7 positive (100%) and cytokeratin 20 negative (0%). Next-generation sequencing performed on a subset demonstrated recurrent AKT1 E17K mutations in 8 cases (100%) and TP53 alterations in 7 cases (88%). Of 12 cases with clinical follow-up (median: 17 mo), 4 developed cervical lymph node metastases, all of which had colloid or signet ring components. Overall, overlapping histologic and immunohistochemical features coupled with recurrent AKT1 E17K mutations across patterns suggests that mucin-producing salivary adenocarcinomas represent a histologically diverse single entity that is closely related to tumors described as salivary intraductal papillary mucinous neoplasm. We propose a unified mucinous adenocarcinoma category subdivided into papillary, colloid, signet ring, and mixed subtypes to facilitate better recognition and classification of these tumors.
Topics: Adenocarcinoma, Mucinous; Aged; Aged, 80 and over; Biomarkers, Tumor; DNA Mutational Analysis; Female; Genetic Predisposition to Disease; High-Throughput Nucleotide Sequencing; Humans; Immunohistochemistry; Keratin-20; Keratin-7; Lymphatic Metastasis; Male; Middle Aged; Mucins; Mutation; Phenotype; Proto-Oncogene Proteins c-akt; Salivary Gland Neoplasms; United States
PubMed: 33739781
DOI: 10.1097/PAS.0000000000001688 -
Abdominal Radiology (New York) Jul 2021To investigate the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of ovarian serous borderline tumors (SBTs), and evaluate whether CT and...
PURPOSE
To investigate the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of ovarian serous borderline tumors (SBTs), and evaluate whether CT and MRI can be used to distinguish micropapillary from typical subtypes.
MATERIALS AND METHODS
We retrospectively reviewed the clinical features and CT and MR imaging findings of 47 patients with SBTs encountered at our institute from September 2013 to December 2019. 30 patients with 58 histologically proven typical SBT and 17 patients with 26 micropapillary SBT were reviewed. Preoperative CT and MR images were evaluated, by two observers in consensus for the laterality, maximum diameter (MD), morphology patterns, internal architecture, attenuation or signal intensity, ADC value, enhancement patterns of solid portions (SP), and extra-ovarian imaging features.
RESULTS
The median age were similar between typical SBT and SBT-MP (32.5 years, 36 years, respectively, P>0.05). Morphology patterns between two subtypes were significantly different on CT and MR images (P < 0.001). Irregular solid tumor (21/37, 56.76%) was the major morphology pattern of typical SBT tumor, while unilocular cyst with mural nodules (14/20, 70%) was the major morphology pattern of SBT-MP on CT images. Similarly, papillary architecture with internal branching (PA&IB) (17/21, 80.95%) was the major morphology pattern of typical SBT tumor, while unilocular cyst with mural nodules (4/6, 66.67%) was the major pattern of SBT-MP on MR images. PA&IB all showed slightly hyperintense papillary architecture with hypointense internal branching on T2-weighted MRI. More calcifications were found in typical SBT (24/37, 64.86%) than SBT-MP mass lesion (6/20, 30%) (P < 0.05). Hemorrhage was less frequently visible in (20/37, 54.05%) typical SBT lessons than SBT-MP mass lesion (18/20, 90%) (P < 0.05). The ovarian preservation is more seen in typical SBT (38/58, 65.52%) than SBT-MP (12/28, 42.86%) in our series (P < 0.05). Mean ADC value of solid portions (papillary architecture and mural nodules) was 1.68 (range from 1.44 to 1.85) × 10 mm/s for typical SBT and 1.62 (range from 1.45 to 1.7) × 10 mm/s for that of SBT-MP. The solid components of the two SBT subtypes showed wash-in appearance enhancements after contrast injection both in CT and MR images except 2 of SBT-MP with no enhancement as complete focal hemorrhage on MR images.
CONCLUSION
Morphology and internal architecture are two major imaging features that can help to distinguish between SBT-MP and typical SBT.
Topics: Adult; Cystadenocarcinoma, Serous; Female; Humans; Magnetic Resonance Imaging; Ovarian Neoplasms; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 33660041
DOI: 10.1007/s00261-021-03000-3 -
Journal of Medical Case Reports Feb 2021Accurate diagnosis of metastatic tumors in the breast is crucial because the therapeutic approach is essentially different from primary tumors. A key morphological...
BACKGROUND
Accurate diagnosis of metastatic tumors in the breast is crucial because the therapeutic approach is essentially different from primary tumors. A key morphological feature of metastatic tumors is their lack of an in situ carcinoma component. Here, we present a unique case of metastatic ovarian carcinoma spreading into mammary ducts and mimicked an in situ component of primary carcinoma. To our knowledge, this is the second case (and the first adult case) confirming the in situ-mimicking growth pattern of a metastatic tumor using immunohistochemistry.
CASE PRESENTATION
A 69-year-old Japanese woman was found to have a breast mass with microcalcifications. She had a known history of ovarian mixed serous and endocervical-type mucinous (seromucinous) carcinoma. Needle biopsy specimen of the breast tumor revealed adenocarcinoma displaying an in situ-looking tubular architecture in addition to invasive micropapillary and papillary architectures with psammoma bodies. From these morphological features, metastatic serous carcinoma and invasive micropapillary carcinoma of breast origin were both suspected. In immunohistochemistry, the cancer cells were immunoreactive for WT1, PAX8, and CA125, and negative for GATA3, mammaglobin, and gross cystic disease fluid protein-15. Therefore, the breast tumor was diagnosed to be metastatic ovarian serous carcinoma. The in situ-looking architecture showed the same immunophenotype, but was surrounded by myoepithelium confirmed by immunohistochemistry (e.g. p63, cytokeratin 14, CD10). Thus, the histogenesis of the in situ-like tubular foci was could be explained by the spread of metastatic ovarian cancer cells into existing mammary ducts.
CONCLUSION
Metastatic tumors may spread into mammary duct units and mimic an in situ carcinoma component of primary breast cancer. This in situ-mimicking growth pattern can be a potential pitfall in establishing a correct diagnosis of metastasis to the breast. A panel of breast-related and extramammary organ/tumor-specific immunohistochemical markers may be helpful in distinguishing metastatic tumors from primary tumors.
Topics: Aged; Breast Neoplasms; Cystadenocarcinoma, Mucinous; Cystadenocarcinoma, Serous; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Mammary Glands, Human; Neoplasms, Complex and Mixed; Ovarian Neoplasms
PubMed: 33593410
DOI: 10.1186/s13256-020-02653-w -
Surgical Pathology Clinics Mar 2021Papillary lesions of the salivary duct systems are uncommon. They encompass a heterogeneous group of benign, intermediate, and potentially aggressive neoplasms. With a... (Review)
Review
Papillary lesions of the salivary duct systems are uncommon. They encompass a heterogeneous group of benign, intermediate, and potentially aggressive neoplasms. With a few exceptions, historical descriptive terms such as papillary adenocarcinoma, papillary cystadenocarcinoma, and papillary adenoma are being replaced by defined entities, at same time acknowledging the papillary features as a histologic pattern. The evolving genetic landscape of these lesions increasingly permits their reproducible categorization. This article discusses those papillary proliferations encountered in the salivary glands with a focus on intraductal papillary mucinous neoplasms and cystadenomas. Intraductal carcinomas and sialadenoma papilliferum are addressed in separate articles in this issue.
Topics: Adenocarcinoma, Papillary; Cell Proliferation; Diagnosis, Differential; Humans; Mutation; Prognosis; Proto-Oncogene Proteins c-akt; Salivary Gland Neoplasms
PubMed: 33526223
DOI: 10.1016/j.path.2020.09.007 -
Head and Neck Pathology Dec 2021Low-grade intraductal carcinoma is a rare neoplasia with an excellent prognosis, previously classified as low-grade cribriform cystadenocarcinoma and low-grade salivary... (Review)
Review
Low-grade intraductal carcinoma is a rare neoplasia with an excellent prognosis, previously classified as low-grade cribriform cystadenocarcinoma and low-grade salivary duct carcinoma. The tumor mainly occurs in the parotid gland and presents a ductal phenotype and an intraductal/intracystic growth pattern. It resembles intraductal breast lesions such as atypical ductal hyperplasia, papillary and cribriform ductal carcinoma in situ. Despite its infrequency, discriminating low-grade intraductal carcinoma from other salivary gland tumors is crucial, especially because of its favorable prognosis. A 74-year-old woman with a history of neurofibromatosis underwent a superficial parotidectomy to remove a sharply demarcated multi-cystic mass, diagnosed as category 4 at FNAC. The histological examination revealed a demarcated but unencapsulated lesion composed of a bigger cyst surrounded by several smaller cysts, lined by a monolayer or bilayer epithelium alternated with a cribriform proliferation, characterized by "Roman-bridges", with occasional micro-papillae. A myoepithelial component, with a basal disposition, was present, confirmed by intense staining for protein p63 and SMA. Immunohistochemical stains showed intense, strong uniform positivity for pan-cytokeratin, protein S100, and SOX10. The Ki67 proliferation index was low (< 10%). A diagnosis of Low-grade Intraductal Carcinoma (LGIC) of the parotid was made. We performed a literature search in PUBMED for "Intraductal carcinoma", "Low-grade Intraductal Carcinoma", "Cribriform Cystadenocarcinoma", "Salivary Duct Carcinoma", and "Low-Grade Salivary Duct Carcinoma". We selected 17 papers published between 1983 and 2020; the most affected anatomical site was the parotid gland (77/90), followed by minor salivary glands (6/90), the intraparotid lymph nodes (3/90) and the submandibular gland (4/90). Their main histopathological features are reported in the paper. Here we present a case report and a review of scientific literature on this topic to provide some essential diagnostic tools to discriminate this rare entity.
Topics: Aged; Biomarkers, Tumor; Biopsy, Fine-Needle; Carcinoma, Ductal; Diagnosis, Differential; Female; Humans; Neoplasm Grading; Parotid Neoplasms; Tomography, X-Ray Computed
PubMed: 33501556
DOI: 10.1007/s12105-021-01290-z -
Indian Journal of Cancer 2021The primary retroperitoneal serous adenocarcinoma (PRSAC) is a rare malignant tumor of the retroperitoneum. It shares the same pathological and biological behavior with... (Review)
Review
The primary retroperitoneal serous adenocarcinoma (PRSAC) is a rare malignant tumor of the retroperitoneum. It shares the same pathological and biological behavior with ovarian serous carcinoma. Most of the cases develop as peritoneal adenocarcinoma and rarely occur in the retroperitoneum. It is reported as serous surface papillary carcinoma of the peritoneum and extraovarian peritoneal serous papillary carcinoma. We present a case of PRSAC in a 60-year-old woman. Only 11 cases of PRSAC have been reported from 1983 to 2019. Histopathological features with immunohistochemical expressions are important to diagnose PRSAC. The outcome and survival mainly depend on the possibility of surgical resection. Molecular genetics of PRSAC should also be studied in relation with its ovarian counterpart.
Topics: Cystadenocarcinoma, Serous; Female; Humans; Middle Aged; Ovarian Neoplasms; Prognosis; Retroperitoneal Neoplasms
PubMed: 33402586
DOI: 10.4103/ijc.IJC_528_19 -
Gynecologic Oncology Jan 2021Uterine papillary serous carcinoma (UPSC) is a variant of endometrial cancer that is aggressive and associated with poor outcomes. We sought to evaluate the cost...
OBJECTIVE
Uterine papillary serous carcinoma (UPSC) is a variant of endometrial cancer that is aggressive and associated with poor outcomes. We sought to evaluate the cost effectiveness of carboplatin/paclitaxel alone versus carboplatin/paclitaxel with trastuzumab among patients with Her2/neu-positive advanced or recurrent UPSC.
METHODS
We designed a Markov model in TreeAge Pro 2019 software to simulate management of a theoretical cohort of 4000 patients with Her2/neu-positive advanced or recurrent uterine papillary serous carcinoma (UPSC) followed for four years. In the carboplatin/paclitaxel with trastuzumab strategy, we included the cost of testing for Her2/neu status. We obtained all model inputs from the literature and a societal perspective was assumed. Outcomes included progression-free survival, progression, UPSC-specific mortality, cost, and quality-adjusted life years (QALYs). The intervention was considered cost effective if the incremental cost-effectiveness ratio (ICER) was below the willingness-to-pay threshold of $100,000 per QALY. Sensitivity analyses were used to determine the robustness of the results.
RESULTS
In our theoretical cohort of 4000 women, treatment with the addition of trastuzumab resulted in 637 fewer deaths and 627 fewer cases of progression compared with treatment with carboplatin/paclitaxel alone. Treatment with trastuzumab was associated with an additional cost of $144,335,895, but was associated with an increase of 2065 QALYs. The ICER was $69,903 per QALY, which was below our willingness-to-pay threshold. Sensitivity analysis demonstrated that this treatment strategy was cost-effective until the cost of 6 months of treatment surpassed $38,505 (baseline input: $27,562).
CONCLUSION
We found that the addition of trastuzumab to carboplatin/paclitaxel was a cost-effective treatment strategy for patients with advanced/recurrent Her2/neu-positive UPSC.
Topics: Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Cost-Benefit Analysis; Cystadenocarcinoma, Papillary; Cystadenocarcinoma, Serous; Female; Humans; Markov Chains; Neoplasm Recurrence, Local; Neoplasm Staging; Paclitaxel; Quality-Adjusted Life Years; Receptor, ErbB-2; Trastuzumab; United States; Uterine Neoplasms
PubMed: 33393480
DOI: 10.1016/j.ygyno.2020.10.018 -
Human Pathology Jun 2021With major advancements and frequent use of abdominal imaging techniques, hepatic cysts are increasingly encountered in clinical practice. Although the majority of cysts... (Review)
Review
With major advancements and frequent use of abdominal imaging techniques, hepatic cysts are increasingly encountered in clinical practice. Although the majority of cysts are benign, a small subset represents neoplastic precursors to cholangiocarcinoma. These cystic precursors include intraductal papillary neoplasms of the bile duct (IPNB) and mucinous cystic neoplasms of the liver (MCN-L), and bear striking pathologic resemblance to corresponding cystic neoplastic precursors within the pancreas. This review examines the salient clinical, gross, microscopic and molecular features of IPNBs and MCN-Ls, and, in particular, provides histopathologic comparison to their pancreatic counterparts. Considering these neoplasms may be diagnostically challenging, we also discuss other hepatic lesions within the differential diagnosis, and the potential for molecular methods to improve their preoperative evaluation and the early detection of cholangiocarcinoma.
Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Cystadenocarcinoma, Mucinous; Diagnosis, Differential; Humans; Liver Neoplasms
PubMed: 33383041
DOI: 10.1016/j.humpath.2020.12.010 -
Computational and Structural... 2020Synthetic lethality is thought to play an important role in anticancer therapies. Herein, to understand the potential distributions and relationships between synthetic...
Synthetic lethality is thought to play an important role in anticancer therapies. Herein, to understand the potential distributions and relationships between synthetic lethal interactions between genes, especially for pairs deriving from different sources, we performed an integrative analysis of genes at multiple molecular levels. Based on inter-species phylogenetic conservation of synthetic lethal interactions, gene pairs from yeast and humans were analyzed; a total of 37,588 candidate gene pairs containing 7,816 genes were collected. Of these, 49.74% of genes had 2-10 interactions, 22.93% were involved in hallmarks of cancer, and 21.61% were identified as core essential genes. Many genes were shown to have important biological roles via functional enrichment analysis, and 65 were identified as potentially crucial in the pathophysiology of cancer. Gene pairs with dysregulated expression patterns had higher prognostic values. Further screening based on mutation and expression levels showed that remaining gene pairs were mainly derived from human predicted or validated pairs, while most predicted pairs from yeast were filtered from analysis. Genes with synthetic lethality were further analyzed with their interactive microRNAs (miRNAs) at the isomiR level which have been widely studied as negatively regulatory molecules. The miRNA-mRNA interaction network revealed that many synthetic lethal genes contributed to the cell cycle (seven of 12 genes), cancer pathways (five of 12 genes), oocyte meiosis, the p53 signaling pathway, and hallmarks of cancer. Our study contributes to the understanding of synthetic lethal interactions and promotes the application of genetic interactions in further cancer precision medicine.
PubMed: 33240468
DOI: 10.1016/j.csbj.2020.10.015