Cytokeratin 20 (CK20) and apomucin 1 (MUC1) expression in ampullary carcinoma: Correlation with tumor progression and prognosis

Yasunari Kawabata,Takeshi Nishi,Touko Inao,Seiji Yano,Takashi Nishisaka,Tsuneo Tanaka

doi:10.1186/1746-1596-5-75

Yasunari Kawabata, Takeshi Nishi + Show 4 more

Open Access

https://doi.org/10.1186/1746-1596-5-75

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Abstract

BackgroundWe assessed the expression of cytokeratin (CK) and apomucin (MUC) in ampullary carcinoma (AC) to develop a system for the classification of ACs on the basis of their clinical significance.MethodWe studied the expressions of CK7, CK20, MUC1, MUC2, MUC5AC, and MUC6 in 43 patients with ACs. Clinical data were obtained retrospectively by examining surgically resected ACs of the patients.ResultsWe classified the cases into 3 groups: tumors expressing CK20 and lacking MUC1 (intestinal type [I-type], 26%), tumors expressing MUC1 and lacking CK20 (pancreatobiliary type [PB-type], 35%), and those expressing or lacking both CK20 and MUC1 (other type [O-type], 39%). Eight (73%) of 11 I-type carcinomas, 3 (20%) of 15 PB-type carcinomas, and 4 (24%) of 17 O-type carcinomas were classified as pT1. The number of I-type carcinomas in the early tumor stages was significantly higher than the number of PB- and O-type carcinomas (p = 0.014 and p = 0.018, respectively). The 5-year survival rates for pT1, pT2, and pT3 tumors were 76%, 33%, and 22%, respectively (p < 0.001). Rates of MUC5AC and MUC6 coexpression for I-type, PB-type, and O-type tumors were 18%, 13%, and 53%, respectively. There was a significant correlation between MUC5AC and MUC6 coexpression and O-type characteristics (p = 0.031). The five-year survival rates for O-type ACs with and without MUC5AC and MUC6 coexpression were 71% and 17%, respectively (p = 0.048).ConclusionsThe immunohistochemical subtypes based on CK and MUC expression correlated with tumor progression. Gastric MUC5AC and MUC6 coexpression correlated with better prognosis for O-type ACs.

Highlights

We assessed the expression of cytokeratin (CK) and apomucin (MUC) in ampullary carcinoma (AC) to develop a system for the classification of Ampullary carcinomas (ACs) on the basis of their clinical significance
We evaluated the immunohistochemical subtypes of ACs by analyzing the expressions of CK7, CK20, MUC1, MUC2, MUC5AC, and MUC6 in these tumors
In the assessment according to the histological criteria proposed by Albores-Saavedra et al.,[4] we found 16 (37%) tumors to be intestinal-type carcinomas, 18 (42%) to be pancreatobiliary-type carcinomas, and 9 (21%) to be unusual-type carcinomas (Table 1)

Summary

Introduction

We assessed the expression of cytokeratin (CK) and apomucin (MUC) in ampullary carcinoma (AC) to develop a system for the classification of ACs on the basis of their clinical significance. Ampullary carcinomas (ACs), uncommon, have a better prognosis than other periampullary tumors such as pancreatic and bile duct carcinomas. The ampulla is formed by the union of 2 distinct types of mucosa. The Ad is covered by intestinal mucosa, while the other parts of the ampulla of Vater (the Ap, Ab, and Ac) are lined with pancreatobiliary-type ductal mucosa [2,3]. ACs may arise from the intestinal-type mucosa as well as from the pancreatobiliary-type mucosa; Kimura et al classified ACs into 2 histological subtypes: intestinal and pancreatobiliary[3]. Albores-Saavedra et al further defined the characteristics of these 2 types and described unusual types such as signet-ring cell carcinoma and undifferentiated carcinoma[4]

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