title: Gastric Invasive Micropapillary Carcinoma with Intestinal Phenotypes Harboring a TP53 R175H Mutation.
abstract: We report a case of gastric invasive micropapillary carcinoma (IMPC) in an 86-year-old female patient. She was admitted to our hospital with a chief complaint of bloody emesis. Upper gastrointestinal endoscopy found a gastric adenocarcinoma at the antrum. The biopsy specimens showed moderately differentiated adenocarcinoma with invasive small tumor nests. Distal gastrectomy with systematic lymph node dissection demonstrated that the tumor had IMPC through a pathological examination. Despite the depth of tumor invasion (the submucosa), extensive lymph node metastases were observed. Anti-D2-40 immunostaining revealed numerous infiltrating tumor cell nests in the lymphatic vessels, which could explain subsequent multiple lymph node metastases. The adenocarcinoma showed intestinal phenotypes by several immunohistochemical studies. One of these antibodies (CD10) clearly demonstrated the inverted apical-basal (inside-out) pattern of IMPC, whereas it showed an ordinary pattern in intestinal metaplasia adjacent to the tumor. Furthermore, genetic analysis by direct sequencing revealed a point mutation in the exon 5 of TP53 in the tumor. The mutation presumably harbors a missense mutation from Arg to His at the codon 175 (R175H). R175H has been previously described as a 'gain-of-function' mutation with a high invasive or metastatic potential in several types of cancers. In summary, this is one of the first reported cases of gastric IMPC with intestinal phenotypes harboring a TP53 R175H mutation in the literature.
authors.affiliation: Divisions of Surgical Pathology, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kukitsu
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan ; Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Johmen
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Natumi
authors.initials: N
authors.lastname: Yamauchi
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Ishikawa
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Saikawa
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Noda
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Tadanori
authors.initials: T
authors.lastname: Saitoh
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ueno
authors.affiliation: Divisions of Surgery, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Yuuya
authors.initials: Y
authors.lastname: Noda
authors.affiliation: Divisions of Surgery, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Sayuki
authors.initials: S
authors.lastname: Yamazaki
authors.affiliation: Divisions of Surgery, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kuroda
authors.affiliation: Divisions of Surgery, Rumoi City Hospital, Rumoi, Japan ; Division of Surgery, Sapporo Memorial Hospital of Surgery, Sapporo, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Koshiko
authors.affiliation: Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sasagawa
keywords: CD10; Gastric cancer; Intestinal phenotypes; Invasive micropapillary carcinoma; R175H; TP53