Stromal micropapillary component as a novel unfavorable prognostic factor of lung adenocarcinoma

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Patients and Methods</p> <p>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 (<it>EGFR</it>) and <it>KRAS </it>mutations.</p> <p>Results</p> <p>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 (<it>p </it>= 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 <it>EGFR </it>mutations, and none of them showed <it>KRAS </it>mutations.</p> <p>Conclusions</p> <p>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.</p> <p>Virtual Slides</p> <p>The virtual slide(s) for this article can be found here: <url>http://www.diagnosticpathology.diagnomx.eu/vs/9433341526290040</url>.</p

Diagnosis, Pathological Findings, and Clinical Management of Gangliocytic Paraganglioma: A Systematic Review

Background: Although gangliocytic paraganglioma (GP) is considered a rare benign neuroendocrine tumor, cases of mortality have been reported. Occasionally, GP is misdiagnosed as neuroendocrine tumor G1, which is associated with a poorer prognosis than GP. To avoid such misdiagnoses, it is important to understand the clinicopathological characteristics of GP. Thus, herein, we discuss the current literature on the clinicopathological characteristics of GP.Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed and Japana Centra Revuo Medicina searches were used to identify papers describing GP. Inclusion criteria included confirmation of epithelioid, spindle-shaped, and ganglion-like cells in the main article and/or figures and whether the paper was cited in other studies of GP. Data were collected on age, sex, site of the primary lesion, tumor size, treatment, prognosis, lymph node metastasis (LNM), depth of tumor invasion, rate of preoperative diagnosis, and clinical symptoms.Results: In total, 162 papers containing 263 cases of GP met the criteria. The mean age at diagnosis was 53.5 years. The male-to-female ratio was 157:104. The mean tumor size was 25.7 mm. The predominant site of the primary tumor was the duodenum (89.7%). The most common clinical sign of GP was gastrointestinal bleeding (47.9%). Other signs and symptoms of GP included abdominal pain (44.7%), anemia (20.3%), incidental findings (12.9%), nausea (6.9%), weight loss (5.5%), general fatigue (5.1%), jaundice (4.6%), and incidental autopsy findings (5.1%). LNM was observed in 11.4% of patients. Liver metastasis was observed in 1.1% of patients. Depth of tumor invasion (penetrating beyond the submucosal layer or sphincter of Oddi) was by far the most significant risk factor for LNM in patients with GP. This suggests, along with histological heterogeneity, that GP may have hamartomatous characteristics. Furthermore, immunohistochemical expression of progesterone receptor and pancreatic polypeptide were useful in distinguishing between GP and neuroendocrine tumor G1, even in small biopsy specimens.Conclusions: We reveal the clinicopathological characteristics of GP, including risk factors for LNM, differential diagnostic approaches, and improvements in the clinical management of this tumor.In addition, GP may have hamartomatous characteristics

Correlation study of observation data of polycyclic aromatic hydrocarbons and chemical transport model calculation data of other pollutants at Wajima

金沢大学大学院自然科学研究科場所：金沢大学自然科学研究科図書館棟1階，講演会場：図書館棟1階　大会議室，ポスター会場：図書館棟1階12会議室,主催・共催：文部科学省２１世紀COE「環日本海域の環境計測と長期・短期変動予測」， 大気環境学会， 金沢大学工学

Correlation study of observation data of polycyclic aromatic hydrocarbons and chemical transport model calculation data of other pollutants at Wajima

金沢大学大学院自然科学研究科場所：東京大学弥生講堂，共催：文部科学省２１世紀COE「環日本海域の環境計測と長期・短期変動予測」，大気環境学

Stromal micropapillary pattern predominant lung adenocarcinoma - a report of two cases

Generally, adenocarcinomas with micropapillary pattern, featuring small papillary tufts lacking a central fibrovascular core, are thought to have poor prognosis. This pattern has been described in various organs. However, tumor cells with micropapillary pattern of lung adenocarcinoma are more often seen to float within alveolar spaces (aerogenous micropapillary pattern, AMP) than in fibrotic stroma like other organs (stromal micropapillary pattern, SMP) and SMP predominant lung adenocarcinoma (SMPPLA) has not been well described yet. We presented two cases of SMPPLA which were found in the last four years. Both the cases showed more than 50% of SMP in the tumor area. The majority of the stromal micropapillary clusters expressed MUC1 and epithelial membrane antigen along the outer surface of cell membrane. On the other hand, connective tissues surrounding stromal micropapillary clusters showed no reactivity for epithelial markers (thyroid transcription factor-1 and cytokeratin) or endothelial marker (D2-40 and CD34). It means clusters of SMP do not exist within air space or lymphatic or vessel lumens. The tumors with SMP often presented lymphatic permeation and vessel invasion, and intriguingly, one of the two cases showed metastasis to the mediastinal lymph node. Additionally, both the cases showed EGFR point mutations of exon 21. These results suggest that SMPPLA might be associated with poor prognosis and effective for EGFR tyrosine kinase inhibitors

IODP Expedition 334: An Investigation of the Sedimentary Record, Fluid Flow and State of Stress on Top of the Seismogenic Zone of an Erosive Subduction Margin

The Costa Rica Seismogenesis Project (CRISP) is an experiment to understand the processes that control nucleation and seismic rupture of large earthquakes at erosional subduction zones. Integrated Ocean Drililng Program (IODP) Expedition 334 by R/V JOIDES Resolution is the first step toward deep drilling through the aseismic and seismic plate boundary at the Costa Rica subduction zone offshore the Osa Peninsula where the Cocos Ridge is subducting beneath the Caribbean plate. Drilling operations included logging while drilling (LWD) at two slope sites (Sites U1378 and U1379) and coring at three slope sites (Sites U1378–1380) and at one site on the Cocos plate (Site U1381). For the first time the lithology, stratigraphy, and age of the slope and incoming sediments as well as the petrology of the subducting Cocos Ridge have been characterized at this margin. The slope sites recorded a high sediment accumulation rate of 160–1035m m.y.-1 possibly caused by on-land uplift triggered by the subduction of the Cocos Ridge. The geochemical data as well as the in situ temperature data obtained at the slope sites suggest that fluids are transported from greater depths. The geochemical profiles at Site U1381 reflect diffusional communication of a fluid with seawater-like chemistry and the igneous basement of the Cocos plate (Solomon et al., 2011; Vannucchi et al., 2012a). The present-day in situ stress orientation determined by borehole breakouts at Site U1378 in the middle slope and Site U1379 in the upper slope shows a marked change in stress state within ~12 km along the CRISP transect; that may correspond to a change from compression (middle slope) to extension (upper slope)