Potential usefulness of mucin immunohistochemical staining of preoperative pancreatic biopsy or juice cytology specimens in the determination of treatment strategies for intraductal papillary mucinous neoplasm

Abstract

We classified resected intraductal papillary mucinous neoplasms (IPMNs) into four subtypes (gastric, intestinal, pancreatobiliary and oncocytic) according to their morphological features and mucin expression, determined their clinicopathological characteristics and investigated the possibility of preoperatively diagnosing these subtypes. Sixty resected tumors, 4 preoperative tumor biopsies and 10 preoperative pancreatic juice cytology specimens were analyzed. The gastric and intestinal types accounted for the majority of IPMNs. Non-gastric type IPMNs were of high-grade malignancy. Many of the pancreatobiliary-type IPMNs were in an advanced stage and were associated with a poor prognosis. The results of mucin immunohistochemical staining of preoperative biopsy and surgically resected specimens were in agreement with each other, and in close agreement with those for pancreatic juice cytology specimens obtained from 10 patients during endoscopic retrograde cholangiopancreatography (ERCP). The immunostaining of preoperative biopsy specimens and ERCP-obtained pancreatic juice cytology specimens may be useful in the differential diagnosis of gastric and intestinal types of IPMN. If such techniques enable the preoperative diagnosis of IPMN subtypes, their use in combination with conventional preoperative imaging modalities may lead to surgical treatment best suited for the biological characteristics of the four subtypes.

Expression of Matrix Metalloproteinases in Intraductal Papillary Mucinous Neoplasm of the Pancreas

“…In this study, we found that there was almost no MMP expression in normal pancreatic duct epithelium, but expression began to appear in low-grade dysplasia, the first stage of tumor development, and the level of expression increased according to histological grade, suggesting that MMPs may be involved in tumorigenesis and progression of IPMN. Clinicohistopathological differences between the histological subtypes of IPMN have been reported (3)(4)(5), and their characteristics are broadly understood. However, few studies have addressed differences at the molecular level between subtypes.…”

“…Histologically, IPMN includes variable grades of dysplasia. When IPMN is diagnosed at the stage of low-grade to high-grade dysplasia, its treatment by resection offers an extremely good prognosis; however, once it has progressed to IPMN-derived invasive carcinoma (IPMC), its prognosis is poor (2,3). The classifications according to epithelial morphology and mucus traits have recently been reported to have clinicopathological significance (4,5).…”

Intraductal papillary mucinous neoplasm of the pancreas: Cytomorphology, imaging, molecular profile, and prognosis

“…The mucin expression profile shows more than 80% positivity for MUC2 and MUC5AC in IPMNs, which is usually negative in ductal adenocarcinoma. MUC1 is expressed in more than 95% of ductal adenocarcinoma cases 53 …”

Malignant transformation and overall survival of morphological subtypes of intraductal papillary mucinous neoplasms of the pancreas: A network meta-analysis

“…The remaining 218 articles were retrieved for full-text review, from which 199 were excluded: 172 not containing morphological data, 15 not including the whole histologic grades (for example, studies only included invasive IPMNs), 10 not having corresponding message between morphological subtypes and histologic grading and 2 duplicates. Finally, 19 studies including 1954 patients who met the inclusion criteria and were included in the meta-analysis [20][21][22][23]27,[36][37][38][39][40][41][42][43][44][45][46][47][48][49].…”

“…7 of 19 studies were involved into the network comparison of overall survival [20,21,27,[36][37][38][39], including 781 patients. By pooling HRs for each subtype with the gastric subtype as baseline subtype, the results found no significant disadvantage of overall survival in intestinal and oncocytic subtype despite of a trend indicating an overall survival benefit of gastric subtype (HR = 1.90, 95% CrI: 0 · 59-4.58 and HR = 3.29, (Fig.…”