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Case Reports
. 2016 Apr;7(Suppl 1):S55-61.
doi: 10.3978/j.issn.2078-6891.2015.029.

Consensus and conflict in invasive micropapillary carcinoma: a case report and review of the literature

Li Lei  1 , Huina Zhang  1 , Xinhai Bob Zhang  1 , Roland Lonser  1 , Kevin Thompson  1 , Anwar Raza  1
Affiliations
Case Reports

Consensus and conflict in invasive micropapillary carcinoma: a case report and review of the literature

Li Lei et al. J Gastrointest Oncol. 2016 Apr.

Abstract

Invasive micropapillary carcinoma (IMPC) is an aggressive histologic subtype of adenocarcinoma that has been gaining increased attention over the past twenty years. It is important to recognize IMPC due to its strong association with early lymphovascular invasion (LVI), high risk of lymph node metastasis, perineural invasion and poor prognosis. Controversies regarding IMPC include differentiating from retraction artifact and mimics, clinical significance of proportion of micropapillary component (MC), pathogenesis, biologic nature of the entity and consequently terminology, etc. We herein present a case of rectal IMPC arising from a tubulovillous adenoma. Since HER2 over-expression has been reported in IMPC of the breast and the bladder but never in the colorectum, given the availability of HER2 targeted therapy, HER2 protein expression in our case is examined by immunohistochemical study which shows weak incomplete membrane staining in less than 5% of cells. Literature is reviewed with emphasis on colorectal IMPC as well as aforementioned controversial topics. In summary, more study is needed to resolve the conflicts and build consensus on IMPC.

Keywords: Micropapillary; adenocarcinoma; colorectum; retraction artifact; reversed polarity.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
(A) An exophytic mass was seen on pelvic MRI; (B) flexible sigmoidoscopy; (C) and rectal ultrasonography. MRI, magnetic resonance imaging.
Figure 2
Figure 2
(A) The majority of the mass shows haphazardly arranged, irregularly shaped glands with high grade nuclear features, consistent with moderately-differentiated adenocarcinoma; (B) approximately 20% of tumor consists of small nests of cohesive tumor cells floating in clear spaces, mimicking lymphovascular invasion (LVI). (magnification, ×100).
Figure 3
Figure 3
(A) CD34 highlights vasculature but does not stain clear spaces surrounding tumor cell nests; (B) CD10 delineates the outer surfaces of tumor nests, consistent with reversed polarity. (magnification, ×200).
See this image and copyright information in PMC

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