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Intraductal Papillary Mucinous Neoplasms Often Contain Epithelium From Multiple Subtypes and/or Are Unclassifiable.
Am J Surg Pathol 2016; 40(1):44-50AJ

Abstract

Pancreatic intraductal papillary mucinous neoplasms (IPMNs) are subclassified into gastric, intestinal, pancreatobiliary, and oncocytic subtypes based on histologic features. The WHO classification scheme suggests use of immunohistochemical stains to help subtype IPMNs with ambiguous histology. Seventy-two pancreatic IPMN resections between 2008 and 2014 were retrospectively evaluated. Immunohistochemistry for CDX2, MUC2, and MUC5AC was performed on cases where the histologic subtype could not be determined on routine hematoxylin and eosin (H&E) sections. There were 41 gastric (57%), 8 intestinal (11%), 4 pancreatobiliary (6%), and 1 oncocytic (1%) IPMNs. Eighteen (25%) IPMNs were either unclassifiable due ambiguous morphology or contained distinct epithelium from >1 subtype (i.e., "mixed"). Two IPMNs initially unclassifiable strictly by H&E morphology were definitively classified as intestinal after positive immunohistochemical staining with CDX2, MUC2, and MUC5AC. Immunohistochemistry for another 7 IPMNs unclassifiable by H&E did not indicate a clear subtype and often contained discordant results (e.g., discordant CDX2 and MUC2 staining). In our experience, a considerable number of IPMNs are either unclassifiable or contain epithelium from >1 subtype. Furthermore, among those IPMNs initially unclassifiable by H&E morphology, application of immunohistochemical stains to aid in subtyping allow for definite classification in only a small subset of cases. These data, when taken in context with the significant ranges in the reported prevalence of specific histologic subtypes, suggest that accurate IPMN subtyping is poorly reproducible in up to 25% of cases, and in these problematic cases, immunohistochemistry adds little value.

Authors+Show Affiliations

Department of Pathology, Stanford University School of Medicine, Stanford, CA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26469398

Citation

Schaberg, Kurt B., et al. "Intraductal Papillary Mucinous Neoplasms Often Contain Epithelium From Multiple Subtypes And/or Are Unclassifiable." The American Journal of Surgical Pathology, vol. 40, no. 1, 2016, pp. 44-50.
Schaberg KB, DiMaio MA, Longacre TA. Intraductal Papillary Mucinous Neoplasms Often Contain Epithelium From Multiple Subtypes and/or Are Unclassifiable. Am J Surg Pathol. 2016;40(1):44-50.
Schaberg, K. B., DiMaio, M. A., & Longacre, T. A. (2016). Intraductal Papillary Mucinous Neoplasms Often Contain Epithelium From Multiple Subtypes and/or Are Unclassifiable. The American Journal of Surgical Pathology, 40(1), pp. 44-50. doi:10.1097/PAS.0000000000000528.
Schaberg KB, DiMaio MA, Longacre TA. Intraductal Papillary Mucinous Neoplasms Often Contain Epithelium From Multiple Subtypes And/or Are Unclassifiable. Am J Surg Pathol. 2016;40(1):44-50. PubMed PMID: 26469398.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraductal Papillary Mucinous Neoplasms Often Contain Epithelium From Multiple Subtypes and/or Are Unclassifiable. AU - Schaberg,Kurt B, AU - DiMaio,Michael A, AU - Longacre,Teri A, PY - 2015/10/16/entrez PY - 2015/10/16/pubmed PY - 2016/4/12/medline SP - 44 EP - 50 JF - The American journal of surgical pathology JO - Am. J. Surg. Pathol. VL - 40 IS - 1 N2 - Pancreatic intraductal papillary mucinous neoplasms (IPMNs) are subclassified into gastric, intestinal, pancreatobiliary, and oncocytic subtypes based on histologic features. The WHO classification scheme suggests use of immunohistochemical stains to help subtype IPMNs with ambiguous histology. Seventy-two pancreatic IPMN resections between 2008 and 2014 were retrospectively evaluated. Immunohistochemistry for CDX2, MUC2, and MUC5AC was performed on cases where the histologic subtype could not be determined on routine hematoxylin and eosin (H&E) sections. There were 41 gastric (57%), 8 intestinal (11%), 4 pancreatobiliary (6%), and 1 oncocytic (1%) IPMNs. Eighteen (25%) IPMNs were either unclassifiable due ambiguous morphology or contained distinct epithelium from >1 subtype (i.e., "mixed"). Two IPMNs initially unclassifiable strictly by H&E morphology were definitively classified as intestinal after positive immunohistochemical staining with CDX2, MUC2, and MUC5AC. Immunohistochemistry for another 7 IPMNs unclassifiable by H&E did not indicate a clear subtype and often contained discordant results (e.g., discordant CDX2 and MUC2 staining). In our experience, a considerable number of IPMNs are either unclassifiable or contain epithelium from >1 subtype. Furthermore, among those IPMNs initially unclassifiable by H&E morphology, application of immunohistochemical stains to aid in subtyping allow for definite classification in only a small subset of cases. These data, when taken in context with the significant ranges in the reported prevalence of specific histologic subtypes, suggest that accurate IPMN subtyping is poorly reproducible in up to 25% of cases, and in these problematic cases, immunohistochemistry adds little value. SN - 1532-0979 UR - https://www.unboundmedicine.com/medline/citation/26469398/Intraductal_Papillary_Mucinous_Neoplasms_Often_Contain_Epithelium_From_Multiple_Subtypes_and/or_Are_Unclassifiable_ L2 - http://Insights.ovid.com/pubmed?pmid=26469398 DB - PRIME DP - Unbound Medicine ER -