Micropapillary adenocarcinoma of lung: Morphological criteria and diagnostic reproducibility among pulmonary pathologists

Paloma del C. Monroig-Bosque, Joel A. Morales-Rosado, Anja Roden, Andrew Churg, Roberto Barrios, Philip Cagle, Yimin Ge, Timothy C. Allen, Maxwell L. Smith, Brandon Larsen, Lynette M. Sholl, Mary B. Beasley, Alain Borczuk, Kirtee Raparia, Alberto Ayala, Henry D. Tazelaar, Ross Miller, Neda Kalhor, Cesar A. Moran, Jae Y. Ro

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Context: Invasive micropapillary adenocarcinoma (MPC)is an aggressive variant of lung adenocarcinoma, frequently manifesting with advanced stage lymph node metastasis and decreased survival. Objective: Identification of this morphology is important, as it is strongly correlated with poor prognosis regardless of the amount of MPC component. To date, no study has investigated the morphological criteria used to objectively diagnose it. Design: Herein, we selected 30 cases of potential MPC of lung, and distributed 2 digital images per case among 15 pulmonary pathology experts. Reviewers were requested to diagnostically interpret, assign the percentage of MPC component, and record the morphological features they identified. The noted features included: columnar cells, elongated slender cell nests, extensive stromal retraction, lumen formation with internal epithelial tufting, epithelial signet ring-like forms, intracytoplasmic vacuolization, multiple nests in the same alveolar space, back-to-back lacunar spaces, epithelial nest anastomosis, marked pleomorphism, peripherally oriented nuclei, randomly distributed nuclei, small/medium/large tumor nest size, fibrovascular cores, and spread through air-spaces (STAS). Results: Cluster analysis revealed three subgroups with the following diagnoses: “MPC”, “combined papillary and MPC”, and “others”. The subgroups correlated with the reported median percentage of MPC. Intracytoplasmic vacuolization, epithelial nest anastomosis/confluence, multiple nests in the same alveolar space, and small/medium tumor nest size were the most common criteria identified in the cases diagnosed as MPC. Peripherally oriented nuclei and epithelial signet ring-like forms were frequently identified in both the “MPC” and “combined papillary and MPC” groups. Conclusions: Our study provides objective diagnostic criteria to diagnose MPC of lung.

Original languageEnglish (US)
Pages (from-to)43-50
Number of pages8
JournalAnnals of Diagnostic Pathology
Volume41
DOIs
StatePublished - Aug 1 2019

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Adenocarcinoma
Lung
Papillary Adenocarcinoma
Pathologists
Adenocarcinoma of lung
Cluster Analysis
Neoplasms
Lymph Nodes
Air
Pathology
Neoplasm Metastasis

Keywords

  • Lung Adenocarcinoma
  • Micropapillary
  • Morphology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Micropapillary adenocarcinoma of lung : Morphological criteria and diagnostic reproducibility among pulmonary pathologists. / Monroig-Bosque, Paloma del C.; Morales-Rosado, Joel A.; Roden, Anja; Churg, Andrew; Barrios, Roberto; Cagle, Philip; Ge, Yimin; Allen, Timothy C.; Smith, Maxwell L.; Larsen, Brandon; Sholl, Lynette M.; Beasley, Mary B.; Borczuk, Alain; Raparia, Kirtee; Ayala, Alberto; Tazelaar, Henry D.; Miller, Ross; Kalhor, Neda; Moran, Cesar A.; Ro, Jae Y.

In: Annals of Diagnostic Pathology, Vol. 41, 01.08.2019, p. 43-50.

Research output: Contribution to journalArticle

Monroig-Bosque, PDC, Morales-Rosado, JA, Roden, A, Churg, A, Barrios, R, Cagle, P, Ge, Y, Allen, TC, Smith, ML, Larsen, B, Sholl, LM, Beasley, MB, Borczuk, A, Raparia, K, Ayala, A, Tazelaar, HD, Miller, R, Kalhor, N, Moran, CA & Ro, JY 2019, 'Micropapillary adenocarcinoma of lung: Morphological criteria and diagnostic reproducibility among pulmonary pathologists', Annals of Diagnostic Pathology, vol. 41, pp. 43-50. https://doi.org/10.1016/j.anndiagpath.2019.04.008
Monroig-Bosque, Paloma del C. ; Morales-Rosado, Joel A. ; Roden, Anja ; Churg, Andrew ; Barrios, Roberto ; Cagle, Philip ; Ge, Yimin ; Allen, Timothy C. ; Smith, Maxwell L. ; Larsen, Brandon ; Sholl, Lynette M. ; Beasley, Mary B. ; Borczuk, Alain ; Raparia, Kirtee ; Ayala, Alberto ; Tazelaar, Henry D. ; Miller, Ross ; Kalhor, Neda ; Moran, Cesar A. ; Ro, Jae Y. / Micropapillary adenocarcinoma of lung : Morphological criteria and diagnostic reproducibility among pulmonary pathologists. In: Annals of Diagnostic Pathology. 2019 ; Vol. 41. pp. 43-50.
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abstract = "Context: Invasive micropapillary adenocarcinoma (MPC)is an aggressive variant of lung adenocarcinoma, frequently manifesting with advanced stage lymph node metastasis and decreased survival. Objective: Identification of this morphology is important, as it is strongly correlated with poor prognosis regardless of the amount of MPC component. To date, no study has investigated the morphological criteria used to objectively diagnose it. Design: Herein, we selected 30 cases of potential MPC of lung, and distributed 2 digital images per case among 15 pulmonary pathology experts. Reviewers were requested to diagnostically interpret, assign the percentage of MPC component, and record the morphological features they identified. The noted features included: columnar cells, elongated slender cell nests, extensive stromal retraction, lumen formation with internal epithelial tufting, epithelial signet ring-like forms, intracytoplasmic vacuolization, multiple nests in the same alveolar space, back-to-back lacunar spaces, epithelial nest anastomosis, marked pleomorphism, peripherally oriented nuclei, randomly distributed nuclei, small/medium/large tumor nest size, fibrovascular cores, and spread through air-spaces (STAS). Results: Cluster analysis revealed three subgroups with the following diagnoses: “MPC”, “combined papillary and MPC”, and “others”. The subgroups correlated with the reported median percentage of MPC. Intracytoplasmic vacuolization, epithelial nest anastomosis/confluence, multiple nests in the same alveolar space, and small/medium tumor nest size were the most common criteria identified in the cases diagnosed as MPC. Peripherally oriented nuclei and epithelial signet ring-like forms were frequently identified in both the “MPC” and “combined papillary and MPC” groups. Conclusions: Our study provides objective diagnostic criteria to diagnose MPC of lung.",
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T2 - Morphological criteria and diagnostic reproducibility among pulmonary pathologists

AU - Monroig-Bosque, Paloma del C.

AU - Morales-Rosado, Joel A.

AU - Roden, Anja

AU - Churg, Andrew

AU - Barrios, Roberto

AU - Cagle, Philip

AU - Ge, Yimin

AU - Allen, Timothy C.

AU - Smith, Maxwell L.

AU - Larsen, Brandon

AU - Sholl, Lynette M.

AU - Beasley, Mary B.

AU - Borczuk, Alain

AU - Raparia, Kirtee

AU - Ayala, Alberto

AU - Tazelaar, Henry D.

AU - Miller, Ross

AU - Kalhor, Neda

AU - Moran, Cesar A.

AU - Ro, Jae Y.

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N2 - Context: Invasive micropapillary adenocarcinoma (MPC)is an aggressive variant of lung adenocarcinoma, frequently manifesting with advanced stage lymph node metastasis and decreased survival. Objective: Identification of this morphology is important, as it is strongly correlated with poor prognosis regardless of the amount of MPC component. To date, no study has investigated the morphological criteria used to objectively diagnose it. Design: Herein, we selected 30 cases of potential MPC of lung, and distributed 2 digital images per case among 15 pulmonary pathology experts. Reviewers were requested to diagnostically interpret, assign the percentage of MPC component, and record the morphological features they identified. The noted features included: columnar cells, elongated slender cell nests, extensive stromal retraction, lumen formation with internal epithelial tufting, epithelial signet ring-like forms, intracytoplasmic vacuolization, multiple nests in the same alveolar space, back-to-back lacunar spaces, epithelial nest anastomosis, marked pleomorphism, peripherally oriented nuclei, randomly distributed nuclei, small/medium/large tumor nest size, fibrovascular cores, and spread through air-spaces (STAS). Results: Cluster analysis revealed three subgroups with the following diagnoses: “MPC”, “combined papillary and MPC”, and “others”. The subgroups correlated with the reported median percentage of MPC. Intracytoplasmic vacuolization, epithelial nest anastomosis/confluence, multiple nests in the same alveolar space, and small/medium tumor nest size were the most common criteria identified in the cases diagnosed as MPC. Peripherally oriented nuclei and epithelial signet ring-like forms were frequently identified in both the “MPC” and “combined papillary and MPC” groups. Conclusions: Our study provides objective diagnostic criteria to diagnose MPC of lung.

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