Difference between revisions of "Mucinous carcinoma"

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Colonic mucinous adenocarcinoma. H&E stain.

Mucinous carcinoma, also mucinous adenocarcinoma, is an epithelial neoplasm that produces mucin. Mucinous carcinoma can arise in a number of sites. It is also known as colloid carcinoma.^[1]

General

Prognostic significance dependent on the primary site:

Breast mucinous carcinoma has a better prognosis.
Colorectal mucinous carcinoma has a worse prognosis.^[2]

Specific sites

Gross

Gelatinous-like material.
- May have a consistency similar to Jello.

Image:

Microscopic

Features:

Mucin - amphormous whispy or cream material.
Cytologically atypical cells within the mucin.
+/-Tumour without mucin.
- Maximum amount acceptable depends on the primary site (see proportion of mucin section below).

Note:

Mucin alone -- should prompt a search for atypical cells, i.e. levels should be done.

DDx:

Benign mucocele.
Mucin extravasation - no malignant cells present.
Adenoma with pseudoinvasion (pseudocarcinoma).^[3]
Adenocarcinoma with mucinous features - see proportion of mucin section.
Other myxoid tumours - has an exhaustive long DDx.

Images

Colonic mucinous adenocarcinoma - very low mag. (WC/Nephron)
Colonic mucinous adenocarcinoma - low mag. (WC/Nephron)

www:

Mucinous tumours of the ovary - several images (flickr.com).

Proportion of mucin

The criteria for diagnosing "mucinous carcinoma" varies by the anatomical site:

Mucinous prostate carcinoma: > 25% of the tumour.^[4]
Mucinous colorectal carcinoma: > 50% of the tumour.^[5]
Mucinous gastric carcinoma: > 50% of the tumour.
Mucinous (noncystic) carcinoma of the pancreas: > 80% of the tumour.^[6]
Mucinous breast carcinoma: > 90% of the tumour.^[7]
- One source suggests: > 50% of the tumour.^[8]

Molecular

May be associated with a KRAS mutation.

IHC

IHC can be used to suggest a primary site for a mucinous adenocarcinoma:^[9]

Upper GI tract: CK7 +ve (38/41 cases), CDX2 -ve (4 +ve/41 cases).
Lower GI tract: CDX2 +ve (42/42 cases), CK20 +ve (41/42 cases), CK7 -ve (8 +ve/42 cases) positive cases usu. in rectum/anus.
Breast: CK7 +ve (18/18 cases), ER +ve (16/18 cases).
Lung: CK7 +ve (16/16 cases).
Gynecologic: CK7 +ve (25/27 cases).

Sign out

In biopsies:

Adenocarcinoma with a mucinous component is probably the most objective way to sign out a case, if the primary site is not firmly established and a non-mucinous component is present.

OMENTUM, CORE BIOPSY:
- METASTATIC MUCINOUS ADENOCARCINOMA, SEE COMMENT.

COMMENT:
The tumour cells stain as follows:
POSITIVE: CK20, CDX2.
NEGATIVE: CK7.

The immunostains are suggestive of a lower gastrointestinal tract primary. Radiologic 
and endoscopic correlation is suggested.

References

↑ URL: http://www.merriam-webster.com/dictionary/colloid%20carcinoma. Accessed on: 14 February 2014.
↑ Hyngstrom, JR.; Hu, CY.; Xing, Y.; You, YN.; Feig, BW.; Skibber, JM.; Rodriguez-Bigas, MA.; Cormier, JN. et al. (Apr 2012). "Clinicopathology and Outcomes for Mucinous and Signet Ring Colorectal Adenocarcinoma: Analysis from the National Cancer Data Base.". Ann Surg Oncol. doi:10.1245/s10434-012-2321-7. PMID 22476818.
↑ Odze, Robert D.; Goldblum, John R. (2009). Surgical pathology of the GI tract, liver, biliary tract and pancreas (2nd ed.). Saunders. pp. 512. ISBN 978-1416040590.
↑ Grignon DJ (March 2004). "Unusual subtypes of prostate cancer". Mod. Pathol. 17 (3): 316–27. doi:10.1038/modpathol.3800052. PMID 14976541.
↑ Tozawa E, Ajioka Y, Watanabe H, et al. (2007). "Mucin expression, p53 overexpression, and peritumoral lymphocytic infiltration of advanced colorectal carcinoma with mucus component: is mucinous carcinoma a distinct histological entity?". Pathol. Res. Pract. 203 (8): 567–74. doi:10.1016/j.prp.2007.04.013. PMID 17679024.
↑ Adsay, NV.; Pierson, C.; Sarkar, F.; Abrams, J.; Weaver, D.; Conlon, KC.; Brennan, MF.; Klimstra, DS. (Jan 2001). "Colloid (mucinous noncystic) carcinoma of the pancreas.". Am J Surg Pathol 25 (1): 26-42. PMID 11145249.
↑ Dogan, E.; Aksoy, S.; Dizdar, O.; Arslan, C.; Dede, DS.; Ozisik, Y.; Altundag, K.. "Pure mucinous carcinoma of the breast: a single center experience.". J BUON 16 (3): 565-7. PMID 22006768.
↑ Park S, Koo J, Kim JH, Yang WI, Park BW, Lee KS (March 2010). "Clinicopathological characteristics of mucinous carcinoma of the breast in Korea: comparison with invasive ductal carcinoma-not otherwise specified". J. Korean Med. Sci. 25 (3): 361–8. doi:10.3346/jkms.2010.25.3.361. PMC 2826751. PMID 20191033. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826751/.
↑ Chu, PG.; Chung, L.; Weiss, LM.; Lau, SK. (Dec 2011). "Determining the site of origin of mucinous adenocarcinoma: an immunohistochemical study of 175 cases.". Am J Surg Pathol 35 (12): 1830-6. doi:10.1097/PAS.0b013e3182299c25. PMID 21881489.

[1] URL: http://www.merriam-webster.com/dictionary/colloid%20carcinoma. Accessed on: 14 February 2014.

[pmid22476818-2] Hyngstrom, JR.; Hu, CY.; Xing, Y.; You, YN.; Feig, BW.; Skibber, JM.; Rodriguez-Bigas, MA.; Cormier, JN. et al. (Apr 2012). "Clinicopathology and Outcomes for Mucinous and Signet Ring Colorectal Adenocarcinoma: Analysis from the National Cancer Data Base.". Ann Surg Oncol. doi:10.1245/s10434-012-2321-7. PMID 22476818.

[Ref_Odze512-3] Odze, Robert D.; Goldblum, John R. (2009). Surgical pathology of the GI tract, liver, biliary tract and pancreas (2nd ed.). Saunders. pp. 512. ISBN 978-1416040590.

[pmid14976541-4] Grignon DJ (March 2004). "Unusual subtypes of prostate cancer". Mod. Pathol. 17 (3): 316–27. doi:10.1038/modpathol.3800052. PMID 14976541.

[pmid17679024-5] Tozawa E, Ajioka Y, Watanabe H, et al. (2007). "Mucin expression, p53 overexpression, and peritumoral lymphocytic infiltration of advanced colorectal carcinoma with mucus component: is mucinous carcinoma a distinct histological entity?". Pathol. Res. Pract. 203 (8): 567–74. doi:10.1016/j.prp.2007.04.013. PMID 17679024.

[pmid11145249-6] Adsay, NV.; Pierson, C.; Sarkar, F.; Abrams, J.; Weaver, D.; Conlon, KC.; Brennan, MF.; Klimstra, DS. (Jan 2001). "Colloid (mucinous noncystic) carcinoma of the pancreas.". Am J Surg Pathol 25 (1): 26-42. PMID 11145249.

[pmid22006768-7] Dogan, E.; Aksoy, S.; Dizdar, O.; Arslan, C.; Dede, DS.; Ozisik, Y.; Altundag, K.. "Pure mucinous carcinoma of the breast: a single center experience.". J BUON 16 (3): 565-7. PMID 22006768.

[pmid20191033-8] Park S, Koo J, Kim JH, Yang WI, Park BW, Lee KS (March 2010). "Clinicopathological characteristics of mucinous carcinoma of the breast in Korea: comparison with invasive ductal carcinoma-not otherwise specified". J. Korean Med. Sci. 25 (3): 361–8. doi:10.3346/jkms.2010.25.3.361. PMC 2826751. PMID 20191033. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826751/.

[pmid21881489-9] Chu, PG.; Chung, L.; Weiss, LM.; Lau, SK. (Dec 2011). "Determining the site of origin of mucinous adenocarcinoma: an immunohistochemical study of 175 cases.". Am J Surg Pathol 35 (12): 1830-6. doi:10.1097/PAS.0b013e3182299c25. PMID 21881489.

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@@ Line 50: / Line 50: @@
 *[[Mucinous colorectal carcinoma]]: > 50% of the tumour.<ref name=pmid17679024 >{{cite journal |author=Tozawa E, Ajioka Y, Watanabe H, ''et al.'' |title=Mucin expression, p53 overexpression, and peritumoral lymphocytic infiltration of advanced colorectal carcinoma with mucus component: is mucinous carcinoma a distinct histological entity? |journal=Pathol. Res. Pract. |volume=203 |issue=8 |pages=567–74 |year=2007 |pmid=17679024 |doi=10.1016/j.prp.2007.04.013 |url=}}</ref>
 *[[Mucinous gastric carcinoma]]: > 50% of the tumour.
-*Mucinous (noncystic) carcinoma (CC) of the pancreas: > 80% of the tumour.<ref name=pmid11145249>{{Cite journal  | last1 = Adsay | first1 = NV. | last2 = Pierson | first2 = C. | last3 = Sarkar | first3 = F. | last4 = Abrams | first4 = J. | last5 = Weaver | first5 = D. | last6 = Conlon | first6 = KC. | last7 = Brennan | first7 = MF. | last8 = Klimstra | first8 = DS. | title = Colloid (mucinous noncystic) carcinoma of the pancreas. | journal = Am J Surg Pathol | volume = 25 | issue = 1 | pages = 26-42 | month = Jan | year = 2001 | doi =  | PMID = 11145249 }}</ref>
+*Mucinous (noncystic) carcinoma of the [[pancreas]]: > 80% of the tumour.<ref name=pmid11145249>{{Cite journal  | last1 = Adsay | first1 = NV. | last2 = Pierson | first2 = C. | last3 = Sarkar | first3 = F. | last4 = Abrams | first4 = J. | last5 = Weaver | first5 = D. | last6 = Conlon | first6 = KC. | last7 = Brennan | first7 = MF. | last8 = Klimstra | first8 = DS. | title = Colloid (mucinous noncystic) carcinoma of the pancreas. | journal = Am J Surg Pathol | volume = 25 | issue = 1 | pages = 26-42 | month = Jan | year = 2001 | doi =  | PMID = 11145249 }}</ref>
 *[[Mucinous breast carcinoma]]: > 90% of the tumour.<ref name=pmid22006768>{{Cite journal  | last1 = Dogan | first1 = E. | last2 = Aksoy | first2 = S. | last3 = Dizdar | first3 = O. | last4 = Arslan | first4 = C. | last5 = Dede | first5 = DS. | last6 = Ozisik | first6 = Y. | last7 = Altundag | first7 = K. | title = Pure mucinous carcinoma of the breast: a single center experience. | journal = J BUON | volume = 16 | issue = 3 | pages = 565-7 | month =  | year =  | doi =  | PMID = 22006768 }}</ref>
 **One source suggests: > 50% of the tumour.<ref name=pmid20191033>{{cite journal |author=Park S, Koo J, Kim JH, Yang WI, Park BW, Lee KS |title=Clinicopathological characteristics of mucinous carcinoma of the breast in Korea: comparison with invasive ductal carcinoma-not otherwise specified |journal=J. Korean Med. Sci. |volume=25 |issue=3 |pages=361–8 |year=2010 |month=March |pmid=20191033 |pmc=2826751 |doi=10.3346/jkms.2010.25.3.361 |url=}}</ref>