Immunocytochemical detection of p53 protein as an adjunct in cytologic diagnosis from pancreatic duct brushings in mucin-producing tumors of the pancreas

Abstract

In cases of mucin-producing tumor (MPT) of the pancreas, a new clinical entity of pancreatic tumor, it has been reported to be difficult to distinguish adenoma from carcinoma preoperatively. This observation caused the authors to develop a new method of p53 immunocytochemistry using cytologic samples obtained by endoscopic retrograde pancreatic duct brushing (ERPDB). Fifteen cases of MPT (9 with carcinoma and 6 with adenoma) were examined. In all cases, histologic diagnosis was determined by surgery or autopsy. A wire with a small brush was pushed into the dilatated pancreatic duct detected by endoscopic retrograde pancreatography (ERP). Specimens obtained by brushing were prepared on slides and subsequently fixed with ethanol. Papanicolaou staining and p53 immunocytochemistry were performed simultaneously. The ability of conventional cytology to distinguish adenoma from carcinoma was compared with that of p53 immunocytochemistry. Five of 9 cases (56%) with carcinoma of MPT were correctly diagnosed by Papanicolaou staining. Two of four cases, classified as benign by Papanicolaou staining, expressed p53 protein. Overall, 7 of 9 cases (78%) with carcinoma MPT were correctly diagnosed by Papanicolaou staining associated with p53 immunocytochemistry. In the cases with adenoma MPT, all cases were classified as benign by Papanicolaou staining and no case positive for p53 protein was encountered. These results suggest that p53 immunocytochemistry as an adjunct in cytologic diagnosis using ERPDB may contribute to differentiating adenoma from carcinoma MPT of the pancreas preoperatively.