Kulkarni Maithili Mandar, Khandeparkar Siddhi Gaurish Sinai, Joshi Avinash R, Kakade Aniket, Fegade Lokesh, Narkhede Ketan
Associate Professor, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India.
Professor, Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India.
J Clin Diagn Res. 2017 May;11(5):EC17-EC20. doi: 10.7860/JCDR/2017/26842.9830. Epub 2017 May 1.
The ampulla of Vater consists of papilla, common channel, distal common bile duct and the distal main pancreatic duct. Ampullary carcinomas arise from two different types of mucosa, reflecting their broad histomorphological spectrum. Adenocarcinomas originating in the ampulla of Vater are classified as having either 'Intestinal' or 'Pancreatobiliary' type of differentiation. Pancreatobiliary type has consistently shown a worse prognosis. Various types of mucins are distributed in normal tissues and gastrointestinal tumours. MUC1, MUC2 and MUC5AC are known to be the most important amongst all.
To study clinicopathological features of different types of carcinoma of ampulla with MUC1, MUC2 and MUC5AC expression.
We included 20 cases of ampullary adenocarcinoma in this study, diagnosed after radical surgery. The histopathological slides were reviewed and the tumours were classified into intestinal type, pancreatobilliary and other types. Representative block of tumours was subjected to immunohistochemical (IHC) study with MUC1, MUC2 and MUC5AC antibodies. Results were subsequently analysed.
Pancreaticobiliary type of ampullary carcinoma cases predominated (50%) over intestinal type (25%). Carcinomas of "other types" included one case each of mucinous carcinoma, adenosquamous carcinoma and undifferentiated carcinoma and well differentiated neuroendocrine tumours. Pancreatobiliary type of carcinomas was associated with higher tumour stage and grade and lymph node metastasis. All the pancreatobiliary type expressed MUC1 and all intestinal type carcinomas expressed MUC2. MUC 5AC expression was seen predominantly in pancreatobiliary type of ampullary carcinomas.
Mucin markers are associated with two different subtypes of ampullary carcinomas which have different prognosis. Immunohistochemical study of mucin expression can define the different types of carcinomas of ampulla of Vater with better objective criteria.
壶腹由乳头、共同通道、胆总管远端和主胰管远端组成。壶腹癌起源于两种不同类型的黏膜，这反映了其广泛的组织形态学谱。起源于壶腹的腺癌分为具有“肠型”或“胰胆管型”分化。胰胆管型的预后一直较差。各种类型的黏蛋白分布于正常组织和胃肠道肿瘤中。已知MUC1、MUC2和MUC5AC是其中最重要的。
研究不同类型壶腹癌中MUC1、MUC2和MUC5AC表达的临床病理特征。
本研究纳入20例壶腹腺癌病例，均为根治性手术后确诊。复习组织病理学切片，将肿瘤分为肠型、胰胆管型和其他类型。取肿瘤代表性组织块，用MUC1、MUC2和MUC5AC抗体进行免疫组织化学（IHC）研究。随后对结果进行分析。
胰胆管型壶腹癌病例（50%）多于肠型（25%）。“其他类型”的癌包括黏液腺癌、腺鳞癌、未分化癌各1例以及高分化神经内分泌肿瘤。胰胆管型癌与更高的肿瘤分期、分级及淋巴结转移相关。所有胰胆管型均表达MUC1，所有肠型癌均表达MUC2。MUC 5AC表达主要见于胰胆管型壶腹癌。
黏蛋白标志物与两种预后不同的壶腹癌亚型相关。黏蛋白表达的免疫组织化学研究可以用更好的客观标准来界定不同类型的 Vater 壶腹癌。
