[Diagnosis and differential diagnosis of intraductal papillary mucinous neoplasm of pancreas].
OBJECTIVE
To study the clinicopathologic features of intraductal papillary mucinous neoplasm (IPMN) and its distinction from mucinous cystic neoplasm of pancreas.


METHODS
The clinical, radiologic and histologic features of 17 cases of IPMN and 13 cases of mucinous cystic neoplasm (MCN) were reviewed. Mucin profiles (MUC1, MUC2 and MUC5AC) were studied by histology (HE) and immunohistochemistry (EnVision).


RESULTS
10 of the 17 cases of IPMN were males. 13 cases of the IPMN were located in head of pancreas. Communication with the main pancreatic duct was demonstrated in 15 cases. Histologically, there were mild to severe papillary ingrowths of dysplastic epithelial cells, associated with intervening normal or atrophic pancreatic parenchyma. Ovarian-like stroma was not seen. Ancillary investigations showed that MUC2 and MUC5AC were detected in tumor cells of 9 and 4 cases respectively. The 4 cases with invasive component showed MUC1 positivity. On the other hand, 11 of the 13 cases of MCN occurred in middle-aged to elderly females and were located in the body and tail of pancreas. Ovarian-like stroma was commonly seen and there was no connection with the main pancreatic duct. All non-invasive MCN, regardless of the degree of cytologic atypia, were positive for MUC5AC (but not MUC2). In the 2 cases with invasive component, MUC1 expression was observed, as in IPMN.


CONCLUSIONS
The age and sex of patients, tumor location, absence of ovarian-like stroma, communication with main pancreatic duct and characteristic mucin profiles represent useful parameters in distinguishing IPMN from MCN of pancreas. The tumor cells of IPMN express mainly MUC2, while those of MCN express MUC5AC. MUC1 may also be a useful marker in demonstration of stromal invasion in these tumors.
Ji
Yuan
Y
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China. yji@zshospital.com
Tan
Yun-shan
YS
Zhu
Xiong-zeng
XZ
Zeng
Hai-ying
HY
Kuang
Tian-tao
TT
Jin
Da-yong
DY
D000328:Adult; D000367:Age Factors; D000368:Aged; D000951:Antigens, Neoplasm / Q000378:metabolism*; D014408:Biomarkers, Tumor / Q000378:metabolism; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D018282:Cystadenocarcinoma, Mucinous / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D018291:Cystadenoma, Mucinous / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055271:Mucin 5AC; D018396:Mucin-1; D055262:Mucin-2; D009077:Mucins / Q000378:metabolism*; D010179:Pancreas / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D011230:Precancerous Conditions / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D012737:Sex Factors
D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C060192:MUC1 protein, human; C524625:MUC2 protein, human; C524678:MUC5AC protein, human; D055271:Mucin 5AC; D018396:Mucin-1; D055262:Mucin-2; D009077:Mucins