Farzaneh Ted, Nowroozizadeh Behdokht, Han Min, Lee Whayoung
Department of Pathology, University of California, Irvine, Orange, California, USA.
Acta Cytol. 2021;65(3):250-256. doi: 10.1159/000515446. Epub 2021 Apr 22.
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm. Diagnosis of SPN requires an integrated approach with aid of radiology, biopsy, cytology, and immunohistochemical stains. Although morphological features in combination with nuclear positivity of β-catenin IHC have been the gold standard of SPN diagnosis, but overlapping morphology and immunohistochemical findings with other entities in differential diagnoses such as pancreatic neuroendocrine tumors and pancreatic ductal adenocarcinoma make the diagnosis of SPN difficult particularly in limited cytology specimens. Lymphoid enhancer-binding factor 1 (LEF1), a key player in the Wnt signaling pathway, has shown promising diagnostic utility in SPN in recent literatures.
In this retrospective study, we evaluated the diagnostic utility of LEF1 IHC in SPN in cytology specimens. LEF1 IHC was performed and compared with β-catenin, synaptophysin, and chromogranin immunostains in 13 SPN and 23 pancreatic neuroendocrine tumors (PanNETs) cytology cases with retrievable cell blocks.
LEF1 was positive in 13 of 13 (100%) SPNs and was negative in all PanNETs (0%).
LEF1 shows 100% sensitivity and specificity in cytology specimens for SPN and can be valuable immuno-stain in the diagnosis of SPN in cytology cell blocks.
胰腺实性假乳头状肿瘤（SPN）是一种罕见肿瘤。SPN的诊断需要借助放射学、活检、细胞学及免疫组化染色等综合方法。尽管形态学特征结合β-连环蛋白免疫组化的核阳性一直是SPN诊断的金标准，但在鉴别诊断中，如胰腺神经内分泌肿瘤和胰腺导管腺癌，其形态学和免疫组化结果与其他实体存在重叠，这使得SPN的诊断变得困难，尤其是在有限的细胞学标本中。淋巴样增强因子1（LEF1）是Wnt信号通路中的关键因子，近期文献显示其在SPN诊断中具有良好的应用前景。
在这项回顾性研究中，我们评估了LEF1免疫组化在细胞学标本中对SPN的诊断价值。对13例SPN和23例胰腺神经内分泌肿瘤（PanNETs）的细胞学病例进行了LEF1免疫组化检测，并与β-连环蛋白、突触素和嗜铬粒蛋白免疫染色进行比较，这些病例均有可获取的细胞块。
13例SPN中13例（100%）LEF1呈阳性，所有PanNETs均为阴性（0%）。
LEF1在细胞学标本中对SPN具有100%的敏感性和特异性，可作为细胞学细胞块中SPN诊断的有价值免疫染色。
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