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Albumin expression distinguishes bile duct adenomas from metastatic adenocarcinoma
Author(s) -
Moy Andrea P,
Arora Kshitij,
Deshpande Vikram
Publication year - 2016
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.12942
Subject(s) - bile duct , adenocarcinoma , immunohistochemistry , pathology , pancreatic duct , medicine , adenoma , pancreas , gastroenterology , cancer
Aims Bile duct adenomas may be difficult to distinguish from metastatic carcinomas, particularly well‐differentiated pancreatic ductal adenocarcinoma. Prior studies have evaluated the utility of various immunohistochemical markers, although these markers are notable for low sensitivity and/or specificity. The aim of this study was to investigate the utility of albumin and BRAFV 600E expression in distinguishing between metastatic pancreatic adenocarcinoma and bile duct adenoma. Methods and results We studied 26 bile duct adenomas, three bile duct hamartomas, and 158 pancreatic ductal adenocarcinomas. Branched‐chain in‐situ hybridization ( bISH ) for albumin was performed; bISH is based on the branched DNA technology, wherein signal amplification is achieved via a series of sequential steps. Additionally, BRAFV 600E immunohistochemistry ( IHC ) was performed on a subset of cases. Twenty‐three of 25 (92%) bile duct adenomas were positive for albumin; 18 (72%) showed diffuse staining, and five showed focal staining (20%), including two challenging examples. Two bile duct hamartomas also stained positively. All pancreatic adenocarcinomas were negative for albumin. Seven of 16 (44%) bile duct adenomas and five of 106 (5%) pancreatic ductal adenocarcinomas were positive for BRAFV 600E by IHC . The sensitivity and specificity of expression of albumin, as detected by bISH , for distinguishing bile duct adenomas from metastatic pancreatic adenocarcinomas were 92% and 100%, respectively; the sensitivity and specificity of BRAFV 600E IHC for distinguishing bile duct adenomas from metastatic pancreatic adenocarcinomas were 43.8% and 95.3%, respectively. Conclusions Diagnostically challenging examples of bile duct adenoma may be distinguished from metastatic pancreatic adenocarcinoma by the use of albumin bISH .