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Published in: Virchows Archiv 6/2004

01-12-2004 | Original Article

Identification of a lower grade muconodular subtype of gastric mucinous cancer

Authors: Enrico Solcia, Ombretta Luinetti, Francesca Tava, Catherine Klersy, Federica Grillo, Nicola Pandolfo, Roberto Fiocca

Published in: Virchows Archiv | Issue 6/2004

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Abstract

Until now, survival analysis of gastric mucinous cancers showed either no difference or an even worse prognosis than stage-adjusted non-mucinous tumours. In the pancreas and breast, mucinous cancers showing well-demarcated mucin deposits (muconodular pattern), expansile growth and predominance of MUC2 mucin are known to have a more favourable prognosis. In this study, an attempt was made to separate, among 41 gastric mucinous cancers, a subgroup of tumours with muconodular expansile pattern, possibly predictive of a more favourable outcome. A group of 15 tumours was identified, which were characterised by overwhelming (80–100%) mucinous component, predominance of mucus over tumour cells inside muconodules, moderately aggressive growth of their epithelial component (reduced proliferative rate, moderate anaplasia, lack of angioinvasion and limited lymphoinvasion) and dominant expression of intestinal goblet cell markers, with special reference to MUC2 mucin. Univariate and multivariate survival analysis showed a significantly improved outcome of these lower grade muconodular tumours compared with the remaining mucinous cancers as well as with non-mucinous cancers of cohesive, diffuse (signet-ring cell included) and undifferentiated high-grade types.
Literature
1.
go back to reference Adachi Y, Mori M, Kido A, Shimono R, Maehara Y, Sugimachi K (1992) A clinicopathologic study of mucinous gastric carcinoma. Cancer 69:866–871PubMed Adachi Y, Mori M, Kido A, Shimono R, Maehara Y, Sugimachi K (1992) A clinicopathologic study of mucinous gastric carcinoma. Cancer 69:866–871PubMed
2.
go back to reference Adachi Y, Yasuda K, Inomata M, Sato K, Shiraishi N, Kitano S (2000) Pathology and prognosis of gastric carcinoma: well versus poorly differentiated type. Cancer 89:1418–1424CrossRefPubMed Adachi Y, Yasuda K, Inomata M, Sato K, Shiraishi N, Kitano S (2000) Pathology and prognosis of gastric carcinoma: well versus poorly differentiated type. Cancer 89:1418–1424CrossRefPubMed
3.
go back to reference Adsay NV, Pierson C, Sarkar F, Abrams J, Weaver D, Conlon KC, Brennan MF, Klimstra DS (2001) Colloid (mucinous noncystic) carcinoma of the pancreas. Am J Surg Pathol 25:26–42PubMed Adsay NV, Pierson C, Sarkar F, Abrams J, Weaver D, Conlon KC, Brennan MF, Klimstra DS (2001) Colloid (mucinous noncystic) carcinoma of the pancreas. Am J Surg Pathol 25:26–42PubMed
4.
go back to reference Adsay NV, Merati K, Nassar H, Shia J, Sarkar F, Pierson CR, Cheng JD, Visscher DW, Hruban RH, Klimstra DS (2003) Pathogenesis of colloid (pure mucinous) carcinoma of exocrine organs: coupling of gel-forming mucin (MUC2) production with altered cell polarity and abnormal cell-stroma interaction may be the key factor in the morphogenesis and indolent behavior of colloid carcinoma in the breast and pancreas. Am J Surg Pathol 27:571–578CrossRefPubMed Adsay NV, Merati K, Nassar H, Shia J, Sarkar F, Pierson CR, Cheng JD, Visscher DW, Hruban RH, Klimstra DS (2003) Pathogenesis of colloid (pure mucinous) carcinoma of exocrine organs: coupling of gel-forming mucin (MUC2) production with altered cell polarity and abnormal cell-stroma interaction may be the key factor in the morphogenesis and indolent behavior of colloid carcinoma in the breast and pancreas. Am J Surg Pathol 27:571–578CrossRefPubMed
5.
go back to reference Bara J, Chastre E, Mahiou J, Singh RL, Forgue-Lafitte ME, Hollande E, Godeau F (1998) Gastric M1 mucin, an early oncofetal marker of colon carcinogenesis, is encoded by the MUC5AC gene. Int J Cancer 75:767–773CrossRefPubMed Bara J, Chastre E, Mahiou J, Singh RL, Forgue-Lafitte ME, Hollande E, Godeau F (1998) Gastric M1 mucin, an early oncofetal marker of colon carcinogenesis, is encoded by the MUC5AC gene. Int J Cancer 75:767–773CrossRefPubMed
6.
go back to reference Biemer-Huttmann AE, Walsh MD, McGuckin MA, Ajioka Y, Watanabe H, Leggett BA, Jass JR (1999) Immunohistochemical staining patterns of MUC1, MUC2, MUC4, and MUC5AC mucins in hyperplastic polyps, serrated adenomas, and traditional adenomas of the colorectum. J Histochem Cytochem 47:1039–1047PubMed Biemer-Huttmann AE, Walsh MD, McGuckin MA, Ajioka Y, Watanabe H, Leggett BA, Jass JR (1999) Immunohistochemical staining patterns of MUC1, MUC2, MUC4, and MUC5AC mucins in hyperplastic polyps, serrated adenomas, and traditional adenomas of the colorectum. J Histochem Cytochem 47:1039–1047PubMed
7.
go back to reference Brander L, Needham PR, Morgan AD (1974) Indolent mucoid carcinoma of stomach. J Clin Pathol 27:536–541PubMed Brander L, Needham PR, Morgan AD (1974) Indolent mucoid carcinoma of stomach. J Clin Pathol 27:536–541PubMed
8.
go back to reference Candusso ME, Luinetti O, Villani L, Alberizzi P, Klersy C, Fiocca R, Ranzani GN, Solcia E (2002) Loss of heterozygosity at 18q21 region in gastric cancer involves a number of cancer-related genes and correlates with stage and histology, but lacks independent prognostic value. J Pathol 197:44–50CrossRefPubMed Candusso ME, Luinetti O, Villani L, Alberizzi P, Klersy C, Fiocca R, Ranzani GN, Solcia E (2002) Loss of heterozygosity at 18q21 region in gastric cancer involves a number of cancer-related genes and correlates with stage and histology, but lacks independent prognostic value. J Pathol 197:44–50CrossRefPubMed
9.
go back to reference Chiaravalli AM, Cornaggia M, Furlan D, Capella C, Fiocca R, Tagliabue G, Klersy C, Solcia E (2001) The role of histological investigation in prognostic evaluation of advanced gastric cancer. Analysis of histological structure and molecular changes compared with invasive pattern and stage. Virchows Arch 439:158–169CrossRefPubMed Chiaravalli AM, Cornaggia M, Furlan D, Capella C, Fiocca R, Tagliabue G, Klersy C, Solcia E (2001) The role of histological investigation in prognostic evaluation of advanced gastric cancer. Analysis of histological structure and molecular changes compared with invasive pattern and stage. Virchows Arch 439:158–169CrossRefPubMed
10.
go back to reference Endoh Y, Tamura G, Motoyama T, Ajioka Y, Watanabe H (1999) Well-differentiated adenocarcinoma mimicking complete-type intestinal metaplasia in the stomach. Hum Pathol 30:826–832CrossRefPubMed Endoh Y, Tamura G, Motoyama T, Ajioka Y, Watanabe H (1999) Well-differentiated adenocarcinoma mimicking complete-type intestinal metaplasia in the stomach. Hum Pathol 30:826–832CrossRefPubMed
11.
go back to reference Fiocca R, Villani L, Tenti P, Solcia E, Cornaggia M, Frigerio B, Capella C (1987) Characterization of four main cell types in gastric cancer: foveolar, mucopeptic, intestinal columnar and goblet cells. An histopathologic, histochemical and ultrastructural study of “early” and “advanced” tumours. Pathol Res Pract 182:308–325PubMed Fiocca R, Villani L, Tenti P, Solcia E, Cornaggia M, Frigerio B, Capella C (1987) Characterization of four main cell types in gastric cancer: foveolar, mucopeptic, intestinal columnar and goblet cells. An histopathologic, histochemical and ultrastructural study of “early” and “advanced” tumours. Pathol Res Pract 182:308–325PubMed
12.
go back to reference Fiocca R, Villani L, Tenti P, Cornaggia M, Finzi G, Capella C, Prat M, Bussolati G, Solcia E (1988) Widespread expression of intestinal markers in gastric carcinoma: a light and electron microscopic study using BD-5 monoclonal antibody. J Clin Pathol 41:178–187PubMed Fiocca R, Villani L, Tenti P, Cornaggia M, Finzi G, Capella C, Prat M, Bussolati G, Solcia E (1988) Widespread expression of intestinal markers in gastric carcinoma: a light and electron microscopic study using BD-5 monoclonal antibody. J Clin Pathol 41:178–187PubMed
13.
go back to reference Fiocca R, Villani L, Tenti P, Cornaggia M, Finzi G, Riva C, Capella C, Bara J, Samloff IM, Solcia E (1990) The foveolar cell component of gastric cancer. Hum Pathol 21:260–270CrossRefPubMed Fiocca R, Villani L, Tenti P, Cornaggia M, Finzi G, Riva C, Capella C, Bara J, Samloff IM, Solcia E (1990) The foveolar cell component of gastric cancer. Hum Pathol 21:260–270CrossRefPubMed
14.
go back to reference Gürbüz Y, Kahlke V, Kloppel G (2002) How do gastric carcinoma classification systems relate to mucin expression patterns? An immunohistochemical analysis in a series of advanced gastric carcinomas. Virchows Arch 440:505–511CrossRefPubMed Gürbüz Y, Kahlke V, Kloppel G (2002) How do gastric carcinoma classification systems relate to mucin expression patterns? An immunohistochemical analysis in a series of advanced gastric carcinomas. Virchows Arch 440:505–511CrossRefPubMed
15.
go back to reference Hanski C (1995) Is mucinous carcinoma of the colorectum a distinct genetic entity? Br J Cancer 72:1350–1356PubMed Hanski C (1995) Is mucinous carcinoma of the colorectum a distinct genetic entity? Br J Cancer 72:1350–1356PubMed
16.
go back to reference Hanski C, Hofmeier M, Schmitt-Graff A, Riede E, Hanski ML, Borchard F, Sieber E, Niedobitek F, Foss HD, Stein H, Riecken EO (1997) Overexpression or ectopic expression of MUC2 is the common property of mucinous carcinomas of the colon, pancreas, breast, and ovary. J Pathol 182:385–391CrossRefPubMed Hanski C, Hofmeier M, Schmitt-Graff A, Riede E, Hanski ML, Borchard F, Sieber E, Niedobitek F, Foss HD, Stein H, Riecken EO (1997) Overexpression or ectopic expression of MUC2 is the common property of mucinous carcinomas of the colon, pancreas, breast, and ovary. J Pathol 182:385–391CrossRefPubMed
17.
go back to reference Kawamura H, Kondo Y, Osawa S, Nisida Y, Okada K, Isizu H, Uebayasi T, Takahasi M, Hata T (2001) A clinicopathologic study of mucinous adenocarcinoma of the stomach. Gastric Cancer 4:83–86PubMed Kawamura H, Kondo Y, Osawa S, Nisida Y, Okada K, Isizu H, Uebayasi T, Takahasi M, Hata T (2001) A clinicopathologic study of mucinous adenocarcinoma of the stomach. Gastric Cancer 4:83–86PubMed
18.
go back to reference Komaki K, Sakamoto G, Sugano H, Morimoto T, Monden Y (1988) Mucinous carcinoma of the breast in Japan. A prognostic analysis based on morphologic features. Cancer 61:989–996PubMed Komaki K, Sakamoto G, Sugano H, Morimoto T, Monden Y (1988) Mucinous carcinoma of the breast in Japan. A prognostic analysis based on morphologic features. Cancer 61:989–996PubMed
19.
go back to reference Kubo T (1971) Histologic appearance of gastric carcinoma in high and low mortality countries: comparison between Kyushu, Japan and Minnesota, USA. Cancer 28:726–734PubMed Kubo T (1971) Histologic appearance of gastric carcinoma in high and low mortality countries: comparison between Kyushu, Japan and Minnesota, USA. Cancer 28:726–734PubMed
20.
go back to reference Luinetti O, Fiocca R, Villani L, Alberizzi P, Ranzani GN, Solcia E (1998) Genetic pattern, histological structure, and cellular phenotype in early and advanced gastric cancers: evidence for structure-related genetic subsets and for loss of glandular structure during progression of some tumours. Hum Pathol 29:702–709CrossRefPubMed Luinetti O, Fiocca R, Villani L, Alberizzi P, Ranzani GN, Solcia E (1998) Genetic pattern, histological structure, and cellular phenotype in early and advanced gastric cancers: evidence for structure-related genetic subsets and for loss of glandular structure during progression of some tumours. Hum Pathol 29:702–709CrossRefPubMed
21.
go back to reference Luttges J, Zamboni G, Longnecker D, Kloppel G (2001) The immunohistochemical mucin expression pattern distinguishes different types of intraductal papillary mucinous neoplasms of the pancreas and determines their relationship to mucinous noncystic carcinoma and ductal adenocarcinoma. Am J Surg Pathol 25:942–948PubMed Luttges J, Zamboni G, Longnecker D, Kloppel G (2001) The immunohistochemical mucin expression pattern distinguishes different types of intraductal papillary mucinous neoplasms of the pancreas and determines their relationship to mucinous noncystic carcinoma and ductal adenocarcinoma. Am J Surg Pathol 25:942–948PubMed
22.
go back to reference Messerini L, Ciantelli M, Baglioni S, Palomba A, Zampi G, Papi L (1999) Prognostic significance of microsatellite instability in sporadic mucinous colorectal cancers. Hum Pathol 30:629–634CrossRefPubMed Messerini L, Ciantelli M, Baglioni S, Palomba A, Zampi G, Papi L (1999) Prognostic significance of microsatellite instability in sporadic mucinous colorectal cancers. Hum Pathol 30:629–634CrossRefPubMed
23.
go back to reference Nardelli J, Bara J, Rosa B, Burtin P (1983) Intestinal metaplasia and carcinomas of the human stomach: an immunohistological study. J Histochem Cytochem 31:366–375PubMed Nardelli J, Bara J, Rosa B, Burtin P (1983) Intestinal metaplasia and carcinomas of the human stomach: an immunohistological study. J Histochem Cytochem 31:366–375PubMed
24.
go back to reference Pinto-de-Sousa J, David L, Reis CA, Gomes R, Silva L, Pimenta A (2002) Mucins MUC1, MUC2, MUC5AC and MUC6 expression in the evaluation of differentiation and clinico-biological behaviour of gastric carcinoma. Virchows Arch 440:304–310CrossRefPubMed Pinto-de-Sousa J, David L, Reis CA, Gomes R, Silva L, Pimenta A (2002) Mucins MUC1, MUC2, MUC5AC and MUC6 expression in the evaluation of differentiation and clinico-biological behaviour of gastric carcinoma. Virchows Arch 440:304–310CrossRefPubMed
25.
go back to reference Reis CA, David L, Carvalho F, Mandel U, de Bolos C, Mirgorodskaya E, Clausen H, Sobrinho-Simões M (2000) Immunohistochemical study of the expression of MUC6 mucin and co-expression of other secreted mucins (MUC5AC and MUC2) in human gastric carcinomas. J Histochem Cytochem 48:377–388PubMed Reis CA, David L, Carvalho F, Mandel U, de Bolos C, Mirgorodskaya E, Clausen H, Sobrinho-Simões M (2000) Immunohistochemical study of the expression of MUC6 mucin and co-expression of other secreted mucins (MUC5AC and MUC2) in human gastric carcinomas. J Histochem Cytochem 48:377–388PubMed
26.
go back to reference Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C (1994) Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum. Oncology 51:30–34PubMed Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C (1994) Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum. Oncology 51:30–34PubMed
27.
go back to reference Sessa F, Solcia E, Capella C, Bonato M, Scarpa A, Zamboni G, Pellegata NS, Ranzani GN, Rickaert F, Kloppel G (1994) Intraductal papillary-mucinous tumours represent a distinct group of pancreatic neoplasms: an investigation of tumour cell differentiation and K-ras, p53 and c-erbB-2 abnormalities in 26 patients. Virchows Arch 425:357–367CrossRefPubMed Sessa F, Solcia E, Capella C, Bonato M, Scarpa A, Zamboni G, Pellegata NS, Ranzani GN, Rickaert F, Kloppel G (1994) Intraductal papillary-mucinous tumours represent a distinct group of pancreatic neoplasms: an investigation of tumour cell differentiation and K-ras, p53 and c-erbB-2 abnormalities in 26 patients. Virchows Arch 425:357–367CrossRefPubMed
28.
go back to reference Shibuya H, Nishida R, Koide S, Kurokawa J, Okita K (2000) Clinicopathological study of mucinous gastric carcinoma. Ann Chir Gynaecol 89:273–276PubMed Shibuya H, Nishida R, Koide S, Kurokawa J, Okita K (2000) Clinicopathological study of mucinous gastric carcinoma. Ann Chir Gynaecol 89:273–276PubMed
29.
go back to reference Sobin LH, Wittekind C (1997) TNM classification of malignant tumours, 5th edn. Wiley-Liss, New York, pp 59–62 Sobin LH, Wittekind C (1997) TNM classification of malignant tumours, 5th edn. Wiley-Liss, New York, pp 59–62
30.
go back to reference Solcia E, Capella C, Kloppel G (1997) Tumors of the pancreas. Armed Forces Institute Pathology. Atlas of Tumor Pathology, vol. 20. American Registry of Pathology, Washington, DC Solcia E, Capella C, Kloppel G (1997) Tumors of the pancreas. Armed Forces Institute Pathology. Atlas of Tumor Pathology, vol. 20. American Registry of Pathology, Washington, DC
31.
go back to reference Tsukashita S, Kushima R, Bamba M, Sugihara H, Hattori T (2001) MUC gene expression and histogenesis of adenocarcinoma of the stomach. Int J Cancer 94:166–170CrossRefPubMed Tsukashita S, Kushima R, Bamba M, Sugihara H, Hattori T (2001) MUC gene expression and histogenesis of adenocarcinoma of the stomach. Int J Cancer 94:166–170CrossRefPubMed
32.
go back to reference Velcich A, Yang W, Heyer J, Fragale A, Nicholas C, Viani S, Kucherlapati R, Lipkin M, Yang K, Augenlicht L (2002) Colorectal cancer in mice genetically deficient in the mucin Muc2. Science 295:1726–1729CrossRefPubMed Velcich A, Yang W, Heyer J, Fragale A, Nicholas C, Viani S, Kucherlapati R, Lipkin M, Yang K, Augenlicht L (2002) Colorectal cancer in mice genetically deficient in the mucin Muc2. Science 295:1726–1729CrossRefPubMed
33.
go back to reference Wu CY, Yeh HZ, Shih RT, Chen GH (1998) A clinicopathologic study of mucinous gastric carcinoma including multivariate analysis. Cancer 83:1312–1318CrossRefPubMed Wu CY, Yeh HZ, Shih RT, Chen GH (1998) A clinicopathologic study of mucinous gastric carcinoma including multivariate analysis. Cancer 83:1312–1318CrossRefPubMed
Metadata
Title
Identification of a lower grade muconodular subtype of gastric mucinous cancer
Authors
Enrico Solcia
Ombretta Luinetti
Francesca Tava
Catherine Klersy
Federica Grillo
Nicola Pandolfo
Roberto Fiocca
Publication date
01-12-2004
Publisher
Springer-Verlag
Published in
Virchows Archiv / Issue 6/2004
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI
https://doi.org/10.1007/s00428-004-1130-1

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