Intestinal type adenocarcinoma: a previously unrecognized histologic variant of ductal carcinoma of the pancreas
Intestinal type adenocarcinoma: a previously unrecognized histologic variant of ductal carcinoma of the pancreas
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DOI：
10.1016/j.anndiagpath.2006.06.008
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发表时间：
2007-02-01
影响因子：
2
通讯作者：
Hruban, Ralph
中科院分区：
文献类型：
--
作者：
Albores-Saavedra, Jorge;Simpson, Karen;Hruban, Ralph
具有肠分化的腺癌已在各种解剖部位被描述。然而，据我们所知，具有肠道表型的导管腺癌尚未在胰腺中被描述。我们在此报告1例胰腺导管癌，其形态与结肠腺癌相似。在110例连续切除的胰腺导管癌中，肠型胰腺癌占10%。所有肠型癌均表达细胞角蛋白7、癌胚抗原、CDX2和MUC2。细胞角蛋白7和癌胚抗原的反应模式是弥漫性的，而粘蛋白2染色和CDX2核标记的反应模式是局灶性的，主要局限于杯状细胞，很少见于柱状细胞。6例癌中含有内分泌细胞，柱状细胞和杯状细胞混杂在一起。5例癌伴肠型胰腺高级别上皮内瘤变。女性6例，男性5例。年龄52 ~ 76岁，平均61岁。临床表现与常规导管癌无明显差异。所有肿瘤起源于胰腺头部，5例在手术切除时已经转移到区域淋巴结。只有1名患者存活了5年。3例患者术后2.8 ~ 8.9个月无病。6名患者直接死于癌症，我也没能跟进。需要更多的研究来确定这种独特的胰腺导管腺癌的组织学变异的生物学行为。(C) 2007爱思唯尔公司版权所有。
Adenocarcinomas with intestinal differentiation have been described in a wide variety of anatomical sites. To our knowledge, however, ductal adenocarcinomas with intestinal phenotype have not been described in the pancreas. We report here I I ductal carcinomas of the pancreas that were morphologically similar to colonic adenocarcinomas. These pancreatic carcinomas of intestinal type represented 10% of 110 consecutively removed ductal carcinomas of the pancreas. All intestinal type carcinomas expressed cytokeratin 7, carcinoembryonic antigen, CDX2, and MUC2. The pattern of reactivity of cytokeratin 7 and carcinoembryonic antigen was diffuse, whereas that of mucin 2 staining and CDX2 nuclear labeling was focal and confined predominantly to goblet cells and less frequently to columnar cells. Six carcinomas contained collections of endocrine cells admixed with the columnar and goblet cells. Five carcinomas were associated with high-grade pancreatic intraepithelial neoplasia of intestinal type. Six patients were female and 5 were male. Their ages ranged from 52 to 76 years (mean age, 61 years). The clinical presentation did not differ from that of the conventional ductal carcinomas. All carcinomas originated in the head of the pancreas, and 5 had metastasized to the regional lymph nodes at the time of surgical resection. Only I patient survived 5 years. Three patients are disease free from 2.8 to 8.9 months after surgery. Six patients died as a direct result of the carcinomas, and I was lost to follow-up. More studies are needed to determine the biologic behavior of this distinctive histologic variant of ductal adenocarcinoma of the pancreas. (C) 2007 Elsevier Inc. All rights reserved.