Invasive Micropapillary Carcinoma of the Breast DaeKyum Kim
Invasive Micropapillary Carcinoma of the Breast Dae-Kyum Kim, Sang-Uk Woo, Jeong-Han Kim, Seok-Jin Nam, Yoon-La Choi 1 , Young-Hae Koh 1 and Jung-Hyun Yang Department of Surgery and 1 Pathology, Samsung Medical Center, Sungkyunkwan University, School of Medicine
Introduction • Invasive micropapillary carcinoma (IMPC) is one of new histologic patterns of breast initially described in 1993 (Siriaungkgul and Tavassoli) • A high frequency of axillary node metastasis and one of an aggressive subtype of breast cancer • Series reported to date are small with short follow up intervals
• Pure IMPC and mixed IMPC • However, the clinical significance of IMPC extent is unclear
Methods • Between Oct. 1994 and Aug. 2004 • 2020 cases of invasive breast cancer at Samsung Medical Center • 40 cases (2. 0%) of invasive micropapillary carcinoma • Retrospective review for clinicopathologic features • Pure IMPC; IMPC 80% of whole tumor area Mixed IMPC; IMPC < 80% of whole tumor area • Statistics Mann-Whitney test Chi-square or Fisher’s exact test
Results 1. Age Mean age= 46. 1 yr No. of patients (yr)
2. Chief Complaint No. of patients
3. Duration of Chief Complaint Mean Duration =2. 4 mo No. of patients
4. Tumor Size 11 (27. 5%) 20 (50. 0%) 9 (22. 5%) Mean size = 3. 4 cm No. of patients
5. N stage N 3 14 (35. 0%) N 2 N 0 5 (12. 5%) (17. 5%) N 1 No. of patients 7 14 (35. 0%)
6. EIC and Endolymphatic Tumor Emboli (ETE) EIC ETE present (%) 13 (32. 5) 34 (85. 0) absent (%) 27 (67. 5) 6 (15. 0)
7. Nuclear Grade No. of patients (%) I 2 ( 5. 0) II 24 (60. 0) III 14 (35. 0) I; low, II; intermediate, III; high
8. Immunohistochemical Staining positive rate (%) Estrogen receptor (ER) 31/40 (77. 5) Progesterone receptor (PR) 23/40 (57. 5) P 53 16/40 (40. 0) c-erb-B 2 16/40 (40. 0)
9. Mixed IMPC and Pure IMPC 19 (47. 5%) 21 (52. 5%) P = 1. 000 No. of patients
46/F. Mixed IMPC (above right) with Invasive ductal ca (above Left) in about half area A lymph node having a IMPC feature (Right)
10. Axillary Lymph Node Metastasis and Related Factors Size T 1 T 2 T 3 Nuclear I Grade II III EIC yes no No. of patients with metastatic LN (%) 10/11 (90. 9) 16/20 (80. 0) 9/ 9 (100. 0) 2/ 2 (100. 0) 22/24 (91. 7) 11/14 (78. 6) 10/13 (76. 9) 25/27 (92. 6) P-value 0. 476 0. 494 0. 307
Factors ETE yes no ER positive negative P 53 positive negative HER 2 positive negative No. of patients with metastatic LN (%) 32/34 (94. 1) 3/ 6 (50. 0) 28/31 (90. 3) 7/ 9 (77. 8) 20/23 (87. 0) 15/17 (88. 2) 15/16 (93. 8) 20/24 (83. 3) P-value 0. 018 0. 311 1. 000 0. 631 0. 633
11. Operations 11 (27. 5%) No. of patients 29 (72. 5%)
12. Disease Free Survival Cumm survival FU time
12. Survival Cumm survival FU time
Conclusions • IMPC is a aggressive subtype of breast cancers with a high frequency of axillary lymph nodes metastases • Sentinel lymph node biopsy may not be indicated in these grave cancers • A mixed IMPC type may not be differ from a pure IMPC in their biologic characteristics
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