Stromal micropapillary component as a novel unfavorable prognostic factor of lung adenocarcinoma
Open Access
- 6 January 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Diagnostic Pathology
- Vol. 7 (1), 3
- https://doi.org/10.1186/1746-1596-7-3
Abstract
Pulmonary adenocarcinomas with a micropapillary component having small papillary tufts and lacking a central fibrovascular core are thought to result in poor prognosis. However, the component consists of tumor cells often floating within alveolar spaces (aerogenous micropapillary component [AMPC]) rather than invading fibrotic stroma observed in other organs like breast (stromal invasive micropapillary component [SMPC]). We previously observed cases of lung adenocarcinoma with predominant SMPC that was associated with micropapillary growth of tumors in fibrotic stroma observed in other organs. We evaluated the incidence and clinicopathological characteristics of SMPC in lung adenocarcinoma cases. We investigated the clinicopathological characteristics and prognostic significance of SMPC in lung adenocarcinoma cases by reviewing 559 patients who had undergone surgical resection. We examined the SMPC by performing immunohistochemical analysis with 17 antibodies and by genetic analysis with epidermal growth factor receptor (EGFR) and KRAS mutations. SMPC-positive (SMPC(+)) tumors were observed in 19 cases (3.4%). The presence of SMPC was significantly associated with tumor size, advanced-stage disease, lymph node metastasis, pleural invasion, lymphatic invasion, and vascular invasion. Patients with SMPC(+) tumors had significantly poorer outcomes than those with SMPC-negative tumors. Multivariate analysis revealed that SMPC was a significant independent prognostic factor of lung adenocarcinoma, especially for disease-free survival of pathological stage I patients (p = 0.035). SMPC showed significantly higher expression of E-cadherin and lower expression of CD44 than the corresponding expression levels shown by AMPC and showed lower surfactant apoprotein A and phospho-c-Met expression level than corresponding expression levels shown by tumor cell components without a micropapillary component. Fourteen cases with SMPC(+) tumors (74%) showed EGFR mutations, and none of them showed KRAS mutations. SMPC(+) tumors are rare, but they may be associated with a poor prognosis and have different phenotypic and genotypic characteristics from those of AMPC(+) tumors. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9433341526290040.Keywords
This publication has 27 references indexed in Scilit:
- Stromal micropapillary pattern predominant lung adenocarcinoma - a report of two casesDiagnostic Pathology, 2011
- Correlation between morphology and EGFR mutations in lung adenocarcinomas: Significance of the micropapillary pattern and the hobnail cell typeLung Cancer, 2009
- Histopathological features and prognostic significance of the micropapillary pattern in lung adenocarcinomaLaboratory Investigation, 2008
- A micropapillary pattern is predictive of a poor prognosis in lung adenocarcinoma, and reduced surfactant apoprotein A expression in the micropapillary pattern is an excellent indicator of a poor prognosisLaboratory Investigation, 2007
- Rapid and Simple Detection of Hot Spot Point Mutations of Epidermal Growth Factor Receptor, BRAF, and NRAS in Cancers Using the Loop-Hybrid Mobility Shift AssayThe Journal of Molecular Diagnostics, 2006
- Lung adenocarcinoma with a micropapillary pattern: a clinicopathological study of 25 casesAPMIS, 2006
- Surfactant Protein A Gene Deletion and Prognostics for Patients with Stage I Non–Small Cell Lung CancerClinical Cancer Research, 2005
- Relationship between micropapillary component and micrometastasis in the regional lymph nodes of patients with stage I lung adenocarcinomaHistopathology, 2004
- Dominant Papillary Subtype Is a Significant Predictor of the Response to Gefitinib in Adenocarcinoma of the LungClinical Cancer Research, 2004
- CD44: From adhesion molecules to signalling regulatorsNature Reviews Molecular Cell Biology, 2003