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Papillary adenocarcinoma of the kidney is an uncommon variant of renal tubular carcinoma, which on radiographic and ultrasonographic evaluation presents characteristically as a predominantly solid hypovascular or avascular mass. Surgery is required to distinguish this lesion from other solid renal lesions, which differs from the more common form of renal tubular carcinoma in several important respects.
This retrospective study examined the outcome in 42 women with early stage (FIGO I/II) endometrial adenocarcinoma (papillary, n = 22 and nonpapillary, n = 20). In patients with papillary carcinoma, median survival was longer when surgery and/or radiotherapy was applied (18 to 36 months) than when such treatment was not used or systemic progestational therapy was employed (6 to 9 months). Among those evaluable women, the 5-year survival rate was significantly (p = 0.01) better in the nonpapillary than the papillary type adenocarcinoma, 45% (9/20) versus 6% (1/16) respectively. However, abdominal failure and distant metastasis rates in papillary carcinoma were 5% while local recurrence and distant metastasis rates in the nonpapillary variety were correspondingly 20% and 15%.
In 1987 a clinicopathologic study by the Armed Forces Institute of Pathology (AFIP) of rare sweat gland tumors, termed aggressive digital papillary adenoma and adenocarcinoma, was published. Since that time, the AFIP has continued to collect these tumors for study. Based on additional follow-up data, we think the original classification of these tumors requires revision. Sixty-seven cases of aggressive digital papillary adenoma and adenocarcinoma were studied according to their clinical characteristics and histologic features. Fifty of these were originally diagnosed as adenoma and 17 as adenocarcinoma. Follow up on 45 (67%) of the patients was obtained. None of the clinical or histologic parameters studied were found to be predictive of recurrence or metastasis, indicating that the originally proposed criteria for distinguishing between benign (adenoma) and malignant (adenocarcinoma) do not predict biologic behavior. When primary tumors were treated by subsequent reexcision or amputation, only one recurred (5%), when not so treated, 11 recurred (50%) regardless of the original diagnosis (p <0.05). Metastasis occurred in six (14%) cases and in three cases led to the death of the patient. Three of these metastatic cases had met the earlier criteria for adenoma. Pulmonary metastases were observed in five cases. No effective treatment for widespread metastatic disease has yet been developed. Because histologic features with prognostic significance could not be demonstrated in this retrospective review, we propose that all aggressive digital papillary tumors be designated aggressive digital papillary adenocarcinoma.
Papillary adenocarcinomas of the prostate are rare tumors which may arise from the prostatic ducts and the utricle; 2 cases are described. The diagnosis of these tumors is best established by cystourethroscopy and transurethral resection. The more common prostatic acinar adenocarcinoma is frequently associated with these tumors. The histopathologic recognition of papillary adenocarcinoma of the prostate and its differentiation from acinar adenocarcinoma is important since the natural history and response to treatment may be different.
Papillary adenocarcinoma resembling ductal carcinoma and arising in the peripheral zone is extremely rare. We report a case of prostatic papillary adenocarcinoma with ductal features. The patient was a 68-year-old man who initially presented with dysuria and sensation of residual urine after voiding. Prostatic needle biopsy findings supported pathological diagnosis of prostatitis. The symptoms were improved by medication for prostatitis, and prostate-specific antigen (PSA) level of 22.6 ng/ml descreased to 9.9 ng/ml. It remained between 7.2 ng/ml and 9.9 ng/ml for 2 years. However, it gradually increased to 11.9 ng/ml. Transrectal digital examination, T2-weighted magnetic resonance imaging (MRI) of the prostate and transrecral ultrasound showed a mass in the enlarged right side of the prostate. Transrectal needle biopsy of the mass was performed, and papillary adenocarcinoma was suspected by histological examination. Radical prostatectomy was performed. Histological and immunohistochemical examination of the prostatectomy specimen revealed pure prostatic papillary adenocarcinoma with ductal features.
BACKGROUND: Aggressive digital papillary adenocarcinoma is a rare malignancy with a propensity for metastases and recurrence. The role of lymph node staging in this tumor is poorly defined. We describe the use of sentinel lymph node mapping and biopsy in staging this tumor. OBJECTIVE: To describe and discuss the use of lymphatic mapping in staging aggressive digital papillary adenocarcinoma. METHODS: Sentinel lymph node mapping and biopsy was performed after excision of an aggressive digital papillary adenocarcinoma of the toe. RESULTS: Metastatic tumor cells were absent in sentinel lymph nodes by hematoxylin and eosin staining and immunocytochemistry analysis. CONCLUSION: We describe the first reported case of staging lymph nodes in a patient with aggressive digital papillary adenocarcinoma utilizing sentinel lymph node mapping and biopsy.
Aggressive digital papillary adenocarcinoma is a rare neoplasm of eccrine sweat gland origin. An acral location and a high recurrence rate are characteristic features. Its histopathologic features are distinctive, and the tumor expresses carcinoembryonic and S-100 protein antigens. We demonstrated immunoreactivity of the tumor to ferritin antibody, a new immunohistologic marker for sweat gland malignancies.
Clinical and immunohistochemical studies were conducted to evaluate prostatic papillary adenocarcinoma and prostatic papillary hyperplasia. Subjects consisted of 5 cases of papillary adenocarcinoma and 2 cases of papillary hyperplasia. There is no conclusive clinical factor for preoperative diagnosis, but we attach importance to endoscopic findings. PSA, PAP, high molecular weight cytokeratin, and PCNA were evaluated immunohistochemically. PSA became positive in every instance but one--a case of papillary adenocarcinoma which became +/-. PAP was + in all cases, except for 1 case of papillary adenocarcinoma. Basal cells were positive for high molecular weight cytokeratin in 2 cases of papillary hyperplasia but were missing in papillary adenocarcinoma. Although PCNA was free from positive nuclei in papillary hyperplasia, positive nuclei were found in all cases of papillary adenocarcinoma. Considering these immunohistochemical results, papillary adenocarcinoma can be said to originate in the glandular epithelium of the prostate, as does ordinary prostatic carcinoma.
Papillary adenocarcinoma of the prostate, previously referred to as endometrioid carcinoma, is a variant of prostatic adenocarcinoma. Clinical and pathological evidence of involvement of the periurethral prostatic duct or verumontanum is usually required for definitive diagnosis of papillary adenocarcinoma. However, significant histologic and clinical features of papillary adenocarcinoma overlap with typical acinar carcinoma. Four cases of papillary adenocarcinoma were studied for the clinical features, histologic characteristics and immunohistochemical nature of prostatic specific antigen. In two cases, there were papillary regions, near the verumontanum, but in the other two cases, there were no papillary regions in the urethra. In two cases, acinar adenocarcinoma coexisted with papillary adenocarcinoma. All cases displayed positive immunohistochemical staining for prostatic specific antigen. In accordance with the observations of others, we suggest that papillary adenocarcinoma is one aspect of growth pattern of acinar adenocarcinoma, not a concept of a unique clinical and pathological entity.
Digital papillary adenocarcinoma is a rare tumour originating from sweat glands, often occurring in digits of the hand or foot. We present the case of a 52-year-old mechanic with this tumour at the distal phalanx of the middle finger. It was primarily excised. After histological verification of the diagnosis, amputation and axillary lymphadenectomy was performed. So far, no clinical or histological parameters were found to be predictive for recurrence or metastasis. This indicates that the originally proposed criteria for distinguishing between benign (adenoma) and malignant (adenocarcinoma) do not necessarily predict biologic behaviour. As according to the available literature metastases occurred in 14 % of the described patients within ten years, we propose an aggressive surgical approach consisting of amputation and regional lymph node dissection.
Papillary adenocarcinoma should be regarded as a subtype of endometrial carcinoma with poor prognosis. Review of 22 cases indicates an older average age than is found with the usual endometrioid type, with frequent surgical upstaging, deep myometrial invasion, nodal and adnexal involvement, positive peritoneal washings, upper abdominal recurrence, and poor response to conventional treatment. These observations suggest a different natural history from that of the more common histologic subtypes of endometrial carcinoma. Management should include initial exploration of the entire abdominal cavity to determine the true extent of the disease, and treatment must include the upper abdomen.
Thirty-four patients with primary endometrial papillary adenocarcinoma diagnosed in our institution from 1970 to 1982 were studied. Papillary adenocarcinomas represented 10% of all endometrial adenocarcinomas seen during this period. Papillary neoplasms were morphologically subclassified as either papillary serous adenocarcinoma or well-differentiated papillary adenocarcinoma, following review of the histological sections obtained prior to radiotherapy or chemotherapy. Twenty-five patients were found to have papillary serous adenocarcinoma, and nine had well-differentiated papillary adenocarcinoma. A control group of 305 patients with endometrial adenocarcinoma of nonpapillary type was compared with respect to age, race, and survival. Fifty percent of the patients with papillary serous adenocarcinoma were black and they were significantly older (p = 0.001) than the control group, with a mean age of 71 years. Thirty percent of the papillary serous adenocarcinoma group had deep myometrial invasion and peritoneal surface involvement by tumor. In 20% of these patients there was a discrepancy between the clinical stage and the surgical stage at laparotomy. Survival was markedly worse (p = 0.01) than that of the control group. Patients with well-differentiated papillary adenocarcinomas were similar to control patients with respect to age and racial status and had similar clinical survival outcome. We conclude that well-differentiated papillary adenocarcinoma of the endometrium is a distinct form of papillary adenocarcinoma, and must be morphologically and clinically distinguished from papillary serous adenocarcinomas because of its better prognosis. Morphological differentiation of these two papillary variants of endometrial adenocarcinoma is presented.
Villoglandular papillary adenocarcinoma of the uterine cervix was recently (1989) described by three main histological features: exophytic proliferation, papillary architecture and mild to moderate cellular atypicality. The authors report a case of villoglandular papillary adenocarcinoma, clinical stage IB, which was peculiar because of its association with a co-existing and simultaneously discovered invasive squamous cell carcinoma. These two patterns were juxtaposed and not intermingled. The patient was treated with radical hysterectomy followed by vaginal radiation therapy. She remains without evidence of recurrence after 12 months of follow-up. Five main clinicopathological features of the villoglandular papillary adenocarcinoma could be stressed: rare histological variant (72 described cases), young age of patients (25-45 years old), superficial stromal invasion, usual association with other tumoral patterns (in situ or invasive adenocarcinoma as well as in situ or invasive squamous cell carcinoma) and excellent prognosis. For selected cases, a conservative surgical approach (cervical conization) was possible.
Aggressive digital papillary adenoma (ADPA) and adenocarcinoma (ADPAca) are adnexal tumors that are not often recognized because of their rarity. We present a rare case of ADPAca involving the left middle finger of a 43-year-old man. Histopathological features of ADPAca are distinct from those of other eccrine sweat gland tumors; however, ADPAca may be misdiagnosed particularly for a metastasis of papillary adenocarcinoma originating in the colon, thyroid, or breast. Clinicopathological correlation is essential to ule out a possible risk of metastatic carcinoma of the skin. Recognition of these tumors is important because of a potential risk of local recurrence nd distant metastases. Aggressive surgical treatment consisting of digit amputation is advocated in the treatment of ADPAca.
Papillary adenocarcinomas remain at present some of the rare tumours of the biliary pathways. They raise numerous problems in connection with the diagnosis and with the surgical attitude. The authors present their personal experience acquired in 8 cases of papillary adenocarcinomas of the biliary pathways in which, after removal by curettage external biliary drainage was performed (4 cases, 2 survivals for 3 and 10 months respectively). Cholecystogastrostomy was performed in 2 cases and choledocoduodenostomy in two more patients (survivals of 3 and 20 months respectively).
Metastatic papillary adenocarcinomas of the ovary are rare compared to primary ovarian papillary serous carcinomas. We report a case of pulmonary papillary adenocarcinoma metastatic to the ovary and show how this tumor can be differentiated immunohistochemically from an ovarian primary. Paraffin blocks of the ovarian tumor were analyzed for carcinoembryonic antigen, CA 125, surfactant, E-cadherin, N-cadherin, and vimentin. These markers are useful in differentiating epithelial tumors of lung versus ovarian origin. The papillary tumor showed expression of carcinoembryonic antigen, surfactant, and E-cadherin, but was negative for CA 125, N-cadherin, and vimentin. These findings support a lung carcinoma metastatic to the ovary.
Papillary adenocarcinoma is extremely rare in the squamous epithelium-lined esophagus. The histopathologic and immunohistochemical characteristics were examined in a composite tumor showing distinct papillary adenocarcinoma and squamous cell carcinoma of the esophagus resected from a 66-year-old man. The esophageal tumor consisted both grossly and histologically of two distinct components: an ulcerative part showing a squamous cell carcinoma, and a polypoid part corresponding to a papillary adenocarcinoma. In addition, the in situ squamous cell carcinoma was contiguous with the esophageal tumor. Mucin secretion was found only in the papillary adenocarcinoma component. Immunohistochemically, tumor cells of the papillary adenocarcinoma component were positive for carcinoembryonic antigen, secretory component, and lactoferrin. These staining patterns were similar to those of the normal esophageal gland proper. These histologic, mucin-histochemical, and immunohistochemical findings suggest that the papillary adenocarcinoma originated from the submucosal esophageal gland and the squamous cell carcinoma from the squamous epithelium lining the esophagus.
Digital papillary adenocarcinoma (DPAc) is a relatively rare neoplasm arising from the sweat glands with a predilection for the hand. A case of DPAc in the third finger at the level of the proximal phalanx in a 55-year-old male is presented. Our paper recommends specific consideration of DPAc in evaluating digital soft tissue masses, particularly those that present with an aggressive nature.