Mucinous carcinoma

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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.

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]
  • 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:

  1. Mucin - amphormous whispy or cream material.
  2. Cytologically atypical cells within the mucin.
  3. +/-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:

Proportion of mucin

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

Images

Case
Case
www

Molecular

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

  1. URL: http://www.merriam-webster.com/dictionary/colloid%20carcinoma. Accessed on: 14 February 2014.
  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.
  3. 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.
  4. 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.
  5. Grignon DJ (March 2004). "Unusual subtypes of prostate cancer". Mod. Pathol. 17 (3): 316–27. doi:10.1038/modpathol.3800052. PMID 14976541.
  6. 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.
  7. 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.
  8. 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.
  9. 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. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2826751/.
  10. 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.