Gastrointestinal Carcinoma with Plasmacytoid Morphology: Positivity for c-MET, Arylsulfatase, and Markers of Epithelial-Mesenchymal Transition, as Indicators of Aggressivity.

Zsolt Kovacs,Calin Molnar,Laura Banias,Simona Gurzu,Mihaela Sincu,Ioan Jung,Catalin Satala

doi:10.1155/2019/5836821

Zsolt Kovacs, Calin Molnar + Show 5 more

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https://doi.org/10.1155/2019/5836821

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Abstract

Background Plasmacytoid urothelial carcinoma is a rare and aggressive histologic variant of high-grade carcinoma of the urinary bladder. Few than 250 cases have been reported in the urinary bladder till January 2019. In this paper, a case series of unusual gastrointestinal carcinomas with plasmacytoid morphology was included. Only one similar case of the stomach was previously published and no such cases were found in colon. Methods We present the complex immunoprofile, using a panel of 39 biomarkers, of the largest group of primary gastrointestinal carcinomas with plasmacytoid morphology reported in literature (one from upper rectum and six from stomach). Results All of the seven cases showed lymph node metastases and only one survived over 25 weeks after surgical excision. The indicators of aggressivity were age (over 60), advanced stage (from IIIA to IV), E-cadherin negativity, and vimentin positivity. The immunoprofile indicated unfavorable prognosis for mesenchymal-type carcinomas (negativity for E-cadherin and positivity for vimentin, with membrane to nuclear translocation or negativity of β-catenin). The survivor showed an “epithelial-type adenocarcinoma with plasmacytoid dedifferentiation”, with membrane positivity for E-cadherin and β-catenin and vimentin negativity. All of the cases expressed c-MET and were negative for HER-2. Conclusions Primary carcinoma with plasmacytoid morphology is a dedifferentiated variant of adenocarcinoma or poorly cohesive carcinomas. Vimentin positive dedifferentiated-poorly cohesive carcinomas should be considered as mesenchymal-type highly malignant carcinomas. This rare histologic variant of gastrointestinal cancer might respond to anti-c-MET tyrosine kinases.

Highlights

Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive histologic variant of high-grade carcinoma of the urinary bladder [1,2,3,4] whose diagnosis is difficult to make.The PUC variant was described in the urinary bladder in 1991 [4] but was recognized by the World Health Organization (WHO) in 2004 [3, 5].About 1-3% of all UCs are diagnosed as PUCs [5]. 61 cases have been reported in the English literature till 2012 [3], less than 100 cases till 2017 [3], and less than 250 till January 2019
We present a comprehensive immunoprofile of 7 primary carcinomas with plasmacytoid morphology of the gastrointestinal tract: one from colon and 6 cases with gastric localization
We reviewed the Hematoxylin and Eosin- (HE-) stained slides to confirm diagnosis and quantify the percentage and microscopic subtype of adenocarcinoma versus carcinoma with plasmacytoid morphology component

Summary

Introduction

Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive histologic variant of high-grade carcinoma of the urinary bladder [1,2,3,4] whose diagnosis is difficult to make.The PUC variant was described in the urinary bladder in 1991 [4] but was recognized by the World Health Organization (WHO) in 2004 [3, 5].About 1-3% of all UCs are diagnosed as PUCs [5]. 61 cases have been reported in the English literature till 2012 [3], less than 100 cases till 2017 [3], and less than 250 till January 2019. Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive histologic variant of high-grade carcinoma of the urinary bladder [1,2,3,4] whose diagnosis is difficult to make. 61 cases have been reported in the English literature till 2012 [3], less than 100 cases till 2017 [3], and less than 250 till January 2019 They occur more frequently in males (M:F=3:1), around the age of 69 (range 46–87 years) [4, 6]. Plasmacytoid urothelial carcinoma is a rare and aggressive histologic variant of high-grade carcinoma of the urinary bladder. Vimentin positive dedifferentiated-poorly cohesive carcinomas should be considered as mesenchymal-type highly malignant carcinomas This rare histologic variant of gastrointestinal cancer might respond to anti-c-MET tyrosine kinases

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