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[Combined application of immunohistochemical markers to identify pathologic subtypes of ampullary carcinoma and its clinical significance].
Zhonghua Bing Li Xue Za Zhi 2019; 48(2):92-97ZB

Abstract

Objective:

To investigate the expression of immunomarkers CK7, CK20, CK17, CDX2, MUC1 and MUC2 in primary adenocarcinoma of the ampulla of Vater, to explore the role of these markers in the histopathologic subclassification of ampullary carcinoma; and to provide biologic basis for precision treatment of patients with different types of ampullary carcinoma.

Methods:

Forty-two cases of primary ampullary carcinoma were collected at Peking University People's Hospital, from 2012 to 2018 year. There were 22 males and 20 females. Aged range 42 to 88 years old, with mean aged (62±11) years. Among the patients, 6 was high differentiation, 19 median differentiation, and 17 low differentiation. Immunohistochemical studies on the expression of CK7, CK20, CK17, CDX2, MUC1 and MUC2 were performed in 42 cases of primary ampullary carcinoma. The relationship between different ampullary carcinoma subtypes and clinicopathologic survival data was analyzed using SPSS 16.0 statistical software.

Results:

Three histopathologic subtypes were observed. Among 42 cases, 8(19.0%)were classified as intestinal subtype, which showed a positive expression rate of 8/8 for both CK20 and CDX2, and 5/8 for MUC2. Both CK7 and CK17 were weakly expressed in one case (1/8). No expression was observed for MUC1 in this subtype. Twenty-two (52.4%,22/42) cases were classified as pancreaticobiliary subtype, which showed a positive expression rate of 100.0%(22/22) for both CK7 and MUC1, and 90.9% (20/22) for CK17. No expression was observed for CK20, CDX2 and MUC2.The remaining 12 (28.6%) cases were classified as mixed subtype, which showed variable expression patterns. The expression frequencies of these 6 immunomarkers in different subtypes of ampullary carcinoma did not correlate with various clinicopathologic factors such as patient gender and age, tumor size, histologic differentiation, pancreatic and bile duct invasion, or the depth of duodenal invasion. However, stage Ⅲ+Ⅳ diseases were more commonly seen in pancreaticobiliary type (63.6%,14/22) than intestinal type (2/8) and mixed type (3/9; χ(2)=6.508, P=0.039). Follow-up data showed a trend of better survival rate for patients with intestinal subtype than those with mixed and pancreaticobiliary subtypes.

Conclusions:

Ampullary carcinoma can be subclassified into three different subtypes using a panel of six immunomarkers, especially for the identification of subtypes of poorly differentiated carcinoma. CK7, CK17 and MUC1 are major markers of pancreaticobiliary subtype, whereas CK20, CDX2 and MUC2 are useful markers for intestinal subtype. The mixed subtype variably expresses these markers. The prognosis of patients with intestinal subtype appears better than that of pancreaticobiliary and mixed subtypes. Accurate subtyping of ampullary carcinoma is clinically important to patient management and prognosis assessment.

Authors+Show Affiliations

Department of Pathology, Peking University People's Hospital, Beijing 100044, China.Department of Pathology, Peking University People's Hospital, Beijing 100044, China.Department of Pathology, University of California, Los Angeles, CA 90095, U S A.Department of Pathology, Peking University People's Hospital, Beijing 100044, China.Department of Radiology, Peking University People's Hospital, Beijing 100044, China.Department of Pathology, the Second People's Hospital of Hami City, Xinjiang Uygur Autonomous Region, Hami 839001, China.Department of General Surgery, Peking University People's Hospital, Beijing 100044, China.Department of Pathology, Peking University People's Hospital, Beijing 100044, China.Department of Pathology, Peking University People's Hospital, Beijing 100044, China.

Pub Type(s)

Journal Article

Language

chi

PubMed ID

30695858

Citation

Liu, F F., et al. "[Combined Application of Immunohistochemical Markers to Identify Pathologic Subtypes of Ampullary Carcinoma and Its Clinical Significance]." Zhonghua Bing Li Xue Za Zhi = Chinese Journal of Pathology, vol. 48, no. 2, 2019, pp. 92-97.
Liu FF, Shen DH, Wang HL, et al. [Combined application of immunohistochemical markers to identify pathologic subtypes of ampullary carcinoma and its clinical significance]. Zhonghua Bing Li Xue Za Zhi. 2019;48(2):92-97.
Liu, F. F., Shen, D. H., Wang, H. L., Ma, Y. T., Yuan, F., Liu, J., ... Zhang, Y. Y. (2019). [Combined application of immunohistochemical markers to identify pathologic subtypes of ampullary carcinoma and its clinical significance]. Zhonghua Bing Li Xue Za Zhi = Chinese Journal of Pathology, 48(2), pp. 92-97. doi:10.3760/cma.j.issn.0529-5807.2019.02.003.
Liu FF, et al. [Combined Application of Immunohistochemical Markers to Identify Pathologic Subtypes of Ampullary Carcinoma and Its Clinical Significance]. Zhonghua Bing Li Xue Za Zhi. 2019 Feb 8;48(2):92-97. PubMed PMID: 30695858.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Combined application of immunohistochemical markers to identify pathologic subtypes of ampullary carcinoma and its clinical significance]. AU - Liu,F F, AU - Shen,D H, AU - Wang,H L, AU - Ma,Y T, AU - Yuan,F, AU - Liu,J, AU - Chen,L, AU - Song,Q J, AU - Zhang,Y Y, PY - 2019/1/30/entrez PY - 2019/1/31/pubmed PY - 2019/4/2/medline KW - Ampulla of Vater KW - Immunohistochemistry KW - Immunophenotyping SP - 92 EP - 97 JF - Zhonghua bing li xue za zhi = Chinese journal of pathology JO - Zhonghua Bing Li Xue Za Zhi VL - 48 IS - 2 N2 - Objective: To investigate the expression of immunomarkers CK7, CK20, CK17, CDX2, MUC1 and MUC2 in primary adenocarcinoma of the ampulla of Vater, to explore the role of these markers in the histopathologic subclassification of ampullary carcinoma; and to provide biologic basis for precision treatment of patients with different types of ampullary carcinoma. Methods: Forty-two cases of primary ampullary carcinoma were collected at Peking University People's Hospital, from 2012 to 2018 year. There were 22 males and 20 females. Aged range 42 to 88 years old, with mean aged (62±11) years. Among the patients, 6 was high differentiation, 19 median differentiation, and 17 low differentiation. Immunohistochemical studies on the expression of CK7, CK20, CK17, CDX2, MUC1 and MUC2 were performed in 42 cases of primary ampullary carcinoma. The relationship between different ampullary carcinoma subtypes and clinicopathologic survival data was analyzed using SPSS 16.0 statistical software. Results: Three histopathologic subtypes were observed. Among 42 cases, 8(19.0%)were classified as intestinal subtype, which showed a positive expression rate of 8/8 for both CK20 and CDX2, and 5/8 for MUC2. Both CK7 and CK17 were weakly expressed in one case (1/8). No expression was observed for MUC1 in this subtype. Twenty-two (52.4%,22/42) cases were classified as pancreaticobiliary subtype, which showed a positive expression rate of 100.0%(22/22) for both CK7 and MUC1, and 90.9% (20/22) for CK17. No expression was observed for CK20, CDX2 and MUC2.The remaining 12 (28.6%) cases were classified as mixed subtype, which showed variable expression patterns. The expression frequencies of these 6 immunomarkers in different subtypes of ampullary carcinoma did not correlate with various clinicopathologic factors such as patient gender and age, tumor size, histologic differentiation, pancreatic and bile duct invasion, or the depth of duodenal invasion. However, stage Ⅲ+Ⅳ diseases were more commonly seen in pancreaticobiliary type (63.6%,14/22) than intestinal type (2/8) and mixed type (3/9; χ(2)=6.508, P=0.039). Follow-up data showed a trend of better survival rate for patients with intestinal subtype than those with mixed and pancreaticobiliary subtypes. Conclusions: Ampullary carcinoma can be subclassified into three different subtypes using a panel of six immunomarkers, especially for the identification of subtypes of poorly differentiated carcinoma. CK7, CK17 and MUC1 are major markers of pancreaticobiliary subtype, whereas CK20, CDX2 and MUC2 are useful markers for intestinal subtype. The mixed subtype variably expresses these markers. The prognosis of patients with intestinal subtype appears better than that of pancreaticobiliary and mixed subtypes. Accurate subtyping of ampullary carcinoma is clinically important to patient management and prognosis assessment. SN - 0529-5807 UR - https://www.unboundmedicine.com/medline/citation/30695858/[Combined_application_of_immunohistochemical_markers_to_identify_pathologic_subtypes_of_ampullary_carcinoma_and_its_clinical_significance]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&issn=0529-5807&year=2019&vol=48&issue=2&fpage=92 DB - PRIME DP - Unbound Medicine ER -