Immunohistochemical distinction between intrahepatic cholangiocarcinoma and pancreatic ductal adenocarcinoma

Terry Lok,Hanlin L Wang,Lihong Chen,Fan Lin

doi:10.1016/j.humpath.2013.10.004

Terry Lok, Hanlin L Wang + Show 2 more

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Distinction between primary intrahepatic cholangiocarcinoma (ICC) and metastatic pancreatic ductal adenocarcinoma (PDA) on a liver biopsy is essentially impossible histologically but has important clinical implications. In this study, 41 ICCs and 60 PDAs were immunohistochemically evaluated for the expression of S100P, pVHL, IMP3, maspin, MUC5AC, and CK17 proteins. The results showed pVHL expression in 29 (71%) ICCs but in only 3 (5%) PDAs. S100P, MUC5AC, and CK17 were frequently expressed in PDAs, seen in 57 (95%), 40 (67%), and 36 (60%) cases, respectively. In contrast, only 11 (27%), 5 (12%), and 5 (12%) ICC cases expressed these proteins. IMP3 was expressed in 37 (90%) ICC and 54 (90%) PDA cases with equal frequency. All 60 (100%) PDA and 30 (73%) ICC cases showed positive maspin immunoreactivity. A S100P-/pVHL+/MUC5AC-/CK17- staining pattern was essentially indicative of ICC, whereas the S100P+/pVHL-/MUC5AC+/CK17+ and S100P+/pVHL-/MUC5AC-/CK17+ staining patterns were suggestive of PDA. These observations demonstrate that S100P, pVHL, MUC5AC, and CK17 are a useful immunohistochemical panel that may help distinguish primary ICC from metastatic PDA.

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Distinction between primary intrahepatic cholangiocarcinoma (ICC) and metastatic pancreatic ductal adenocarcinoma (PDA) on a liver biopsy is essentially impossible histologically
We have recently established the diagnostic value of S100P, the von Hippel-Lindau gene product, insulin-like growth factor-II messenger RNA-binding protein-3 (IMP3), and mammary serine protease inhibitor for PDA, gallbladder adenocarcinoma, and adenocarcinoma of the extrahepatic bile ducts [4,5,6,7,8,9,10]
Immunohistochemical expression of MUC5AC and cytokeratin 17 (CK17) proteins in adenocarcinomas of the pancreas, gallbladder, and bile ducts has been examined in several studies [11,12,13,14,15,16], but their use in the distinction between ICC and PDA has not been investigated

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Distinction between primary intrahepatic cholangiocarcinoma (ICC) and metastatic pancreatic ductal adenocarcinoma (PDA) on a liver biopsy is essentially impossible histologically. We have recently established the diagnostic value of S100P, the von Hippel-Lindau gene product (pVHL), insulin-like growth factor-II messenger RNA-binding protein-3 (IMP3), and mammary serine protease inhibitor (maspin) for PDA, gallbladder adenocarcinoma, and adenocarcinoma of the extrahepatic bile ducts [4,5,6,7,8,9,10] These studies demonstrated that these biomarkers constitute a useful diagnostic immunohistochemical panel for confirming the diagnosis of adenocarcinoma in difficult cases, which can be helpful in the distinction from normal or reactive epithelium of the pancreas, gallbladder, and extrahepatic bile ducts in surgical, biopsy, and fine-needle aspiration specimens. Immunohistochemical expression of MUC5AC and cytokeratin 17 (CK17) proteins in adenocarcinomas of the pancreas, gallbladder, and bile ducts has been examined in several studies [11,12,13,14,15,16], but their use in the distinction between ICC and PDA has not been investigated

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