Low-grade Papillary Adenocarcinoma Research Articles

Risk Factors of Lymph Node Metastasis and Prognosis in 891 Chinese Patients With Submucosal Early Gastric Carcinoma, Emphasizing Differences Between Gastric Cardiac and Noncardiac Origins.

Differences in risk factors (RF) of lymph node metastasis (LNM) and prognosis between submucosal early gastric cardiac (SEGCC) and noncardiac (SEGNCC) carcinomas remain unclear. In this study, we investigated and compared RF of LNM and prognosis in 891 patients with radical gastrectomy for SEGCC (n=217) or SEGNCC (n=674). Compared with SEGNCC, SEGCC displayed significantly higher proportion of elderly patients (70y or above), the elevated macroscopic type, well/moderately differentiated tubular and low-grade papillary adenocarcinomas, as well as low-grade tumor budding, but lower prevalence of the depressed macroscopic type, poorly differentiated tubular adenocarcinoma, mixed adenocarcinoma, poorly cohesive carcinoma, lymphovascular invasion (LVI), perineural invasion, and high-grade tumor budding. By univariate analysis, significant RF for LNM of the cohort included female sex, poor differentiation, SM2 invasion, LVI, intermediate-grade and high-grade tumor budding, whereas tumor size, histology type, and perineural invasion were the significant RF for LNM in SEGNCC. By multivariate analysis, significant independent RF for LNM included female sex and LVI in SEGCC but were female sex, mixed adenocarcinoma, LVI, and high-grade tumor budding in SEGNCC. The 5-year overall survival was significantly worse in SEGCC than in SEGNCC for patients with LNM, but not for those without. For overall survival, LNM was the only significant independent RF in SEGCC, whereas age 70 years or above and LNM were independent RF in SEGNCC. The results of our study provided the clinicopathologic evidence for individualized clinical management strategies for these 2 groups of patients and suggested different pathogenesis mechanisms between SEGCC and SEGNCC.

Prognostic factors in clinicopathology of oesophagogastric adenocarcinoma: a single-centre longitudinal study of 347 cases over a 20-year period

Oesophagogastric adenocarcinoma (EGA) includes oesophageal (EA), gastro-oesophageal junctional (GEJA), and gastric (GA) adenocarcinomas. The prognostic values of clinicopathological factors in these tumours remain obscure, especially for GEJA that has been inconsistently classified and staged. We studied the prognosis of EGA patients among the three geographic groups in 347 consecutive patients with a median age of 70 years (range 47-94). All patients were male, and 97.1% were white. Based on tumour epicentre location, EGAs were sub-grouped into EA (over 2 cm above the GEJ; n=3, 18.1%), GEJA (within 2 cm above and 3 cm below the GEJ; n=231, 66.6%), and GA (over 3 cm below the GEJ; n=53, 15.3%). We found that the median overall survival (OS) was the longest in EA (62.9 months), compared to GEJA (33.4), and GA (38.1) (p<0.001). Significant risk factors for OS included tumour location (p=0.018), size (p<0.001), differentiation (p<0.001), adenocarcinoma subtype (p<0.001), and TNM stage (p<0.001). Independent risk factors for OS comprised low-grade papillary adenocarcinoma [odds ratio (OR) 0.449, 95% confidence interval (CI) 0.214-0.944, p<0.05), mixed adenocarcinoma (OR 1.531, 95% CI 1.056-2.218, p<0.05), adenosquamous carcinoma (OR 2.206, 95% CI 1.087-4.475, p<0.05), N stage (OR 1.505, 95% CI 1.043-2.171, p<0.05), and M stage (OR 10.036, 95% CI 2.519-39.993, p=0.001)]. EGA was further divided into low-risk (common well-moderately differentiated tubular and low-grade papillary adenocarcinomas) and high-risk (uncommon adenocarcinoma subtypes, adenosquamous carcinoma) subgroups. In this grouping, the median OS was significantly longer in the low-risk (83 months) than in the high-risk (10 months) subgroups (p<0.001). In conclusion, the prognosis of EGA patients was significantly better in EA than in GEJA or GA and could be stratified into low and high-risk subgroups with significantly different outcomes.

LOW-GRADE PAPILLARY ADENOCARCINOMA: A RARE ENTITY

Introduction Low-grade papillary adenocarcinoma (LGPA) of the minor salivary glands is uncommon, which is noted to occur after 40 years of age with a male/female ratio of 2:1. Adenocarcinoma in this site includes salivary and nonsalivary types pathologically. The prevalence of LGPA is 17%, which is often poorly recognized and misdiagnosed, as it has a greater potential for local recurrence with evidence of regional metastasis, and only a few cases are reported in the literature. LGPA represents a relatively rare histologic variant of polymorphous low-grade adenocarcinoma. Case Presentation A 50-year-old female patient reported a complaint of a swelling in the posterior part of the hard palate that was associated with pain of 1-year duration. On examination, a mobile submucosal swelling of 1-cm size was noted in the posterior part of the hard palate laterally on the left side, and wide excision of the lesion was performed. On histologic examination, the lesional tissue exhibited extensive well-defined papillary arrangement of tumor cells that had a columnar appearance. The lesion was interpreted as LGPA on histologic examination, which was followed by immunohistochemistry to confirm the diagnosis. She is disease-free over a period of 2 years, and follow-up is being continued to monitor for development of recurrence. Conclusion A rare case of LGPA is reported for its diagnostic challenge; the lesion has a biological tendency to develop local recurrence and regional metastasis. Low-grade papillary adenocarcinoma (LGPA) of the minor salivary glands is uncommon, which is noted to occur after 40 years of age with a male/female ratio of 2:1. Adenocarcinoma in this site includes salivary and nonsalivary types pathologically. The prevalence of LGPA is 17%, which is often poorly recognized and misdiagnosed, as it has a greater potential for local recurrence with evidence of regional metastasis, and only a few cases are reported in the literature. LGPA represents a relatively rare histologic variant of polymorphous low-grade adenocarcinoma. A 50-year-old female patient reported a complaint of a swelling in the posterior part of the hard palate that was associated with pain of 1-year duration. On examination, a mobile submucosal swelling of 1-cm size was noted in the posterior part of the hard palate laterally on the left side, and wide excision of the lesion was performed. On histologic examination, the lesional tissue exhibited extensive well-defined papillary arrangement of tumor cells that had a columnar appearance. The lesion was interpreted as LGPA on histologic examination, which was followed by immunohistochemistry to confirm the diagnosis. She is disease-free over a period of 2 years, and follow-up is being continued to monitor for development of recurrence. A rare case of LGPA is reported for its diagnostic challenge; the lesion has a biological tendency to develop local recurrence and regional metastasis.

갑상선 유사 저악성도 비인두 유두상 선암종 1예

Primary thyroid-like low-grade papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. It is important that clinicians recognize this disease, as these neoplasms are amenable to surgical resection and carry an excellent prognosis. We present a case with a pedunculated tumor in the roof of the nasopharynx. Complete tumor excision via endonasal approach and electrocauterization of the origin of mass was undergone. Postoperative histopathological examinations and immunohistochemical studies confirmed thyroid-like low-grade papillary adenocarcinoma of the nasopharynx. In addition, we include a review of the literature about this rare entity. (J Clinical Otolaryngol 2017;28:283-287)

Circulating tumor cells as a new and additional approach to follow-up patients with serous low-grade ovarian adenocarcinoma \u2013 a case report and review of the literature

BackgroundCurrent methods for follow-up of Ovarian Cancer (OC) are widespread, especially with CA125, which, however, is not a perfect biomarker and thus further investigation for new methods of evaluation are warranted. The feasibility of Circulating Tumor Cells (CTCs) in advanced OC was investigated in this case report.Case presentationA 19-year-old woman with advanced low-grade serous papillary adenocarcinoma and relapsed disease did not have a CA125 correspondent with disease relapse. CTCs were evaluated, compared with CA125 and with image exams. Relapses were not correspondent to elevations of CA125. CTCs demonstrated usefulness, being proportional to major disease relapse, especially in the peritoneum. CTCs may be used as a complementary diagnosis tool when marginal/small increases in CA-125 levels are observed.ConclusionsIn OC, CTCs can be an important tool to predict recurrence, response to treatment and improve the quality of decision-making, in order to offer the best treatment to a determined group of patients.

Low-Grade, Nonintestinal Nonsalivary Sinonasal Adenocarcinoma Associated With an Exophytic Schneiderian Papilloma

Sinonasal adenocarcinoma is a rare tumor of the head and neck accounting for 10% to 20% of all primary malignancies of the nose and paranasal sinuses. There tumors are classified as salivary, intestinal and nonintestinal, nonsalivary. Low-grade nonintestinal nonsalivary are rare tumors whose diagnosis is essentially that of exclusion. Here we present the first case of one such tumor associated with an exophyic Schneiderian papilloma. A 71-year-old retired aerospace engineer presented with a 1-year history of severe nasal obstruction. Endoscopy and compted tomography imaging demonstrated a polypoid lesion occupying his entire right nasal cavity extending into and filling the nasopharynx. Biopsy suggested adenocarcinoma, at least in situ and the patient subsequently underwent complete resection. Pathologic evaluation demonstrated polypoid tumor consistent with a low-grade papillary adenocarcinoma with micropapillary architecture associated with a small amount of residual exophytic Schneiderian papilloma. Immunohistochemistry revealed diffuse expression of CK7, CK 5/6, and S100 protein in tumor cells. Expression of p63 was seen in basal cells only. Tumor cells did not show expression of CK20, CDX2 (intestinal markers), mammaglobin, GATA3 (salivary markers), PAX8, WT1, nor estrogen, progesterone, or androgen receptors confirming its nonintestinal nonsalivary differentiation.

Low-Grade Papillary Adenocarcinoma of The Palate: A Case Report

Low-Grade Papillary Adenocarcinoma of The Palate: A Case Report

Polymorphous Low-Grade Adenocarcinoma

Polymorphous low-grade adenocarcinoma (PLGA) is a low-grade malignant epithelial tumor that is the second most common malignant neoplasm of minor salivary glands. Diagnosis on biopsy remains challenging owing to histological similarities with other salivary glands, including benign and malignant neoplasms. The most important differential diagnoses to consider include pleomorphic adenoma, adenoid cystic carcinoma, low-grade papillary adenocarcinoma, cribriform adenocarcinoma of minor salivary glands, and mucoepidermoid carcinoma. Recently, a PRKD2 rearrangement was described in PLGA. The definitive treatment is complete surgical excision with negative clear margins. These tumors typically follow an indolent course and rarely metastasize but have a propensity to recur. The focus of this review is on the histopathologic features of PLGA and findings that might allow differentiation from histologically similar–appearing salivary gland neoplasms.

Papillary neoplasms of the endolymphatic sac and mucosal lining of the pneumatic spaces of the temporal bone: Role of imaging

Primary adenomatous and adenocarcinomatous lesions of the temporal bone are rare tumors. Primary low-grade papillary adenocarcinomas of the endolymphatic sac origin were first reported by Heffner. These lesions, which are referred to as "Heffner tumors," are slow-growing, bone-destructive infiltrating tumors. Owing to the local bone destruction (usually centered at posterior petromastoid plate), the general consensus favors the endolymphatic sac as being the origin of these tumors. However, controversies regarding the cellular origins of adenomatous tumors of the temporal bone have been reported. Mafee and Shah reported a unique case in which histology was identical to papillary adenocarcinoma of endolymphatic sac in which the sac and duct showed normal findings on magnetic resonance images, which were confirmed on surgery. Computed tomography and magnetic resonance imaging are excellent imaging methods for evaluation of normal and anomaly of the vestibular aqueduct and endolymphatic duct and sac and for the diagnosis of these endolymphatic tumors. This article reviews computed tomography and magnetic resonance imaging characteristics of adenocarcinomatous tumors of temporal bone. This report also concerns a unique case of a papillary adenocarcinoma of presumed endolymphatic sac in a 12-year-old child, in which tumor replaced almost the entire petromastoid resulting in a markedly egg-shell appearance of the bone. To the best of our knowledge, this is the youngest child with papillary endolymphatic sac tumor reported.

An endonasal approach to the resection of a papillary seromucinous adenocarcinoma of the Eustacian tube

ObjectivesPapillary seromucinous adenocarcinoma of the sinonasal tract is exceedingly rare. The objectives of this case report are to describe a case of papillary seromucinous adenocarcinoma presenting in the nasopharynx and to review the literature pertaining to other similar cases.MethodsA review of the patient's chart and a review of the English literature were conducted.ResultsWe describe the case of a 64 year-old woman who presented with a 3-year history of epistaxis and right-sided otitis media with effusion. The patient had been followed for a known nasopharyngeal mass that had twice been biopsied and in both cases was considered a benign mass pathologically. A third biopsy was diagnosed as a low-grade papillary seromucinous adenocarcinoma. The patient was otherwise asymptomatic. The patient was referred to a multidisciplinary cancer clinic at which endoscopic resection was determined to be the preferred treatment modality. A literature review and approach to patients with nasopharyngeal masses will be presented.ConclusionsPapillary seromucinous adenocarcinoma is a rare tumor that can present in the nasopharynx. We describe the endoscopic surgical management of one such patient that presented to our care.

Management of Low-Grade Papillary Adenocarcinomas of the Endolymphatic Sac

Management of Low-Grade Papillary Adenocarcinomas of the Endolymphatic Sac

Biphasic Low-Grade Nasopharyngeal Papillary Adenocarcinoma with a Prominent Spindle Cell Component: Report of a Case Localized to the Posterior Nasal Septum

A case (female, 39years of) of thyroid-like nasopharyngeal low-grade papillary adenocarcinoma with a significant spindle cell component is presented. The tumor was located on the posterior nasal septum. The spindle cells displayed nuclear features very much similar to the epithelial component and the two cell types merged imperceptibly. Immunohistochemically, the neoplastic cells (including the spindle cell component) were strongly and diffusely positive for TTF-1, cytokeratins (AE1-3), cytokeratin 19 and vimentin. C-kit immunohistochemistry showed diffuse mild to moderate membranous positivity with focal areas displaying moderate to strong immunoreactivity. EMA was strongly positive in the epithelial component with membranous and cytoplasmic reactivity whereas the spindle cell component was weakly although diffusely positive. Carcinoembryonic antigen, calcitonin, chromogranin A, S100-protein, thyroglobulin, cdx2 and p63 were negative. The proliferative activity (Mib-1/Ki-67) was low; 3-4%. In the molecular genetic study we found no mutations at position 1799 (exon 15) in the BRAF-gene, (BRAFV600E) or in exons 9 and 11 of the KIT-gene.

Cytomorphological diagnosis of malignant eccrine tumors: Report of two cases

Though FNAC has been successfully used in diagnosing various neoplastic and nonneoplastic cutaneous lesions, there is a paucity of case reports describing the cytomorphological features of adnexal tumors. We hereby describe the cytological features of two histologically confirmed cases of malignant eccrine tumors. Case number 1 presented with an ulcerated infraclavicular swelling whereas case number 2 presented with a cystic swelling over left foot. FNA and histological examination of the resected specimens was performed using standard techniques. A cytological diagnosis of low grade papillary adenocarcinoma arising from skin adnexal structures was given in case number 1. Aspirate from case number 2 was reported as positive for malignant cells, and histological examination was advised. Histological examination revealed the presence of malignant eccrine acrospiroma in case number 1 and papillary digital adenocarcinoma in case number 2. Careful cytological examination displayed the characteristic of two cell population seen in eccrine tumors in both the cases. Diagnosis of malignant eccrine tumors cannot be made with certainity on cytology alone, hence the need to document the cytological features of these entities is emphasized.

Low-Grade Papillary Adenocarcinoma of the Palate: The Significance of Distinguishing it from Polymorphous Low-Grade Adenocarcinoma

Low-grade papillary adenocarcinoma (LGPA) represents a relatively rare histological variant of polymorphous low-grade adenocarcinoma (PLGA). There has been a debate as to whether LGPA is associated with greater aggressive potential compared to PLGA; this is further obfuscated by the fact that diagnostic criteria for LGPA have not been well-defined. We believe that this is the first report of a patient with LGPA who developed metastases to the femur and scalp. We review the published evidence for classifying LGPA as distinct from PLGA. The weight of published data does support the idea that LGPA is oncologically distinct from LGPA. However, as uniform diagnostic criteria are lacking, we suggest a cut-off value of 10% or greater papillary formation as being necessary to separate LGPA from PLGA.

MUCINOUS LOW-GRADE ADENOCARCINOMA ARISING IN AN INTRACRANIAL ENTEROGENOUS CYST

Enterogenous cysts (ECs) of the central nervous system are developmental malformations that occur in the spinal canal, posterior fossa, or cerebral hemispheres. They are usually benign lesions, and malignant transformation is rare. To date, only three cases of malignant transformation have been reported in the literature. We present a case of a cerebellopontine EC showing foci of epithelial dysplasia and malignant transformation into a low-grade papillary mucinous adenocarcinoma. A 25 year-old man with a 6-year history of hypoacusia presented to our department with facial nerve deficit, visual disturbances, and gait instability. A magnetic resonance imaging scan demonstrated a multiloculated cerebellopontine angle cyst with supratentorial hydrocephalus. A retrosigmoidal approach was used to achieve cyst removal. This was followed several months later by ventriculoperitoneal shunt placement. The cyst was adherent to the brainstem, cranial nerves, and vessels, and it resembled a thin encapsulated structure filled with mucinous-like substance. No solid component was identified. Histopathological examination revealed an EC with foci of malignant transformation in a mucinous papillary adenocarcinoma. Magnetic resonance imaging was performed 5 months postoperatively due to progressive clinical worsening; this scan revealed lesion recurrence with severe brainstem compression. Emergency surgery was performed, and a large decompression was achieved. Subsequent follow-up computed tomographic scans showed progression of the residual tumor. The patient's neurological condition rapidly worsened, ultimately resulting in death. The present report suggests that a careful histological examination of all ECs after surgery should be made to exclude dysplastic foci or carcinomatous transformation. Although the clinical behavior of ECs with malignant transformation is unpredictable, surgery remains the treatment of choice. The use of possible adjuvant chemo- or radiotherapy has not been established.

Head Neck Pathol Radiology Pathology Classics

Head Neck Pathol Radiology Pathology Classics

Papillary adenocarcinoma with oncocytic features arising from the ethmoid sinus

Objectives: We report a case of low-grade papillary adenocarcinoma with unique oncocytic features arising in the ethmoid sinus of a 72-year-old female. Methods: A review of the case history, pathological findings, and medical literature is performed. Results: A 72-year-old female presented with a 2-month history of progressive right-sided nasal obstruction. Preoperative nasal endoscopy showed a glistening, pink-red, soft mass arising from the middle meatus suspicious for inverting papilloma. Paranasal CT revealed a soft tissue density opacifing the right ethmoid sinus with ipsilateral maxillary and frontal sinus opacification. Complete endoscopic sphenoethmoidectomy was performed. Pathological examination of the surgical specimen revealed a low-grade papillary adenocarcinoma with oncocytic features. Special staining for MIB-1, p53, and Ki-67 was confirmatory. One year following surgical resection, nasal endoscopy revealed a recurrent mass in the surgical field; paranasal CT was confirmatory. A completion external and endoscopic ethmoidectomy was performed with complete removal of the neoplasm. Pathological examination revealed recurrent low-grade papillary adenocarcinoma. At 3 months postoperatively, the patient remains free from recurrent neoplasm. Conclusion: The management of ethmoid adenocarcinoma is dependent on the extent of disease and its pathological characteristics. Locally aggressive low-grade neoplasms, such as inverting papilloma, have been successfully treated with complete endoscopic resection with good rates of local control. Similarly, low-grade papillary adenocarcinoma has been successfully treated with endoscopic resection. In this case report, a rare oncocytic form of papillary adenocarcinoma is described that behaves similarly to other low-grade sinonasal papillary adenocarcinomas. Meticulous endoscopic surgical resection must be performed as local recurrence is common.

Recurrent Superficial Papillary Adenocarcinoma of the Bladder

Primary adenocarcinoma of the bladder is the third most common type of bladder carcinoma after transitional and squamous cell carcinomas. This neoplasm comprises 0.5% to 2% of all epithelial malignant bladder tumors. Primary vesical adenocarcinomas are most frequently single lesions with a predilection for the trigone and bladder dome. Most of these lesions are muscle invasive at presentation. Papillary adenocarcinoma, a rare subtype of bladder adenocarcinoma, was first reported in 1985.1 We report a unique case of recurrent superficial papillary adenocarcinoma of the bladder that was managed conservatively without progression for more than 5 years. CASE REPORT A 60-year-old white female presented with moderate persistent irritative bladder symptoms. Medical history was remarkable for grade 1 colon carcinoma that was resected in 1981, breast cancer with lymph node involvement that was treated with modified radical mastectomy, axillary node dissection, chemotherapy and 8 to 9 years of hormonal therapy (tamoxifen); neurofibromatosis of the trunk and limbs; temporal lobe seizures and Hashimoto’s thyroiditis. The patient also had a history of allergic reaction (hives) to certain drugs. She was initially diagnosed with interstitial cystitis. However, cystourethroscopy in November 1995 showed a papillary tumor involving the left anterolateral bladder wall with several small satellite lesions. The tumor was resected and pathological examination demonstrated low grade papillary adenocarcinoma with clear cell features with invasion to the lamina propria but no muscle invasion. Differential diagnosis was supported by positive mucicarmine and CA 125 staining (figs. 1 and 2). Evaluation for metastasis was negative.

Endoscopic management of low-grade papillary adenocarcinoma of the ethmoid sinus: Case report and review of the literature

The management of ethmoid adenocarcinoma depends on the extent of disease at presentation and the histopathological characterization of the tumor. We present one patient with the papillary variant of low-grade adenocarcinoma of the ethmoid sinus (LGPAE) to discuss the clinical presentation, pathological features, and treatment options for this lesion. We focus on our endoscopic removal of this indolent neoplasm to explore the rationale for and dangers of endoscopic tumor removal of low-grade sinonasal malignancy.

Polymorphous low-grade adenocarcinoma of the oral cavity: A report of 14 cases

The clinicopathologic characteristics of 14 new cases of low-grade polymorphous adenocarcinoma of the oral cavity are presented. Tumors were located in the palate in 10 cases, and in one case each in the base of the tongue, buccal mucosa, tonsil, and retromolar pad. Nine cases were previously diagnosed as other categories of benign and malignant tumors. The tumors were classified as terminal-duct and low-grade papillary adenocarcinomas. Three cases developed local recurrence and four cases had lymph nodes metastasis, two on admission and two during the course of the disease. Two of the local recurrences and all cases with metastasis were salvaged with further surgery with or without irradiation. Recurrence and metastasis occurred only with the terminal duct adenocarcinoma. There was no death related to the neoplasm, although one patient is living with advanced disease.