Mucin-producing Adenocarcinoma Research Articles

Pulmonary Mucinous Cystadenocarcinoma: Report a Case and Review of CT Findings

A pulmonary mucinous cystadenocarcinoma is an extremely rare tumor that is considered to be a cystic variant of mucin-producing lung adenocarcinoma. We present a case of pulmonary mucinous cystadenocarcinoma in a 54-year-old woman. Chest CT scans showed a 4.3-cm-sized, lobulated, well-defined, and homogeneous mass in the right middle lobe with peripheral stippled calcifications that demonstrated low-attenuation with no enhancement after contrast administration; 18F-fluorodeoxyglucose (FDG) PET/CT demonstrated mild heterogeneous FDG uptake. The mass was diagnosed as adenocarcinoma with mucin production by transbronchial lung biopsy. Right middle lobectomy was performed, and the pathologic examination disclosed a pulmonary mucinous cystadenocarcinoma.

Mucin-producing Tumors and Tumor-like Lesions Involving the Prostate

Mucin-producing tumors of the prostate include both primary and secondary tumors with mucinous differentiation or features involving the prostate gland. These tumors are relatively rare and have variable prognostic and therapeutic implications. Primary mucinous (colloid) adenocarcinoma of the prostate is defined as prostatic adenocarcinoma with mucinous differentiation involving 25% or more of the entire tumor. Another primary tumor of the prostate that may have mucinous features is primary mucin-producing urothelial-type adenocarcinoma of the prostate (mucinous prostatic urethral adenocarcinoma). Primary mucin-producing urothelial-type adenocarcinoma of the prostate is a distinct entity that typically arises from the prostatic urethra possibly from urethritis glandularis or glandular metaplasia with malignant transformation, and it is analogous to adenocarcinoma with mucinous differentiation arising from the urinary bladder. Signet ring cell tumors of the prostate, though rare, may also have mucinous features. Secondary tumors with mucinous differentiation that may involve the prostate include adenocarcinomas of the urinary bladder and colorectum. Pathologists should also be aware of mucin-producing tumor-like lesions involving the prostate, including mucinous metaplasia, and benign Cowper glands that may mimic malignancy. Herein we present an updated and comprehensive review of the clinicopathologic, immunohistochemical, molecular, and prognostic features of mucinous tumors and tumor-like lesions involving the prostate gland, with emphasis on mucinous prostatic adenocarcinoma and its mimickers, including potential diagnostic pitfalls.

Pseudomyxoma Peritonei: More Questions Than Answers

Pseudomyxoma Peritonei: More Questions Than Answers

Mucin-producing adenocarcinoma arising in an atrial myxoma

We describe the unique autopsy findings of a patient who died of a metastasizing giant right atrial adenocarcinoma containing few areas of typical myxoma. That no mucin-producing extracardiac tumor was detected pointed to the atrial adenocarcinoma as being the primary. We hypothesize that the adenocarcinoma may have developed from coexistent bland glandular structures within the myxoma.

A case of multicystic peritoneal mesothelioma

Multicystic peritoneal mesothelioma is an unusual mesothelial lesion that deserves separate consideration because of its characteristic histologic picture and its benign behavior. In the past, this lesion was often confused with cystic lymphangioma, mesenteric lymphatic cyst, diffuse mesothelioma, and disseminated form of mucin-producing adenocarcinoma. Diagnostic accuracy and long-term follow-up are needed due to high incidence of recurrence. We report a rare case of huge multicystic peritoneal mesothelioma in a 36-year-old woman. At follow-up 18 months after surgery, the patient remained asymptomatic with no further growth.

Mucin-Producing Urothelial-Type Adenocarcinoma of the Prostate as a Mimicker of Colonic Adenocarcinoma

A 59-year-old man presented with persistent urinary obstructive symptoms, gross hematuria, and mucusuria. Subsequently, a prostate-specific antigen (PSA)-negative mucin-producing urothelial type adenocarcinoma of prostate was found. The serum PSA level was within the normal limit. Colonoscopy, positron emission tomography, and other tumor surveys showed this to be the only prostate lesion. Microscopically, there was an adenocarcinoma with copious mucin production, with the formation of mucin pools. The neoplastic glands were variously arranged in cribriform, glandular, and villous adenoma-like patterns. This is a very rare tumor, of which there are only 20 cases reported in the literature in the English language. It is critical to distinguish it from mucinous acinar adenocarcinoma of the prostate and from metastatic adenocarcinoma of either the bladder or colon. This is mainly because mucin-producing urothelial type adenocarcinoma of the prostate has a different clinical behavior, and hence, the treatment plan is different from that for conventional prostatic adenocarcinoma. Specifically, it has a more aggressive clinical course and is unresponsive to hormone therapy.

Internal Juguler Vein Trombosis as an Initial Presentation of Signet-Ring Cell Adenocarcinoma of Unknown Origin

Internal jugular vein (IJV) thrombosis is a rare entity. Cases of IJV thrombosis associated with malignancy have been reported. Signet-ring cell adenocarcinoma is a unique subtype of mucin-producing adenocarcinoma that usually develops in the gastrointestinal tract. We report signet-ring cell adenocarcinoma (SRCAC) presented initially with an IJV thrombosis prior to the discovery of the neoplasm. doi:10.4021/jmc225w

Pancreatic cancer metastasis presenting as an arachnoid cyst of the cervical spine: a case report

Spinal extradural arachnoid cysts are rare expanding lesions, and their etiology is mainly unknown. The authors present a rare case of metastatic pancreatic cancer presenting as an arachnoid cyst of the cervical spine. A 61-year-old woman with progressive neurological deficits was presented with a very large cystic mass from C3 to C6 and C7 and T1 that was a metastatic lesion causing severe collapse of vertebral bodies and subluxation. A posterior laminectomy from C3 to C6 for excision of the cysts and marginal excision including laminectomy around C7 and T1 were performed with instrumented fusion to prevent further collapse and subluxation of T1. No communication between the cysts and the subarachnoid space was found in the surgical field. The neurological symptoms rapidly improved immediately after the surgery. The histology of resected specimens was metastatic mucin-producing adenocarcinoma. This report describes a rare case of metastasis of pancreatic cancer presenting as an arachnoid cyst of the cervical spine. The significance of this study is that metastatic cystic lesions from pancreatic cancer should be considered in the differential diagnosis of arachnoid cysts of the spinal canal.

Primary hepatic neuroendocrine carcinoma with nonbacterial thrombotic endocarditis: A case report

Nonbacterial thrombotic endocarditis (NBTE) is occasionally found in patients with carcinoma (lung or gastrointestinal) or debilitating diseases. Definite diagnosis of NBTE should be performed by autopsy. It is difficult to diagnose NBTE if patients have no clinical signs of thromboembolism. Here, we present a case of primary hepatic neuroendocrine carcinoma with NBTE as proven by autopsy.

Signet-ring cell (mucin-producing) adenocarcinoma of minor salivary glands: report of a case

Salivary gland tumors account for a significant group of head and neck neoplasms. Signet-ring cell (mucin-producing) adenocarcinoma of minor salivary glands was described by Ghannoum and Freedman in 2004. We report a case of this extremely rare minor salivary gland neoplasm in an 18-year-old male. To our knowledge, this patient is the youngest to ever be reported having this tumor.

Clinicopathological Features and Immunoexpression Profiles of Goblet Cell Carcinoid and Typical Carcinoid of the Appendix

Goblet cell carcinoid (GCC) of the appendix is currently classified as a neuroendocrine tumor, together with typical carcinoid (TC) of the appendix. However, whether GCC is a variant of TC or a mucin-producing adenocarcinoma is still controversial. To get a better understanding, we investigated the clinicopathological features of 55 Chinese patients (26 GCCs and 29 TCs), and explored the histochemical properties and expression profiles of CK7, CK20, P63, CEA, CgA, NSE, CD56, and Ki67 in 37 out of these 55 patients (18 GCCs and 19 TCs). Our results showed GCC had a male predominance, older age involvement, significantly larger tumor size, and significantly more frequency of mesoappendix infiltration than TC. Alcian blue/PAS stains were positive in all the GCC cases, while negative in all the TC cases. CK7 and CK20 expressions were significantly more frequent in GCC (P = 0.03 and 0.00001, respectively). However, P63 expression was detected in none of the GCC cases but in 6 TC cases (P = 0.02). Although the expression of CgA was similar, strong expression (3+) was significantly more frequent in TC (P = 5.7 × 10(-11)). Also, NSE and CD56 expressions were significantly more frequent in TC (P = 0.02 and 1.26 × 10(-4), respectively). CEA expression was significantly more frequent in GCC (P = 2.4 × 10(-6)). Finally, Ki67 index was low in GCC (4.7%), but significantly higher than TC (0.9%) (P = 5.4 × 10(-6)). Taken together, these distinct features support that GCC differs from TC, a classical neuroendocrine tumor, and harbors an immunophenotype of adenocarcinoma. Therefore, the term "low grade adenocarcinoma with neuroendocrine differentiation" might be more appropriate for GCC.

FDG-PET/CT imaging in assessing mucin-producing non-small cell lung cancer with pathologic correlation

The objective of this study was to describe the PET/CT findings of mucin-producing non-small cell lung cancer (NSCLC) and how those findings are associated with pathology. A review of all patients with FDG-PET/CT identified 11 patients with histopathologically confirmed mucin-producing NSCLC; 3 mucinous bronchioloalveolar carcinoma (mBAC), 5 mixed-type adenocarcinoma with prominent mucinous BAC pattern (ADENO + mBAC), and 3 mixed-type adenocarcinoma with mucin production (ADENO + MUCIN) in our institute. Among 11 patients, only 2 lesions (18%) evidenced positive PET results for standardized uptake value (SUV) of 3.5 (by ROC analysis) whereas all cases were detected correctly at CT. The mean SUV was 2.0 in the 9 lesions not detected and 2.5 in all cases. The mean SUV of pure mBAC was 1.93, that of mucin-producing adenocarcinoma was 2.69 without a significant difference (p = 0.279). No significant correlations between tumor size or stage and SUV were determined. PET/CT for SUV is limited in the detection of mucin-producing NSCLC. Therefore, the CT component of PET/CT may allow for significantly improved sensitivity and help to reduce delayed diagnose. The SUV in mBACs were lower than the other types of mucin-producing adenocarcinoma; however, we determined no significant difference to exist between the SUVs of two groups of lung cancer.

30. Mucin-producing urothelial-type adenocarcinoma of the prostate – discussion of a case and its differential diagnosis

<h3>Introduction</h3> The most common malignancy of the prostate gland is acinar-type adenocarcinoma. The less common types of carcinoma are large duct carcinoma, mucinous carcinoma, urothelial adenocarcinoma and squa-mous neoplasms. Mucin-producing urothelial-type adenocar-cinoma of the prostate is extremely rare. Only two studies have been reported in the recent years. It is considered to be of prostatic urethral origin and equivalent to non-urachal adenocarcinoma of the urinary bladder. The diagnosis is difficult. In this report, we present a rare mucin-producing urothelial-type adenocarcinoma of the prostate. <h3>Case report</h3> A 60-year-old man presented with haematuria and haematospermia. A TURP prostate specimen showed mucinous adenocarcinoma. Serum PSA value was 50.1ng/mL. A radical retropubic prostatectomy was performed. Macroscopically, the prostate parenchyma was widely replaced by a mucinous neoplasm, filling the left posterior quadrant, and much of the right posterior and left anterior quadrants. Microscopically, there was extensive infiltration by mucin-producing adenocarcinoma of intestinal type with extensive mucus pooling. A papillary growth pattern was focally noted and there was a poorly differentiated component. Tumour was present in the prostatic urethra and invaded the left seminal vesicle. The presence of mucin was confirmed by diastatse-resistant positive PAS staining. On immunohistochemistry, tumour cells were positive for CEA, CK20 and CK7 and negative for PSA and PAP. The CK7 positive and CK20 positive profile is more in keeping with urothelial-type carcinoma. <h3>Conclusion</h3> Mucin-producing urothelial-type adenocarcinoma of the prostate is a rare aggressive tumour. Diagnosis is a challenge due to similarity to prostatic mucinous adenocarci-noma and secondary carcinoma, such as that from colorectal or bladder origin. Immunohistochemistry and clinical findings as to probable site of the primary tumour are helpful in making the correct diagnosis.

Thrombotic thrombocytopenic purpura as the first manifestation of metastatic adenocarcinoma in a young woman

Thrombotic microangiopathy occurs in 5–10% of patients with mucin-producing disseminated adenocarcinoma. A 28-year-old woman complained of fatigue, bone pain, and weight loss. There were pallor, icterus, and tenderness in the bones on physical examination. Microangiopathic hemolytic anemia, leukoerythroblastic picture, thrombocytopenia, and normal coagulation tests were detected. Thrombotic thrombocytopenic purpura (TTP) was diagnosed and therapeutic plasma exchange was performed on the patient. On day 5 a laparotomy had to be performed because of acute abdomen due to the rupture of a corpus hemorrhagicum follicle of an ovary. Signet ring cell adenocarcinoma stained with cytokeratin 7 and mucicarmine was seen on ovaries and bone marrow, after the pathological examination. The primary site of tumor could not be investigated, because of the patient’s refusal. Although chemotherapy including cis-platinum, infusional 5-flourouracil, and calcium leucovorin were administered in two courses, she died from respiratory failure. In conclusion, malignancy and bone marrow involvement should be considered when associated with leukoerythroblastic picture and TTP.

Combined goblet cell carcinoid and mucinous cystadenoma of the vermiform appendix

Goblet cell carcinoid is an uncommon primary tumor of the vermiform appendix, characterized by dual endocrine and glandular differentiation. Whether goblet cell carcinoid represents a morphological variant of appendiceal classical carcinoid or a mucin-producing adenocarcinoma is a matter of conjecture. Rare cases of goblet cell carcinoid with other concomitant appendiceal epithelial neoplasms have been documented. In this report, we describe a rare case of combined appendiceal goblet cell carcinoid and mucinous cystadenoma, and discuss the possible histopathogenesis of this combination.

A Case of Mucin-producing Adenocarcinoma of the Lung with a 10-year Clinical History Before Operation

背景．肺腺癌は他の肺癌組織型と比べslow growing tumorの報告も散見されるが，10年以上の臨床経過を有する報告は少ない.症例．48歳女性．検診にて肝腫瘍を指摘され手術目的で当院受診，術前精査中の胸部CTにて胸部異常影もみつかったため肝腫瘍術後に当科紹介となった．近医にて過去に胸部CT撮影歴があり比較したところ10年前の胸部CTにも同部位に異常影を認めた．先に胸腔鏡下肺部分切除が行われ，術中迅速診断の結果肺癌と診断されたため右中葉切除及びリンパ節郭清（ND2a）を施行した．病理組織結果は粘液産生肺腺癌で最終病理病期はpT1N0M0 stage IAであった.結論．術前約10年という長期の臨床経過を有する肺腺癌の1例を経験した．肺野異常影を認め数年経過の後若干の拡大を認めた場合，緩徐に発育する肺癌もあることを念頭におく必要があると思われた.

Mucoid impaction secondary to mucin-producing metastatic adenocarcinoma of the cervix

Endobronchial metastases are an uncommon complication of malignant tumours. The vast majority are secondary to carcinoma of the breast, colorectum and kidney, or to melanoma. Occasionally, endobronchial tumours can result in partial or complete bronchial obstruction. Here, we describe an uncommon case of endobronchial metastasis of adenocarcinoma of the cervix causing mucoid impaction owing to mucous production by the tumour cells.

Vertebral Artery Occlusion After Chemotherapy

To the Editor: We have read the interesting report by Periard et al about cisplatin-induced strokes.1 The role of tumors as risk factors for vascular disorders has long been established. However, there is little evidence regarding the effects of chemotherapy. Several reports describe vascular toxicity in young patients treated with cisplatin, and these studies suggest a casual link.2,3 We present a patient who experienced a stroke due to vertebral artery occlusion after chemotherapy. A 48-year-old female patient was admitted to our hospital with nausea, vomiting, and headache. The patient also complained of tingling in the left …

Primary Mucin-producing Urothelial-type Adenocarcinoma of Prostate: Report of 15 Cases

Prostatic urothelial-type adenocarcinoma arises through a process of glandular metaplasia of the prostatic urethral urothelium and subsequent in situ adenocarcinoma sometimes associated with villous adenoma. These prostatic adenocarcinomas are analogous to nonurachal adenocarcinomas arising in the bladder from cystitis glandularis. Only 2 cases of urothelial-type adenocarcinoma from an institution other than our own have been previously described. The distinction between adenocarcinoma from another organ secondarily involving the prostate, usual adenocarcinoma of the prostate, and prostatic urothelial-type adenocarcinoma can present a significant diagnostic challenge and has significant therapeutic implications. Fifteen cases of prostatic urothelial-type adenocarcinoma were retrieved from the consult files of one of the authors. Mean patient age at diagnosis was 72 years (range 58 to 93 y). All men had negative colonoscopies, clinically excluding a colonic primary. Bladder primaries were ruled out clinically or pathologically in radical resection specimens. Follow-up was available on all men with a mean of 50.3 months (range 2 to 161 mo). All men presented with urinary obstruction symptoms with 3 (20%) also having mucusuria and 2 (13.3%) also having hematuria. Four men (26.7%) developed metastatic disease and 8 (53.3%) died of disease. In 8/15 (53%) cases, glandular metaplasia of the prostatic urethra and contiguous transition to adenocarcinoma were identified. Multiple histologic patterns were observed including dissection of the stroma by mucin pools 15/15 (100%), villous features 7/15 (47%), necrosis 2/15 (13.3%), signet ring cells 3/15 (20%), perineural invasion 1/15 (6.7%), focal squamous differentiation 1/15 (6.7%), and a granulomatous inflammatory response 1/15 (6.7%). Immunohistochemical stains were negative for prostate specific antigen, prostate specific acid phosphatase, CDX2, and beta-catenin in all cases. Stains were positive for high molecular weight cytokeratin in 12/12 cases (100%), and CK7 and CK20 in 10/12 cases (83.3%). Prostatic urothelial-type adenocarcinoma is a rare aggressive cancer arising in the prostate. The differential diagnosis includes conventional prostatic mucinous adenocarcinoma and secondary infiltration from a colonic or bladder adenocarcinoma. Immunohistochemistry for prostate specific antigen, prostate specific acid phosphatase, and high molecular weight cytokeratin along with morphology can help rule out conventional prostate carcinoma. beta-catenin, CDX2, and clinical studies are needed to rule out colonic adenocarcinoma. As prostatic urothelial-type adenocarcinoma is entirely analogous to bladder adenocarcinoma in both, its morphology and immunophenotype, only clinical studies or in some cases pathologic examination of the cystoprostatectomy specimen can exclude infiltration from a primary bladder adenocarcinoma.

Cytokeratins 7 and 20 Immunoexpression Profile in Goblet Cell and Classical Carcinoids of Appendix

Goblet cell carcinoid (GCC) of the vermiform appendix is an uncommon neoplasm and its histogenesis is controversial. Whether GCC represents a morphological variant of classical appendiceal carcinoid or a mucin-producing adenocarcinoma is still conjectural. Little is known about the immunohistochemical expression of cytokeratins 7 (CK7) and 20 (CK20) in appendiceal neuroendocrine tumors. In this study, we compared the expression of CK7 and CK20 in 17 cases of appendiceal GCC and 25 cases of classical carcinoid. The tumors were also evaluated for Ki-67 proliferation index, mitotic activity, tumor necrosis, extracellular pools of mucin, obvious intestinal type adenocarcinomatous foci, angiolymphatic permeation, perineural/neural infiltration, and the depth of invasion of the appendix wall. Mesoappendiceal extension was present in 14 of 17 (82.3%) cases of GCC, whereas angiolymphatic and perineural/intraaneural involvement were found in 10 of 17 (58.8%) and 14 of 17 (82.3%) cases, respectively. The mitotic count ranged from 0 per 10 high power fields to 6 per 10 high power fields, with an average of 1.4 per 10 high power fields. Necrosis was not seen in any case and pools of extravasated mucin were present in 5 of 17 (29.4%) cases. Immunohistochemically, all 17 (100%) of GCC exhibited strong and diffuse immunopositivity for CK20, whereas expression of CK7 was present in 12 cases (70.5%), ranging from 5 to 50% of tumor cells being labeled. The Ki-67 labeling index ranged from 0 to 75% and showed no correlation to mitotic activity, angiolymphatic invasion or perineural/intraneural permeation. On the other hand, 25 cases of classical carcinoid tumors were consistently negative for CK7; however, 4 cases (16%) showed immunolabeling for CK20 in 25-50% of the tumor cells. The Ki-67 labeling index in classical carcinoids ranged from 0 to 5%. This study shows that in addition to the morphological differences, GCC (CK7/CK20-positive) and classical carcinoid (CK7/CK20-negative) differ in their expression of CK7 and CK20. In addition, GCC shows the same CK7/CK20 immunoexpression as colorectal adenocarcinoma. Goblet cell carcinoid should be regarded as a crypt cell or an amphicrine carcinoma rather than a variant of carcinoid tumor, a lesion that has benign connotations.