Department of Surgery, Academic Medical Center, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
Hum Pathol. 2011 Jun;42(6):824-32. doi: 10.1016/j.humpath.2010.09.017. Epub 2011 Feb 2.
Intraductal papillary mucinous neoplasm of the pancreas is a rare but well-established entity in contrast to intraductal papillary mucinous neoplasm of the biliary tract. The aim of this study was to compare the clinicopathologic features of intraductal papillary mucinous neoplasms of the biliary tract and of the pancreas. Twenty patients who underwent resection for intraductal papillary mucinous neoplasm of the biliary tract were compared with 29 cases resected for intraductal papillary mucinous neoplasm of the pancreas. Clinicopathologic characteristics and resection specimens of all patients were reassessed and immunohistochemically screened for expression of a distinct set of tumor markers. Median ages of patients with intraductal papillary mucinous neoplasms of the biliary tract and of the pancreas were 66 and 62 years, respectively (P < .05). Twelve patients with intraductal papillary mucinous neoplasm of the biliary tract (60%) had neoplasms with infiltrating carcinoma, compared with 6 patients with intraductal papillary mucinous neoplasm of the pancreas (21%, P < .05). Cytokeratin 7 and 20 expressions were equal in biliary and pancreatic intraductal papillary mucinous neoplasms. Cytokeratin 20 expression was mainly found in intestinal-type tumors. Gastric, pancreaticobiliary, and oncocytic subtypes were all observed in the intraductal papillary mucinous neoplasm of the biliary tract group. The distribution was significantly different from the intraductal papillary mucinous neoplasm of the pancreas group. The 3-year overall survival rate of malignant biliary and pancreatic intraductal papillary mucinous neoplasm was 63% and 65%, respectively (P = .798). Positive lymph nodes and a high expression of membranous mucin were associated with a significantly shorter overall survival in patients with malignant intraductal papillary mucinous neoplasm. Finally, p53 and Ki67 proliferation index were both associated with the carcinogenesis of intraductal papillary mucinous neoplasm, whereas DPC4 and CDX2 were not. Clinicopathologic features of intraductal papillary mucinous neoplasm of the biliary tract largely resemble those of intraductal papillary mucinous neoplasm of the pancreas, although intraductal papillary mucinous neoplasm of the biliary tract was associated with a higher malignancy rate at the time of surgical treatment. The level of membranous mucin expression and positive lymph nodes are significant prognosticators in patients with malignant intraductal papillary mucinous neoplasm.
胰腺内乳头状黏液性肿瘤是一种罕见但已确立的实体，与胆管内乳头状黏液性肿瘤形成对比。本研究旨在比较胆管内乳头状黏液性肿瘤和胰腺内乳头状黏液性肿瘤的临床病理特征。对 20 例因胆管内乳头状黏液性肿瘤而行切除术的患者与 29 例因胰腺内乳头状黏液性肿瘤而行切除术的患者进行比较。重新评估所有患者的临床病理特征和切除标本，并对其进行一组独特肿瘤标志物的免疫组织化学筛选。胆管内乳头状黏液性肿瘤患者的中位年龄为 66 岁，胰腺内乳头状黏液性肿瘤患者的中位年龄为 62 岁（P <.05）。胆管内乳头状黏液性肿瘤患者中有 12 例（60%）的肿瘤为浸润性癌，而胰腺内乳头状黏液性肿瘤患者中仅有 6 例（21%）（P <.05）。胆管内乳头状黏液性肿瘤和胰腺内乳头状黏液性肿瘤的细胞角蛋白 7 和 20 表达均相等。细胞角蛋白 20 的表达主要见于肠型肿瘤。胆管内乳头状黏液性肿瘤组中观察到胃型、胰胆型和嗜酸细胞型。其分布与胰腺内乳头状黏液性肿瘤组显著不同。恶性胆管和胰腺内乳头状黏液性肿瘤的 3 年总生存率分别为 63%和 65%（P =.798）。淋巴结阳性和膜状黏蛋白高表达与恶性内乳头状黏液性肿瘤患者的总生存率显著缩短相关。最后，p53 和 Ki67 增殖指数均与内乳头状黏液性肿瘤的癌变相关，而 DPC4 和 CDX2 则不然。胆管内乳头状黏液性肿瘤的临床病理特征与胰腺内乳头状黏液性肿瘤大体相似，尽管胆管内乳头状黏液性肿瘤在手术治疗时的恶性程度更高。膜状黏蛋白表达水平和阳性淋巴结是恶性内乳头状黏液性肿瘤患者的重要预后指标。
