Colloid Carcinoma Research Articles

Colloid Carcinoma With Signet Ring Cell Features in the Backdrop of Crohnʼs Colitis: Related or Unrelated?

49 years old male with ileocolonic Crohn's for past 7 years, on mesalamine 2.4 g/day was referred to our hospital for evaluation of pseudopolyposis and severe ulceration seen on flexible sigmoidoscopy. His CRP was 9.6 mg/L, albumin 3.6 g/dL and Hbg 11.1 g/dL. Patient underwent colonoscopy that showed stricture in the distal ileum with scared deformity of ileocecal valve. There was a stricture in sigmoid colon and friability with nodularity in distal rectum. A rectosigmoid fistula was also noted. Multiple biopsies were taken randomly throughout the colon. Minimally to mildly active Crohn's disease was reported on biopsies with a rectal colloid carcinoma exhibiting signet ring cell features. There were numerous fragments of colloid material containing atypical epithelial cells. A focal area of Cytokeratin positive and CD68 negative signet ring cells was identified in lamina propria, submucosal tissue was spared. Traditional dysplasia resembling tubular adenomas was not present. After expert opinion from a team of pathologist, final diagnosis of invasive colloid carcinoma with signet cell features was established. Patient underwent total proctocolectomy with perineal resection. His operative specimen was staged as T3N0 with 75% mucinous tumor component. He is currently undergoing chemotherapy. Many conventional colorectal cancers (CRCs) produce mucin. When the extracellular mucin comprises ≥50 percent of the tumor, it is classified as colloid or mucinous carcinoma. Colloid carcinoma accounts for approximately 11 to 17 percent of all CRCs. They have a predilection for the rectum and sigmoid colon. Predominant concurrence in Hereditary Non Polyposis Colon Cancer and carcinoma arising from sessile serrated adenomas points towards microsatellite instability carcinogenesis pathway. If intracellular mucin displaces tumor cell nuclei to the side and ≥50 percent of the tumor is made up of cells of this type, it is classified as a signet ring cell carcinoma. They are a rare subtype accounting for only 1 to 2 percent of all CRCs. An association between inflammatory bowel disease and signet ring cell carcinoma has been suggested, and figures of up to 14% have been reported. 30% of patients with signet-ring cell carcinoma also have ulcerative colitis. Whether these rare occurrences are sporadic in nature or related to the presence and severity of Crohn's disease remains to be learnt further.Figure 1Figure 2Figure 3

Colloid (mucinous non-cystic) carcinoma of the pancreas: A case report.

Colloid carcinoma (CC) of the pancreas, also known as mucinous non-cystic carcinoma, is a rare histological variant of pancreatic cancer. The present study reports the case of a 65-year-old male with a pancreatic head tumor 4.6×3.1 cm in size. The tumor had not invaded the superior mesenteric or celiac arteries. Laboratory data showed elevated alkaline phosphatase, γ-gluytamyl transpeptidase and cancer antigen 19-9 (CA19-9) levels. The patient underwent a pancreaticoduodenectomy (PD), and the pathology revealed CC extending to the submucosa of the duodenum, with mild atypical hyperplasia of the pancreatic duct. The patient was negative for circulating tumor cells, indicating a good prognosis. The CA19-9 concentration decreased to within the normal range following surgery. The present study reports a rare case of CC of the pancreas presenting with obstructive jaundice, in which a PD procedure was performed. Primary surgical treatment with curative intent is the optimal management and this subtype of pancreatic cancer is associated with a better prognosis compared with pancreatic ductal adenocarcinoma.

Trends in gastric cancer incidence: a period and birth cohort analysis in a well-defined French population.

The incidence of gastric cancer has declined over the past decades. Little is known about trends by site and histological subtype. The aim of this study was to analyze changes in gastric cancer incidence patterns in a French well-defined population. Data on patients with an epithelial gastric cancer diagnosed between 1982 and 2011 were collected by the population-based digestive cancer registry of Burgundy (n = 4694). Time trends in gastric cancer incidence by period of diagnosis and birth cohort were analyzed by sex, subsite, and histological type. There was a decrease in incidence rates for antral carcinomas (-2.6 % per year in males, -2.5 % per year in females; p < 0.001) and corpus carcinomas (-3.3 % and -3.2 %, respectively; p < 0.001). Annual percentage changes were not significant for fundus carcinomas in both sexes and cardia carcinoma in females, although they increased in males (+1.0 % per year; p < 0.02).When comparing the 1900 cohort and the 1950 cohort, there was a five- to sevenfold decrease in the cumulative risk at 0-79 years for corpus and antral carcinomas in both sexes and a threefold decrease for fundus carcinomas. There were minor variations for cardia carcinomas. There was a decrease of incidence both by period of diagnosis and by birth cohort for adenocarcinoma and colloid carcinoma. It was more marked for undifferentiated carcinoma. The variation for signet-ring carcinoma was minor. Temporal variations in incidence rates of gastric cancer differed according to subsite and histology, suggesting different etiological factors. Available analytical studies provide an explanation for the reported trends by subsite.

P-209 Clinico-epidemiological profile of colorectal cancer in Algerian patients age 40 and under: Alarming Increase in Incidence

Introduction: Colorectal cancer (CRC) is rare before age 40, the average age at diagnosis is generally > 50. In our department of medical oncology in Blida (north of Algeria) we have observed an increased number of young patients with colorectal cancer. The aim of this study is to determine epidemiologic and clinical characteristics of this cancer in young patients ≤ 40. Methods: This is a retrospective study of patients diagnosed with CRC aged 40 and under, treated in department of medical oncology in Blida between January 2012 and December 2014. We were interested to clinico-epidemiological characteristics of this population. Results: During this period, 62 patients with CRC age 40 and under were seen, which is about 17.3% of all CRC patients (total: 368 patients). 25 were male (40.4%) and 37 female (59.6%), median age at diagnosis 32 years, range 15 to 40. Body mass index (BMI) was higher 25 in 16 patients (25.8%), diet high in meat and fat was observed in 23 patients (37%), presence of polyps at colonoscopy was noted in 6 cases, family history of CRC was seen in 7 patients and family history of other cancer was seen in 10 patients. The most common symptoms were pain and rectal bleeding, diagnosis delay was > 3 months in 62% of cases, the rectosigmoid was the most frequent seat, histological type was adenocarcinoma in 90.2% and mucous colloid carcinoma in 9.8%, locally advanced (III) and metastatic stages (IV) were respectively 41% and 33% of cases. Conclusion: Alarming increase of CRC in young people (in our series). The main risk factors in young people are: diet rich in meat and fat, low in vegetables and fruits, physical inactivity, excess weight and unknown behavioral factors. Eating habits and how to live our young population must be analysed carefully. Oncogenetic consultations are necessary for people with a family history of cancer.

An update on clinicopathological, immunohistochemical, and molecular profiles of colloid carcinoma of the lung.

Colloid carcinoma is a rare subtype of lung adenocarcinoma characterized by abundant pools of extracellular mucin and scant malignant epithelium. Because of the rarity of these tumors, many of the reported clinicopathological and immunohistochemical characteristics are contradictory. Moreover, the molecular alterations that underlie these tumors are unknown. We present the clinicopathological, immunohistochemical, and molecular features of 13 cases of colloid carcinoma of the lung. The patients were 9 women and 4 men between the ages of 48 and 86 years. Surgical resection and staging were performed in all patients. Seven patients were in stage T1N0M0, 3 in T2N0M0, 2 in T2N1M0, and 1 in T2N0M1. The tumor was 100% mucinous in 9 patients, whereas in 4 cases, the lesions consisted of 50% to 90% mucin pools with the remainder being a noncolloid adenocarcinoma component ranging in morphology from bronchioalveolar to acinar, papillary, solid, or mixed patterns. Follow-up ranged from 35 to 128 months. Three patients died, 1 of disease and 2 of unrelated causes. The remaining 10 patients are alive at the time of reporting, 3 with recurrent disease. Immunohistochemical studies showed CK7, CK20, and CDX2 expression in all tumors, whereas TTF-1, surfactant A, and napsin A were not present or were only focally positive in most cases. Analysis showed KRAS mutations in 2 cases. All tumors were negative for ALK gene rearrangement and EGFR mutation. Our study highlights the clinicopathological, immunohistochemical, and molecular features of lung colloid adenocarcinoma and attempts to clarify some misconceptions regarding this rare tumor.

GNAS and KRAS Mutations Define Separate Progression Pathways in Intraductal Papillary Mucinous Neoplasm-Associated Carcinoma

Intraductal papillary mucinous neoplasms (IPMN) are being increasingly recognized as important precursors to pancreatic adenocarcinoma. Elucidation of the genetic changes underlying IPMN carcinogenesis may improve the diagnosis and management of IPMN. We sought to determine whether different histologic subtypes of IPMN would exhibit different frequencies of specific genetic mutations. Patients with resected IPMN-associated invasive carcinoma (IPMN-INV) between 1997 and 2012 were reviewed. Areas of carcinoma, high-grade dysplasia, and low-grade dysplasia were micro-dissected from each pathologic specimen. Targeted, massively parallel sequencing was then performed on a panel of 275 genes (including KRAS, GNAS, and RNF43). Thirty-eight patients with resected IPMN-INV and sufficient tissue for micro-dissection were identified. Median follow-up was 2.6 years. Mutations in GNAS were more prevalent in colloid-type IPMN-INV than tubular-type IPMN-INV (89% vs 32% respectively; p = 0.0003). Conversely, KRAS mutations were more prevalent in tubular-type than colloid-type IPMN-INV (89% vs 52%, respectively; p = 0.01). For noninvasive IPMN subtypes, GNAS mutations were more prevalent in intestinal (74%) compared with pancreatobiliary (31%) and gastric (50%) subtypes (p = 0.02). The presence of these mutations did not vary according to the degree of dysplasia (GNAS: invasive 61%, high-grade 59%, low-grade 53%; KRAS: invasive 71%, high-grade 62%, low-grade 74%), suggesting that mutations in these genes occur early in IPMN carcinogenesis. Colloid carcinoma associated with IPMN and its intestinal-type preinvasive precursor are associated with high frequencies of GNAS mutations. The mutation profile of tubular carcinoma resembles that of conventional pancreatic adenocarcinoma. Preoperative determination of mutational status may assist with clinical treatment decisions.

Systematic review and meta-analysis of the spectrum and outcomes of different histologic subtypes of noninvasive and invasive intraductal papillary mucinous neoplasms

Our aim was to review the available evidence to determine the clinical importance of the histologic subtypes of noninvasive and invasive intraductal papillary mucinous neoplasms (IPMNs) on disease characteristics and overall survival. We reviewed systematically 14 comparative studies that reported clinicopathologic characteristics and survival of 1,617 patients with IPMN (900 noninvasive and 717 invasive). The pancreatobiliary subtype was associated with the greatest likelihood of tumor invasion (67.9%; odds ratio [OR], 2.87; 95% CI, 1.90-4.35), harboring an associated mural nodule (56.6%; OR, 2.92; 95% CI, 1.21-7.04), demonstrating tumor recurrence (46.3%; OR, 3.28; 95% CI, 1.41-7.66) and transformation to tubular adenocarcinoma (81.8%; OR, 92.96; 95% CI, 20.76-416.28) among all subtypes. The gastric subtype was associated with the least likelihood of tumor invasion (10.2%; OR, 0.18; 95% CI, 0.13-0.26), association with main duct IPMN (19.2%; OR, 0.12; 95% CI, 0.06-0.26), and tumor recurrence (9.4%; OR, 0.47; 95% CI, 0.26-0.83) among all subtypes. The intestinal subtype had the greatest likelihood of progressing to colloid carcinoma among all subtypes. Tubular adenocarcinoma was associated with an increased risk of vascular invasion (32.9%; OR, 4.86; 95% CI, 1.96-12.01), perineural invasion (54.5%; OR, 2.30; 95% CI, 1.22-4.34), nodal metastasis (52.4%; OR, 3.31; 95% CI, 1.79-6.14), and a positive margin status (17.3%; OR,8.45; 95% CI, 1.52-46.83). Tubular adenocarcinoma (hazard ratio [HR], 1.90; 95% CI, 1.36-2.67) had a poorer 5-year overall survival compared with colloid carcinoma and was similar to the survival observed in pancreatic ductal adenocarcinoma (HR, 2.00; 95% CI, 1.59-2.52). The prognosis of IPMN depends on its pathologic subtype. Subtype identification should be considered an essential component in future guidelines for the management of IPMN.

Clinicopathologic characteristics of 29 invasive carcinomas arising in 178 pancreatic mucinous cystic neoplasms with ovarian-type stroma: implications for management and prognosis.

Information on the clinicopathologic characteristics of invasive carcinomas arising from mucinous cystic neoplasms (MCNs) is limited, because in many early studies they were lumped and analyzed together with noninvasive MCNs. Even more importantly, many of the largest prior studies did not require ovarian-type stroma (OTS) for diagnosis. We analyzed 178 MCNs, all strictly defined by the presence of OTS, 98% of which occurred in perimenopausal women (mean age, 47 y) and arose in the distal pancreas. Twenty-nine (16%) patients had associated invasive carcinoma, and all were female with a mean age of 53. Invasion was far more common in tumors with grossly visible intracystic papillary nodule formation ≥1.0 cm (79.3% vs. 8.7%, P=0.000) as well as in larger tumors (mean cyst size: 9.4 vs. 5.4 cm, P=0.006); only 4/29 (14%) invasive carcinomas occurred in tumors that were <5 cm; however, none were <3 cm. Increased serum CA19-9 level (>37 U/L) was also more common in the invasive tumors (64% vs. 23%, P=0.011). Most invasive carcinomas (79%) were of tubular type, and the remainder (5 cases) were mostly undifferentiated carcinoma (2, with osteoclast-like giant cells), except for 1 with papillary features. Interestingly, there were no colloid carcinomas; 2 patients had nodal metastasis at the time of diagnosis, and both died of disease at 10 and 35 months, respectively. While noninvasive MCNs had an excellent prognosis (100% at 5 y), tumors with invasion often had an aggressive clinical course with 3- and 5-year survival rates of 44% and 26%, respectively (P=0.000). The pT2 (>2 cm) invasive tumors had a worse prognosis than pT1 (≤2 cm) tumors (P=0.000), albeit 3 patients with T1a (<0.5 cm) disease also died of disease. In conclusion, invasive carcinomas are seen in 16% of MCNs and are mostly of tubular (pancreatobiliary) type; colloid carcinoma is not seen in MCNs. Serum CA19-9 is often higher in invasive carcinomas, and invasion is typically seen in OTS-depleted areas with lower progesterone receptor expression. Invasion is not seen in small tumors (<3 cm) and those lacking intracystic papillary (mural) nodules of ≥1 cm, thus making the current branch-duct intraductal papillary mucinous neoplasm management protocols also applicable to MCNs.

Cyst Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Imaging and Pathology

Background: Intraductal papillary mucinous neoplasms (IPMNs) display diverse macroscopic, histological, and immunohistochemical characteristics with typical morphological appearance in magnetic resonance imaging. Depending on those, IPMNs may show progression into invasive carcinomas with variable frequency. Overall, IPMN-associated invasive carcinomas are found in about 30% of all IPMNs, revealing phenotpyes comparable with conventional ductal adenocarcinomas or mucinous (colloid) carcinomas of the pancreas. In Sendai-negative side-branch IPMNs, however, the annual risk of the development of invasive cancer is 2%; thus, risk stratification with regard to imaging and preoperative biomarkers and cytology is mandatory. Methods and Results: The present study addresses the radiological and interventional preoperative measures including histological features to determine the risk of malignancy and the prognosis of IPMNs. Conclusion: While preoperative imaging largely relies on the detection of macroscopic features of IPMNs, which are associated with a divergent risk of malignant behavior, in resected specimens the determination of the grade of dysplasia and the detection of an invasive component are the most important features to estimate the prognosis of IPMNs.

Fine-Needle Aspiration Cytology of Colloid Carcinoma of the Pancreas

Colloid carcinoma is a rare invasive carcinoma of the pancreas believed to arise from intestinal-type intraductal papillary mucinous neoplasm. Previous cytologic descriptions of invasive carcinomas associated with intraductal papillary mucinous neoplasms do not uniformly specify the type of invasive carcinoma or may not use current diagnostic criteria for colloid carcinoma. We searched our archive for ultrasound-guided fine-needle aspirates of the pancreas with histologic correlation showing colloid carcinoma (defined by containing >80% extracellular mucin) and reviewed corresponding cytology and histology. We identified 7 fine-needle aspirates from resected colloid carcinomas. In 5 of 7, an associated intraductal papillary mucinous neoplasm of predominantly intestinal type was identified with the invasive component and comprising less than 10% to 100% of the mass lesion. After cytologic-histological correlation, it was determined that 5 of 7 cases contained colloid carcinoma, whereas 2 were excluded for showing discrepant features suggesting sampling error. The 5 aspirates containing colloid carcinoma uniformly showed low cellularity (tumor cells comprised <20% of smeared material), abundant thick/glassy mucin, degenerating inflammatory cells in mucin, mild nuclear membrane abnormalities, and disordered sheets. The majority (4/5, 80%) were diagnosed previously as “suspicious for mucinous neoplasm.” Colloid carcinoma cytology overlaps with intraductal papillary mucinous neoplasm and may be subject to underdiagnosis because of the well-differentiated cytologic appearance, low cellularity, and thick obscuring mucin.

Evaluation of grading and hormone receptor immunostaining on fine needle aspirates in carcinoma breast.

Background:Grading and hormone receptor determination in breast carcinoma are predictive factors for response to hormonal therapy.Aim:This study was undertaken to grade breast carcinoma and to determine estrogen receptor (ER) and progesterone receptor (PR) expression on fine-needle aspiration cytology (FNAC). Furthermore, the objective was to compare the results with histological grading and immunohistochemistry on surgical material.Materials and Methods:Fifty cases of breast carcinoma diagnosed on FNAC were included. The cytological grading was done according to the Robinson's grading system. The corresponding histology sections were graded using the modified Bloom-Richardson system. Immunostaining for ER and PR was done on smears and tissue sections.Results:On both cytological and histological evaluation, 49 cases were infiltrating ductal carcinoma and one case was colloid carcinoma. On comparing cytological and histological grading, 78% were correctly graded on cytology. The sensitivity, specificity, positive predictive value and negative predictive value for ER detection on immunocytochemistry (ICC) were 55.6%, 95%, 93.8% and 61.3%, respectively. The sensitivity, specificity, positive and negative predictive value for PR detection on ICC were 57.7%, 95.2%, 93.8% and 64.5%, respectively. The correlation for ER and PR between cytology and histology was 72.3% and 74.5%.Conclusion:The grading along with ER and PR immunostaining of breast carcinoma on smears is advocated because of high concordance between cytology and histology. This allows the patient to be treated with hormonal therapy on the basis of FNAC alone.

Histological Types of Gastric Cancer and &amp;lt;i&amp;gt;Helicobacter pylori&amp;lt;/i&amp;gt; Infection in Yaound&amp;#233;

Introduction: The diffuse type of gastric adenocarcinoma has been found to be more prevalent in low risk countries like Cameroon. The objective of this study was to determine the most frequent histological type of gastric cancer found in Yaoundé and its association to the Helicobacter pylori infection. Materials and Methods: The registries of histopathology laboratories of 4 reference hospitals in Yaoundé, Cameroon have been reviewed for registered primitive gastric malignancies from July 2009 to May 2014. Paraffin blocks mounted on slides and stained with Hematoxylyn and Eosin of gastric cancer cases were re-stained Giemsa to search for Helicobacter pylori and they were classified using the criteria of Lauren in intestinal type or diffuse type. Results: Forty-two cases were reviewed: 25 (59.5%) of them were intestinal type of gastric adenocarcinoma, 11 (26.2%) were diffuse type, 4 (9.5%) were malignant gastric lymphoma, 1 (2.4%) was a stromal tumor, and 1 (2.4%) was a colloid carcinoma. The most common site of location was the proximal gastric portion (52.2%). The overall prevalence of Helicobacter pylori infection was 88.1%, most common with the intestinal type (100%) and malignant lymphoma (100%) than with the diffuse type (72.2%) (p = 0.007). Conclusion: The most common type of gastric adenocarcinoma in Cameroon is the intestinal type and Helicobacter pylori infection is more common in the intestinal type and malignant gastric lymphoma than in the diffuse type. The Helicobacter pylori eradication campaigns are needed.

A Comparison of Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA) and Positron Emission Tomography (PET) in Preoperative Diagnosis of Pancreatic Duct Adenocarcinoma

Introduction: Colloid carcinoma (CC) is a rare invasive carcinoma of the pancreas believed to arise from intestinal type intraductal papillary mucinous neoplasm (IPMN). The cytologic features of CC are not well described because previous cytology descriptions of invasive carcinomas arising from IPMN do not consistently subtype the invasive carcinoma. Furthermore, current diagnostic criteria may not have been used to diagnose the histologic correlates for prior descriptions of CC. We describe fine needle aspiration (FNA) findings for CC using histologically confirmed cases meeting current diagnostic criteria. Materials and Methods: We searched our archive for ultrasound-guided FNAs of the pancreas with histologic correlation showing CC defined by containing >80% extracellular mucin and reviewed corresponding cytology and histology. The following morphologic parameters were evaluated: cellularity, quantity and quality of mucin, cytoarchitecture, cell size, shape, and nuclear features. Results: Six FNA cases from resected CCs were identified. In 4/6 patients an associated IPMN of predominantly intestinal type was identified with the CC component comprising <10-100% of the lesions. Two cases were entirely CC, but one was not entirely submitted for histology and IPMN could not be excluded. By cyto-histo correlation we determined that 4/6 of FNAs contained CC while 2 cases showed discrepant features suggesting sampling error. The 4 FNAs containing CC uniformly showed: low cellularity (tumor cells comprised <20% of smeared material), abundant thick/glassy mucin, degenerating inflammatory cells in mucin, mild nuclear membrane abnormalities, and disordered honeycomb sheets of mucinous cells. All 4 CC FNAs were originally diagnosed as “suspicious for mucinous neoplasm.” Conclusion: The cytologic features of CC are similar to IPMN and may be subject to under-diagnosis due to the well-differentiated cytologic appearance, low cellularity, and thick obscuring mucin.

Fine Needle Aspiration Cytology of Colloid Carcinoma of the Pancreas

Introduction: Colloid carcinoma (CC) is a rare invasive carcinoma of the pancreas believed to arise from intestinal type intraductal papillary mucinous neoplasm (IPMN). The cytologic features of CC are not well described because previous cytology descriptions of invasive carcinomas arising from IPMN do not consistently subtype the invasive carcinoma. Furthermore, current diagnostic criteria may not have been used to diagnose the histologic correlates for prior descriptions of CC. We describe fine needle aspiration (FNA) findings for CC using histologically confirmed cases meeting current diagnostic criteria. Materials and Methods: We searched our archive for ultrasound-guided FNAs of the pancreas with histologic correlation showing CC defined by containing >80% extracellular mucin and reviewed corresponding cytology and histology. The following morphologic parameters were evaluated: cellularity, quantity and quality of mucin, cytoarchitecture, cell size, shape, and nuclear features. Results: Six FNA cases from resected CCs were identified. In 4/6 patients an associated IPMN of predominantly intestinal type was identified with the CC component comprising <10-100% of the lesions. Two cases were entirely CC, but one was not entirely submitted for histology and IPMN could not be excluded. By cyto-histo correlation we determined that 4/6 of FNAs contained CC while 2 cases showed discrepant features suggesting sampling error. The 4 FNAs containing CC uniformly showed: low cellularity (tumor cells comprised <20% of smeared material), abundant thick/glassy mucin, degenerating inflammatory cells in mucin, mild nuclear membrane abnormalities, and disordered honeycomb sheets of mucinous cells. All 4 CC FNAs were originally diagnosed as “suspicious for mucinous neoplasm.” Conclusion: The cytologic features of CC are similar to IPMN and may be subject to under-diagnosis due to the well-differentiated cytologic appearance, low cellularity, and thick obscuring mucin.

Colloid carcinoma of the lung: Current views.

Colloid carcinomas of the lung are rare and unusual neoplasms. These tumors need special attention in order to be properly coded as primary pulmonary tumors as they closely resemble their extrathoracic counterparts in their morphologic and immunohistochemical characteristics. Even though, the latest version of the World Health Organization (WHO) has trivialized this entity into garden variety of adenocarcinomas, recently proposed guidelines on pulmonary adenocarcinomas have created some potential to bring back the controversy that appeared to have been settled a decade ago regarding these tumors. Thus, the current review will highlight not only the current concepts but also will bring the historical perspective in an effort to clarify some misconceptions regarding this rare entity.

Colloid Carcinoma of the Uterine Cervix

Colloid carcinoma, characterized by the presence of a large amount of extracellular mucin that results in the formation of mucous lakes with a relative paucity of neoplastic glandular cells within them, is extremely rare in the uterine cervix. Herein, we report an additional case of colloid carcinoma of the cervix and discuss the immunohistochemical characteristics and histogenesis of this extremely rare tumor. A 47-year-old Japanese female without any history of carcinomas was found to have a bulky mass in the cervix. Biopsy from the cervix revealed adenocarcinoma; subsequently, total hysterectomy was performed. Histopathologic study demonstrated that columnar or cuboidal neoplastic glandular cells forming cribriform or tubular structures floated within the mucous lakes involving almost the entire layer of the cervical wall. Adenocarcinoma in situ (AIS) component was also observed. Immunohistochemically, tumor cells of the colloid carcinoma were positive for cytokeratin 7, MUC5AC, MUC6, and p16 (diffuse), but negative for cytokeratin 20, MUC2, and cdx-2. In addition, human papillomavirus 16 was detected in both colloid carcinoma and AIS components. This is the first reported case of endocervical type colloid carcinoma, and the second documented case of cervical colloid carcinoma with immunohistochemical analyses of mucin. The present case had an endocervical type AIS component, which suggests that AIS may be a precursor lesion of colloid carcinoma. Moreover, this case clearly demonstrates that the occurrence of cervical colloid carcinoma correlates with high-risk human papillomavirus.

First year experience with IORT for breast cancer at the Geneva University Hospitals

Purpose: The Breast Centre at the Geneva University Hospitals implemented guidelines for breast cancer intraoperative radiotherapy (IORT) in 2012. The present study evaluates early breast and skin toxicities observed during the first year of the implementation. Material and methods: From February 2012 to January 2013, 52 women received IORT for primary breast cancer treated with conservative surgery. IORT was delivered with the Intrabeam ® system. The prescribed dose was 20 Gy at the applicator’s surface. No further radiation was to be given according to the following criteria: age ≥50 years old, histopathology of invasive ductal, mucinous, tubular, medullar or colloid carcinoma, unifocal tumor, absence of lymphovascular invasion (LVI), absence of extensive in situ component, tumor size ≤30 mm, pathological nodal status pN0 by sentinel node biopsy or pN1mi by axillary dissection, and clear resection margins ≥2 mm. If the criteria were not met, additional whole breast radiotherapy (WBRT) to an equivalent dose of 50 Gy in 2-Gy fractions was to be given post-operatively. Toxicity grades were based on LENT-SOMA scoring tables. Results: IORT was given as exclusive radiation therapy in 34 (65%) patients, whereas 18 (35%) patients received an additional hypofractionated WBRT of 40-47.25 Gy in 15-21 fractions, one of whom further received after IORT-WBRT an additional electron boost of 13.5 Gy to the tumor bed in 6 fractions. At 1-month post-IORT, no heart toxicity was recorded. Six (11.5%) patients presented grade 2 lung symptoms. Breast/skin most frequent toxicities were seroma, grade 3 in 13 of 52 (25%) patients. One patient had a wound dehiscence requiring suture, and one patient had hematoma after immediate bilateral breast reconstruction with implants. Regarding the 18 patients who received additional WBRT, subsequent reevaluation after the WBRT found no heart toxicity, grade 1 lung symptoms in 1 (5%) patient, and grade 3 breast and skin toxicity in 2 (11%) patients (1 persistent seroma and 1 skin dryness). The breast and skin toxicity observed in patients after additional WBRT was not significantly increased as compared with the toxicity earlier observed after IORT, P=0.631. Conclusions: Early evaluation of IORT found mild to moderate breast and skin toxicity. Toxicity was not significantly increased in patients receiving additional WBRT.

Clinical Implication of Morphological Subtypes in Management of Intraductal Papillary Mucinous Neoplasm

Morphological subtypes of intraductal papillary mucinous neoplasm (IPMN) have been established. Invasive IPMNs include colloid carcinoma and tubular carcinoma. Few studies have explored the association between the morphological and invasive subtypes in a large population. Clinical relevance of the morphological subtypes remains unclear. One hundred sixty-nine consecutive patients who underwent curative resection of IPMN were enrolled. The intraductal components were classified into four distinct epithelial subtypes: gastric, intestinal, pancreatobiliary, and oncocytic. The invasive components were classified as colloid or tubular. The numbers of patients with gastric, intestinal, pancreatobiliary, and oncocytic subtypes were 123, 42, 3, and 1, respectively. Fifty-six patients had invasive cancer (tubular type, 42; colloid type, 14). The proportions of gastric type IPMN within each histological grade were 88 % among adenomas, 43 % among noninvasive carcinomas, 41 % among minimally invasive carcinomas, and 74 % among invasive carcinomas. Gastric subtype was more commonly associated with branch duct type and intestinal subtype with main duct type, and these tendencies were statistically significant (P = 0.0131). Furthermore, there was a strong correlation between gastric and tubular types and between intestinal and colloid types (P < 0.0001). The 5-year survival rate among the 56 invasive cancers was 52.7 % for gastric type and 89.7 % for intestinal type, which was statistically significant (P = 0.030). Gastric type IPMN is mostly derived from branch duct IPMN and often demonstrates benign behavior, as seen with adenomas. However, once gastric type IPMN develops into invasive carcinoma, the survival rate is significantly lower than other types.

Solid masses: What are the underlying histopathological lesions?

The ultrasound signs of breast masses are explained by the histopathological data. Ultrasound masses are classified according to their shape and margin. Round or oval masses are benign when their margins are circumscribed (fibroadenoma, intramammary lymph node); on the other hand, with non-circumscribed margins (microlobulated or irregular), masses that are round or oval may be cancers. Seven histological types of round cancers have been identified: grade III invasive ductal carcinoma, colloid or mucinous carcinoma, medullary carcinoma, intramammary metastases, intracystic papillary carcinoma, lymphoma and high-grade phyllodes tumors. Irregularly shaped ultrasound masses with non-circumscribed margins are predominantly cancers but may in some cases be benign lesions such as sclerosing adenosis, a radial scar, fibroadenoma or phyllodes tumor.

Clinical and prognostic significance of EGFR, MMP-13 and E-cadherin expressions in colorectal signet ring cell adenocarcinoma

Colorectal signet ring cell adenocarcinoma (SRA) is a rare entity that accounts for 1% of colorectal carcinoma (CRC). SRA has specific clinicopathological features different from ordinary adenocarcinoma (OA) and colloid carcinoma (CC). In this study, we aimed to compare SRA, OA and CC regarding clinicopathological, histological parameters, survival, EGFR, MMP-13 and E-cadherin expressions. We studied tumor tissue specimens from 19 patients with SRA, 47 patients with OA and 56 patients with CC. High density manual tissue microarrays were constructed. SRA was significantly associated with younger age, more lymph node metastasis, advanced stage, more lymphovascular emboli, perineural invasion and worse disease-free and overall survival. OA was significantly associated with more peritumoral lymphocytic infiltrate and microscopic abscess formation than SRA. SRA expressed EGFR, MMP-13 and E-cadherin in significantly lower rates than OA. The same was true for CC but with no significant difference of MMP-13 expression with SRA. Neither EGFR, MMP-13 nor E-cadherin expression showed a significant impact on disease-free or overall survival in patients with SRA. Our results support that targeted therapies against EGFR, MMP-13 and E-cadherin are not expected to be useful in patients with SRA. Further molecular studies are needed to introduce tailored targeted therapies for SRA.