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Krishnamurthy K, Sriganeshan V. Pancreatic Intraepithelial Neoplasia (PanIN) as a Morphologic Marker of Pancreatobiliary Type of Ampullary Carcinoma. Pathol Oncol Res 2020; 26:1735-1739. [PMID: 31642034 DOI: 10.1007/s12253-019-00754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/22/2019] [Indexed: 11/24/2022]
Abstract
The classification of ampullary adenocarcinoma into intestinal and pancreatobiliary sub-types has been found to be important in predicting prognosis and determining therapeutic strategy. Due to considerable inter-observer variability in sub-typing based solely on morphology, higher frequency of poorly differentiated cancers and low incidence of the disease, the histomorphologic classification of ampullary adenocarcinoma remains one of the grey zones in surgical pathology. Pan-IN is a well recognized precursor to pancreatic adenocarcinoma. Three studies have shown concurrent Pan-IN in patients with ampullary carcinoma, but their association with the two sub-types has not yet been reported. Fourteen cases of surgical resection for ampullary adenocarcinoma were retrieved from the archives. The cases were classified into two groups based on the presence or absence of concomitant Pan-IN. All the cases were stained for CK7, CK 20, Villin and CDX 2 and were classified as intestinal or pancreatobiliary types based on the staining pattern. All the 10 cases with Pan-IN stained negative for CDX2 and were classified as pancreatobiliary type (p = 0.01). Of the cases without Pan-IN, 3 were classified as intestinal sub-type based on morphology and CDX2 positivity and 1 was classified as pancreatobiliary type. Concomitant Pan-IN was present in 91% of pancreatobiliary type of ampullary adenocarcinoma. The grade of Pan-IN did not influence the grade or stage of the adenocarcinoma (p > 0.05). The co-occurrence of Pan-IN in a high percentage of the pancreatobiliary sub-type and its complete absence in the intestinal sub-type may serve as a strong differentiator between the two sub-types.
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Affiliation(s)
- Kritika Krishnamurthy
- Arkadi M Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, 4300 Alton road, Suite 2400, Miami Beach, FL, 33140, USA.
| | - Vathany Sriganeshan
- Arkadi M Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, 4300 Alton road, Suite 2400, Miami Beach, FL, 33140, USA
- FIU Herbert Wertheim college of Medicine, Miami, FL, USA
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Jun SY, An S, Sung YN, Park Y, Lee JH, Hwang DW, Hong SM. Clinicopathologic and Prognostic Significance of Gallbladder and Cystic Duct Invasion in Distal Bile Duct Carcinoma. Arch Pathol Lab Med 2019; 144:755-763. [DOI: 10.5858/arpa.2019-0218-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
The roles of the gallbladder and cystic duct (CD) invasions in distal bile duct carcinoma (DBDC) have not been well elucidated.
Objective.—
To define the characteristics and prognostic significance of gallbladder or CD invasions in patients with DBDC.
Design.—
Organ invasion patterns with clinicopathologic features were assessed in 258 resected DBDCs.
Results.—
CD invasions (N = 31) were associated with frequent concomitant pancreatic and/or duodenal invasions (23 of 31, 74%) and showed stromal infiltration (16 of 31, 52%) and intraductal cancerization (15 of 31, 48%) patterns. In only 2 cases, invasions with intraductal cancerization were observed in the gallbladder neck. Conversely, all pancreatic (N = 175) and duodenal (83) invasions developed through stromal infiltration. CD invasions were associated with larger tumor size (P = .001), bile duct margin positivity (P = .001), perineural invasions (P = .04), and higher N categories (P = .007). Patients with pancreatic or duodenal invasions had significantly lower survival rates than those without pancreatic (median, 31.0 versus 93.9 months) or duodenal (27.5 versus 56.8 months, P < .001, both) invasions. However, those with gallbladder or CD invasions did not have different survival times (P = .13). Patients with concomitant gallbladder/CD and pancreatic/duodenal invasions demonstrated significantly lower survival rates than those without organ invasions (P < .001).
Conclusions.—
Gallbladder invasions were rare in DBDCs as neck invasions with intraductal cancerization. CD invasions occurred by stromal infiltrations and intraductal cancerization, whereas all pancreatic and duodenal invasions had stromal infiltration patterns. Gallbladder and/or CD invasions did not affect survival rates of patients with DBDC, while pancreatic and duodenal invasions affected survival rates. Therefore, these differences in survival rates may originate from the different invasive patterns of DBDCs.
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Affiliation(s)
- Sun-Young Jun
- From the Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Drs Jun and An); and the Departments of Pathology (Drs Sung and Hong) and Surgery (Drs Park, Lee, and Hwang), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soyeon An
- From the Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Drs Jun and An); and the Departments of Pathology (Drs Sung and Hong) and Surgery (Drs Park, Lee, and Hwang), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You-Na Sung
- From the Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Drs Jun and An); and the Departments of Pathology (Drs Sung and Hong) and Surgery (Drs Park, Lee, and Hwang), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yejong Park
- From the Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Drs Jun and An); and the Departments of Pathology (Drs Sung and Hong) and Surgery (Drs Park, Lee, and Hwang), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Lee
- From the Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Drs Jun and An); and the Departments of Pathology (Drs Sung and Hong) and Surgery (Drs Park, Lee, and Hwang), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae Wook Hwang
- From the Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Drs Jun and An); and the Departments of Pathology (Drs Sung and Hong) and Surgery (Drs Park, Lee, and Hwang), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Mo Hong
- From the Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Drs Jun and An); and the Departments of Pathology (Drs Sung and Hong) and Surgery (Drs Park, Lee, and Hwang), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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