Papillary cystic tumors of the pancreas assessment of their malignant potential

Abstract

Background. Although the biologic characteristics of papillary cystic tumors (PCT) generally indicate a good prognosis, a malignant form has been reported. Methods. Twenty‐two examples of PCT were examined to assess their malignant potential by histologic, flow cytometric, and immunohistochemical studies. Results. Three had hepatic, peritoneal, and/or lymph node metastases (metastasizing tumors [MT]); the other 19 PCT had no such metastatic features (nonmetastasizing tumors [NMT]). Venous invasion was detected in all three MT and two NMT. Compared with the 19 NMT, the MT had a higher nuclear grade and more prominent necrobiotic nests characterized by aggregates of cells with pyknotic nuclei and eosinophilic cytoplasm. In the flow cytometric analysis of cellular DNA content, one MT was aneuploid, and eight NMT were diploid. Immunohistochemically, there was no difference between the MT and NMT. Conclusions. These results support the assumption that venous invasion, nuclear grade, and prominent necrobiotic nests are useful as histologic parameters to detect the malignant potential of PCT. Cancer 1993; 71:82‐92.

Array comparative genomic hybridization analysis of solid pseudopapillary neoplasms of the pancreas

“…[1][2][3][4][5][6] Attempts to separate aggressive from non-aggressive solid pseudopapillary neoplasms based on histologic criteria (such as vascular invasion, necrosis, increased mitotic rate, high nuclear grade) and size has yielded contradictory results with reports of histologically bland solid pseudopapillary neoplasms that have metastasized and histologically malignant solid pseudopapillary neoplasms with indolent outcomes. 4,7,8 Using morphologic features to predict the biological behavior of solid pseudopapillary neoplasms has limitations and is a major obstacle in stratifying patients into low-and highrisk groups as has been observed for other lesions, such as pheochromocytomas and neuroendocrine tumors.…”

“…Both aneuploid and diploid tumors have been detected by flow cytometry. 3,6,[8][9][10][11] Various chromosomal abnormalities have also been reported, primarily using cytogenetic techniques. [12][13][14][15][16] Two studies using comparative genomic hybridization (CGH) found no chromosomal gains or losses, 11,17 while in another study of one case using the more sensitive array CGH technique, two alterations were detected: loss of heterozygosity for HRAS in chromosome band 11p15.5 and a less significant loss of the short arm of chromosome 16.…”

Deregulated Expression of Cell Cycle–Associated Proteins in Solid Pseudopapillary Tumor of the Pancreas

“…Two tumors with metastatic disease were DNA aneuploid (3,4). However, the small number of patients does not allow a definitive conclusion on the prognostic validity of DNA cytometry.…”

“…Flow cytometric analyses have shown that most tumors are diploid (3,8,44), although focal aneuploidy may be found after extensive sampling (44). Two tumors with metastatic disease were DNA aneuploid (3,4).…”

“…After complete tumor resection, more than 95% of the patients are cured (1). In malignant behavior, metastases occur most often in the liver (2)(3)(4)(5)(6)(7). Only a few patients have died of metastatic disease (reviewed in Solcia et al (1)).…”