Mucinous carcinoma
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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]
Colonic mucinous adenocarcinoma. H&E stain.
Mucinous adenocarcinoma of the lung is often cytologically bland as can be seen in this image; on the right is benign ciliated epithelium and on the left is mucinous adenocarcinoma. H&E stain.
General
Prognostic significance dependent on the primary site:
- Breast mucinous carcinoma has a better prognosis.
- Colorectal mucinous carcinoma has a worse prognosis.[2]
- May be non-significant in esophagus if adjusted for grade and stage.[3]
Specific sites
Gross
- Gelatinous-like material.
- May have a consistency similar to Jello.
Images
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).[4]
- Adenocarcinoma with mucinous features - see proportion of mucin section.
- Other myxoid tumours - has an exhaustive long DDx.
Proportion of mucin
The criteria for diagnosing "mucinous carcinoma" varies by the anatomical site:
- Mucinous prostate carcinoma: > 25% of the tumour.[5]
- Mucinous colorectal carcinoma: > 50% of the tumour.[6]
- Mucinous gastric carcinoma: > 50% of the tumour.
- Mucinous (noncystic) carcinoma of the pancreas: > 80% of the tumour.[7]
- Mucinous breast carcinoma: > 90% of the tumour.[8]
- One source suggests: > 50% of the tumour.[9]
Images
Case
Colonic mucinous adenocarcinoma - very low mag. (WC/Nephron)
Colonic mucinous adenocarcinoma - low mag. (WC/Nephron)
Case
Mucinous lung adenocarcinoma (MLA) - very low mag.
MLA - low mag.
MLA - intermed. mag.
MLA - intermed. mag.
MLA - high mag.
MLA - very high mag.
MLA - intermed. mag.
MLA - high mag.
MLA - high mag.
www
Molecular
- May be associated with a KRAS mutation.
IHC
IHC can be used to suggest a primary site for a mucinous adenocarcinoma:[10]
- 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, beta-catenin (nuclear) +ve (27/42 cases).
- Breast: CK7 +ve (18/18 cases), ER +ve (16/18 cases).
- Lung: CK7 +ve (16/16 cases).
- Gynecologic: CK7 +ve (25/27 cases).
A panel:
- CK7, CK20, beta-catenin, CDX2.
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.
See also
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.
- ↑ Zheng, DJ.; Cooke, DT. (Jan 2013). "A survival comparison of mucin-producing adenocarcinoma of the esophagus to conventional adenocarcinoma after esophagectomy.". Am Surg 79 (1): 49-53. PMID 23317610.
- ↑ 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.