Characteristic Clinicopathological Features of the Types of Intraductal Papillary-Mucinous Neoplasms of the Pancreas

Ishida, Masaharu; Egawa, Shinichi; Aoki, Takeshi; Sakata, Naoaki; Mikami, Yukio; Motoi, Fuyuhiko; Abe, Tadayoshi; Fukuyama, Shoji; Sunamura, Makoto; Unno, Michiaki; Moriya, Takuya; Horii, Akira; Furukawa, Toru

doi:10.1097/mpa.0b013e31806da090

Cited by 77 publications

(63 citation statements)

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“…To our knowledge, this is the first report describing the relationship between invasiveness and TSP1 immunoreactivity in IPMN of the pancreas. Several investigators have reported clinicopathological and biological differences on comparing histologic subtypes of IPMN (5,12,13,17,20,25). Using the TSP1 expression pattern, we also analyzed differences in stromal invasion within histological subtypes of IPMN.…”

Section: References Discussionmentioning

confidence: 99%

“…2 Patients in the strongly positive group, with more than 30% of the cancer stroma positive for TSP1 (---, n = 23), showed a significantly poorer prognosis compared to that of patients in the negative-weakly positive group (-, n = 57; P = 0.008 log-rank test). (9,13,17). However, cases of gastric-type IPMNs tended to show a higher incidence of branch duct-type IPMNs, but there was no significant association between the histological subtype and macroscopic type in our study.…”

Section: Clinicopathological Featuresmentioning

confidence: 99%

“…Based on the results on an immunohistochemical study of TSP1, we investigated the therapeutic strategy according to the histological subtype of IPMN. Recently, there have been some reports on the relationship between the histological subtype and invasiveness in IPMN (5,12,13,17,20,25). We also analyzed the correlation between the subtype and stromal TSP1 expression in IPMNs to clarify which subtypes tended to achieve invasiveness fast and which tended to retain the status of adenoma in the pancreatic duct, and discussed the clinicopathological significance.…”

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confidence: 99%

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Stromal thrombospondin-1 expression is a prognostic indicator and a new marker of invasiveness in intraductal papillary-mucinous neoplasm of the pancreas

et al. 2010

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The invasion of intraductal papillary-mucinous neoplasm (IPMN) is sometimes difficult to diagnose using only ordinary hematoxylin-eosin sections. The aim of this study was to evaluate the invasion of IPMN more precisely using thrombospondin-1 (TSP1) immunohistochemistry as a useful adjunct to morphological examination. Eighty patients that underwent primary resection for pancreatic IPMNs were retrospectively analyzed. The 80 IPMNs were studied for the expression of TSP1, MUC1-CORE, MUC2, and MUC5AC. The cases were evaluated for dysplasia, the presence of invasion, hisological subtypes, and survival. The 80 IPMNs were classified into 29 intraductal papillary-mucinous adenomas (IPMAs), 10 borderline IPMNs, 18 noninvasive intraductal papillary-mucinous carcinomas (IPMCs), and 23 invasive IPMCs according to the WHO classification. Invasive IPMCs were further divided into 12 minimally invasive IPMCs (MI-IPMCs) and 11 invasive carcinomas originating from IPMCs (IC-IPMCs) according to the Japan Pancreatic Society classification. The rate of strongly positive cases with more than 30% of the cancer stroma area expressing TSP1 was significantly higher in MI-IPMC and IC-IPMC than in noninvasive IPMC (P = 0.035, 0.005). Furthermore, patients in the strongly positive group had a significantly poorer prognosis compared to patients in the negative-weakly positive group (P = 0.008, log-rank test). Of the 80 tumors, 22 were classified into gastric-, 45 into intestinal-, 7 into pancreatobiliary-, and 6 into oncocytic-type IPMNs according to criteria described previously. The cases with a strongly positive expression of TSP1 were frequently detected in the pancreatobiliary and oncocytic types (P = 0.001). In conclusion, stromal TSP1 expression is a prognostic indicator and a new marker of invasiveness in IPMN.Intraductal papillary-mucinous neoplasms of the pancreas (IPMNs) are a well-characterized group of intraductal, mucin-producing, cystic neoplasms of the pancreas with a clear malignant potential (1, 2). A half of surgically resected IPMNs are intraductal papillary-mucinous adenoma (IPMA) or borderline IPMN even under current international criteria (21), and it is still unclear when they change to noninvasive intraductal papillary-mucinous carcinoma (IPMC), how long IPMC retains a status of "carcinoma in situ", and when IPMC achieves invasiveness. Particularly, invasive carcinoma originating from intraductal papillary-mucinous carcinoma (IC-IPMC) showed similar malignant behavior compared with conventional invasive ductal carcinoma both clinically and histologically (15). Minimally invasive IPMC (MI-IPMC) has been categorized within the classification of pancreatic carcinoma used by

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Section: References Discussionmentioning

confidence: 99%

Section: Clinicopathological Featuresmentioning

confidence: 99%

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confidence: 99%

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Stromal thrombospondin-1 expression is a prognostic indicator and a new marker of invasiveness in intraductal papillary-mucinous neoplasm of the pancreas

et al. 2010

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“…Gastric and pancreatobiliary subtypes are more often associated with invasive tubular adenocarcinoma versus intestinal subtype, which is frequently associated with invasive colloid carcinoma. [5][6][7][8] Furthermore, studies have reported conflicting evidence on whether the histologic IPMN subtype has prognostic significance. [8][9][10][11][12] The Verona consensus meeting in 2013 recently led to the publication of guidelines for pathologic reporting of IPMN with the recommendation that pathologists provide a histologic subtype.…”

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confidence: 99%

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

et al. 2016

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Intraductal papillary mucinous neoplasm is considered a precursor lesion to pancreatic adenocarcinoma. These are further classified into four histologic subtypes: gastric, intestinal, pancreatobiliary, and oncocytic. The first aim of this study was to assess the interobserver variability among five gastrointestinal pathologists in diagnosing intraductal papillary mucinous neoplasm subtypes by morphology alone. The second aim of the study was to compare intraductal papillary mucinous neoplasm subtypes, which received consensus diagnoses (≥80% agreement) with their respective mucin immunoprofiles (MUC1, MUC2, MUC5AC, MUC6, and CDX2). A consensus histologic subtype was reached in 58% of cases (29/50) among the five gastrointestinal pathologists. Overall there was moderate agreement (κ = 0.41, Po 0.01) in subtyping intraductal papillary mucinous neoplasms without the use of immunohistochemistry. The histologic subtype with the best interobserver agreement was intestinal type (κ = 0.56, Po 0.01) followed by pancreatobiliary, gastric, mixed, and oncocytic types (κ = 0.43, Po 0.01; κ = 0.38, Po 0.01; κ = 0.17, Po 0.01; κ = 0.08, Po 0.04, respectively). Both kappa values for mixed and oncocytic subtypes were likely artificially low due to the underrepresentation of these subtypes in this study and not a true indication of poor interobserver agreement. Following an intradepartmental consensus meeting between two gastrointestinal pathologists, 68% of cases (34/50) received a consensus intraductal papillary mucinous neoplasm subtype. Sixty-nine percent of cases (11/16) that did not receive a consensus intraductal papillary mucinous neoplasm subtype could be classified based on their respective immunoprofiles. Standardizing the use of immunohistochemistry with a mucin immunopanel (MUC1, MUC2, MUC5AC, and MUC6) may improve the agreement of diagnosing intraductal papillary mucinous neoplasm histologic subtypes.

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“…IPMN can be divided according to its anatomical location as main duct -branch duct-and mixed-IPMN. The histological classification divides IPMN into four main categories: gastric, intestinal, pancreatobiliary and oncocytic type [14]. Both classifications are very important in determining the malignant potential of the disease.…”

Section: Pathologymentioning

confidence: 99%

Endoscopic Ultrasonography in Management of Cystic Disease of the Pancreas

Othman¹,

Patel²,

Raimondo³

2011

New Techniques in Gastrointestinal Endoscopy

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Characteristic Clinicopathological Features of the Types of Intraductal Papillary-Mucinous Neoplasms of the Pancreas

Abstract: Evaluation of the histological types of IPMN may help to predict the clinical course of patients with IPMN and to design improved clinical management for these patients.

Cited by 77 publications

References 5 publications

Stromal thrombospondin-1 expression is a prognostic indicator and a new marker of invasiveness in intraductal papillary-mucinous neoplasm of the pancreas

Stromal thrombospondin-1 expression is a prognostic indicator and a new marker of invasiveness in intraductal papillary-mucinous neoplasm of the pancreas

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

Endoscopic Ultrasonography in Management of Cystic Disease of the Pancreas

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