First Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan.
Hepatobiliary Pancreat Dis Int. 2012 Aug 15;11(4):424-8. doi: 10.1016/s1499-3872(12)60202-1.
Although invasive ductal adenocarcinoma of the pancreas (PDAC) manifests as a relatively uniform histomorphological feature of the pancreatobiliary type, it may be complicated by metaplastic changes and heterogeneous gastric and intestinal elements. This study aimed to investigate the complication rate and clinicopathological significance of such heterogeneous elements.
Fifty-nine patients who underwent resection of PDAC were examined in this study. Immunohistochemically, tumors showing high expression (>25%) of the intestinal-type (INT) marker CDX2 were classified as PDAC with INT. Those with high expression (>25%) of the gastric-type (GAS) marker MUC5AC were classified as PDAC with GAS, while those with high expression of both markers were classified as PDAC with INT/GAS. These patients were compared with those with PDAC of the negative group in which neither markers was highly expressed to examine their clinicopathological significance.
In the 59 patients, 31 (52.5%) showed high CDX2 or MUC5AC expression. Twenty-eight patients (47.5%) belonged to a negative group, 11 (18.6%) to a PDAC with INT group, 15 (25.4%) to a PDAC with GAS group, and 5 (8.5%) to a PDAC with INT/GAS group. No significant differences were observed for age, gender, size, localization, T classification, or prognosis among the four groups. Although the PDAC with GAS group had well differentiated types significantly more than the other groups, the rate of lymph node metastasis in this group was significantly higher (PDAC with GAS: 73%; other groups: 36%).
Complications with heterogeneous elements are not uncommon in PDAC, and this should be considered during the diagnosis and treatment of PDAC along with histogenesis of the disease.
尽管胰腺浸润性导管腺癌（PDAC）表现出相对统一的胰胆管型组织形态学特征，但它可能伴有化生改变和异质性胃和肠上皮成分。本研究旨在探讨这种异质性成分的发生率和临床病理意义。
本研究纳入 59 例行 PDAC 切除术的患者。免疫组化结果显示，肠型（INT）标志物 CDX2 高表达（>25%）的肿瘤被归类为具有 INT 的 PDAC；胃型（GAS）标志物 MUC5AC 高表达（>25%）的肿瘤被归类为具有 GAS 的 PDAC；同时高表达两种标志物的肿瘤被归类为具有 INT/GAS 的 PDAC。将这些患者与两种标志物均未高表达的 PDAC 阴性组患者进行比较，以研究其临床病理意义。
在 59 例患者中，31 例（52.5%）CDX2 或 MUC5AC 高表达。28 例（47.5%）患者属于阴性组，11 例（18.6%）患者属于具有 INT 的 PDAC 组，15 例（25.4%）患者属于具有 GAS 的 PDAC 组，5 例（8.5%）患者属于具有 INT/GAS 的 PDAC 组。四组患者的年龄、性别、肿瘤大小、部位、T 分期或预后无显著差异。虽然具有 GAS 的 PDAC 组具有分化较好的组织学类型的比例显著高于其他组，但该组的淋巴结转移率显著较高（具有 GAS 的 PDAC：73%；其他组：36%）。
PDAC 中伴有异质性成分并不罕见，在诊断和治疗 PDAC 时应考虑到这一点，同时还应考虑疾病的组织发生。
