A Morphological and Immunohistochemical Study of the Tumoral and Inflammatory Cells in Pancreatic Ductal Adenocarcinoma

Abstract

This study is aimed at investigating tumoral and inflammatory cells and the significance of the prognostic factors of pancreatic ductal adenocarcinoma (PDAC); it is also aimed at determining the role of immunohistochemistry in the diagnosis and prognosis of this neoplasm. Materials and Methods. 230 cases of pancreatic ductal adenocarcinoma were included in the study group; these cases were selected from the archives of the Department of Pathology of the Fundeni Clinical Institute over a ten-year period. Immunohistochemistry was performed using the following antibodies: MUC 1, CD 34, Factor VIII, CD 68, MMP-7, CEA, p21, p53, and Ki 67. Results. There were 133 male (57.8%) and 97 female (42.2%) patients included in this study, with ages between 20 and 81 years old (mean age: 58.2 years) and with tumors located in the pancreatic head ( n = 196 ; 85.2%), pancreatic body ( n = 12 ; 5.2%), and pancreatic tail ( n = 20 , 8.7%), as well as panpancreatic tumors ( n = 2 ; 0.9%). Patients presented with early stages (IA and IB), with low pathologic grade (G1), with small size tumors (less than 1-1.5 cm), with tumors located in the head of the pancreas, (p53: negative; p21: positive; and CD 68: positive in peritumoral tissue), with low nuclear index ( Ki 67 < 10 % ), without metastases at the time of surgery (had a better prognosis), and with a survival rate of about 7 months. Conclusions. Immunohistochemistry is useful for an accurate diagnosis, differential diagnosis, and establishment of additional factors that might have a prognostic importance. It is recommended to study peritumoral tissue from the quantitative and qualitative points of view to increase the number of prognostic factors. This study represents a multidisciplinary approach, and it is a result of teamwork; it presents histopathological methods of examination of this severe illness and describes only a part of the scientific effort to determine the main pathological mechanisms of this neoplasm.

Late pancreatic metastasis of breast cancer or primary cancer?

“…13 The authors concluded that this positivity had no relevance to the outcomes, but should be considered as a lack of absolute specificity of GATA3+ for the mammary cancers 13 . In our case, due to the age of the patient and the high titer of the CA 19-9 determination (twenty times higher than the upper normal limit), the first diagnostic concern focused a primary ductal pancreatic adenocarcinoma and local lymph nodes involvement 2,16,17 . However, the concomitant cholestasis can contribute to very elevated levels of CA19-9 and this phenomenon is described also in benign obstructions of pancreatitis, cholangitis, or cirrhosis, and levels over 1,000 U/ml may normalize with the obstruction treatment 18 .…”

“…Immunohistochemistry evaluation of the tumor samples in our case showed GATA3+, p63+, CK7+, Ki-67+ (50%), PR+ (10%), ER+ (5%), and HER2-, CK20-, and CDX2-. Worthy of note, a similar evaluation of pancreatic carcinomas, greater than 5 cm, in the head of the organ, frequently reveal p21-, p53+, and Ki 67+ (30-35%) in the tumor cells 17 . It is expected that an aggressive pancreatic adenocarcinoma present metastases in over than 50% of cases at the time of diagnosis 13 .…”

“…The aim of the next comments is to emphasize the complexity and pitfalls involving interpretations of tumor markers determinations and immunohistochemistry studies in patients with pancreatic metastases with origin in breast cancers treated many years ago. Elevated determination of the CA 15-3, a major marker of breast cancer, and immunohistochemistry panel GATA3+, Ki-67+, PR+, ER+, with HER2-were considered suggestive of breast cancer metastasis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . GATA3 is a useful tool to suspect of mammary origin, in special for ER+ low-grade cancer, even with low sensitivity (< 20%) in the triple-negative (TN) metaplastic cancer 11 .…”