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Fundic gland differentiation of oncocytic/pancreatobiliary subtypes of pancreatic intraductal papillary mucinous neoplasm
Author(s) -
Mamat Osman,
Fukumura Yuki,
Saito Tsuyoshi,
Takahashi Michiko,
Mitomi Hiroyuki,
Sai Jin Kan,
Kawasaki Seiji,
Yao Takashi
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.12967
Subject(s) - pathology , immunohistochemistry , mucin 2 , kras , mucin , intraductal papillary mucinous neoplasm , cdx2 , foveolar cell , medicine , histology , cancer , pancreas , biology , gastric mucosa , stomach , colorectal cancer , gene expression , gene , biochemistry , homeobox
Aims Intraductal papillary mucinous neoplasms ( IPMN s) differentiate in several histological directions, which are related to their clinical behaviour. Differentiation of IPMN s to the gastric foveolar epithelium/pyloric gland ( PG ) is well known. However, no study has been conducted regarding fundic gland ( FG ) differentiation. The aim of this study was to determine the frequency of FG differentiation and its relationship with the clinicopathological features of IPMN s, by studying 48 surgically resected IPMN cases consisting of 17 gastric IPMN s, 15 intestinal IPMN s, 10 pancreatobiliary IPMN s, and six oncocytic IPMN s. Methods and results Clinicopathological data, including histological tumour grade, immunohistochemical data for mucins ( MUC s), pepsinogen I, pepsinogen II , and H,K‐ ATP ase, and GNAS / KRAS status, were analysed. Pepsinogen I and H,K‐ ATP ase were used to assess FG differentiation, and pepsinogen II and MUC 6 were used to identify the equivalent cell type of the normal FG . Reverse transcription polymerase chain reaction ( RT ‐ PCR ) for PGA 5 / PGC (pepsinogen I and pepsinogen II mRNA , respectively) and quantitative real‐time RT ‐ PCR ( qRT ‐ PCR ) for PGA 5 were performed to confirm the immunohistochemistry results. Pepsinogen I expression was detected in 12.5% (6/48) of total IPMN s, of which 66.7% (4/6) of oncocytic IPMN s and 20.0% (2/10) of pancreatobiliary IPMN s were pepsinogen I‐positive. No H,K‐ ATP ase‐positive cases were detected. Three oncocytic IPMN s with pepsinogen I expression showed similar histology to normal FG . RT ‐ PCR and qRT ‐ PCR confirmed the immunohistochemical results. All IPMN s with FG differentiation were of the oncocytic or pancreatobiliary subtype, were of histologically high grade, and were without GNAS mutation. Conclusions The differentiation of IPMN s to gastric FG is related to oncocytic and pancreatobiliary subtypes, and to high grade. This is the first report to describe differentiation of IPMN s to the FG , and to reveal its relationship with the clinicopathological features of IPMN s.