title: Increasing expression of gastrointestinal phenotypes and p53 along with histologic progression of intraductal papillary neoplasia of the liver.
abstract: Intraductal papillary neoplasia of the liver (IPN-L) was recently proposed as the name for intraductal papillary proliferation of neoplastic biliary epithelium with a fine fibrovascular stalk resembling intraductal papillary mucinous neoplasm of the pancreas. We histochemically and immunohistochemically examined IPN-L alone or associated with hepatolithiasis, with an emphasis on the gastrointestinal metaplasia, nuclear p53 expression, and histologic progression. A total of 66 cases of IPN-L were divided into 4 groups: group 1, IPN-L with low-grade dysplasia (13 cases); group 2, IPN-L with high-grade dysplasia (20 cases); group 3, IPN-L lined with carcinoma in situ and no or microinvasion (19 cases); and group 4, group 3 with distinct invasive carcinoma (14 cases). It is suggested that IPN-L progresses from group 1 to group 4. As controls, 20 cases of nonneoplastic intrahepatic large bile ducts and 17 cases of nonpapillary invasive intrahepatic cholangiocarcinoma (ICC) were used. Biliary epithelial hypersecretion of sialomucin rather than sulfomucin was prevalent in IPN-L, and this was associated with the progression of INP-L. Immunohistochemically, cytokeratin (CK) 20 and MUC2, a gastrointestinal marker, were expressed more frequently in IPN-L than in nonneoplastic bile ducts and nonpapillary ICC (P <0.01), and their incidence were significantly increased in parallel with the progression of IPN-L (P < 0.01). In contrast, expression of CK 7, a biliary marker, was decreased in IPN-L compared with nonpapillary ICC. Nuclear p53 immunostaining was detected in 30% of IPN-L as a whole and increased in tandem with the progression of IPN-L (P < 0.01). It is suggested that IPN-L forms a spectrum of biliary epithelial neoplasia with frequent gastrointestinal metaplasia, different from the usual nonpapillary ICC, and shows stepwise progression from the perspective of mucin profile, gastrointestinal metaplasia, and p53 nuclear expression.
authors.affiliation: Department of Pathology (II), Kanazawa University School of Medicine, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Shimonishi
authors.forename: Yoh
authors.initials: Y
authors.lastname: Zen
authors.forename: Tse-Ching
authors.initials: TC
authors.lastname: Chen
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
authors.forename: Yi-Yin
authors.initials: YY
authors.lastname: Jan
authors.forename: Ta-Sen
authors.initials: TS
authors.lastname: Yeh
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000378:metabolism* / Q000473:pathology*; D002467:Cell Nucleus / Q000378:metabolism / Q000473:pathology; D018281:Cholangiocarcinoma / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D053552:Keratin-7; D007633:Keratins / Q000378:metabolism; D020347:Lithiasis / Q000150:complications / Q000473:pathology; D008107:Liver Diseases / Q000150:complications / Q000473:pathology; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism; D010641:Phenotype; D011230:Precancerous Conditions / Q000378:metabolism / Q000473:pathology; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism*
chemical_list: C507497:KRT7 protein, human; D053552:Keratin-7; D009077:Mucins; D016159:Tumor Suppressor Protein p53; D007633:Keratins