Histopathological re-evaluation of pancreatic neoplasms : Special reference to immunohistochemistry and molecular biology

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We performed the histopathological re-evaluation of pancreatic neoplasms (including intraductal papillary mucinous neoplasms (IPMN), endocrine tumors, pancreatic intraepithelial neoplasia (PanIN), pancreatic cancers, et al.) by using immunohistochemistry and molecular biology from 2001 to 2003. Then, we tried to find the important hematoxylin-eosin (HE) staining findings related to the above mentioned results.In IPMN cases, slightly high villous architecture and nuclear overlapping were the most important findings to differentiate among intraductal papillary mucinous adenoma (IPMA), intraductal papillary mucinous neoplasm, borderline (IPMB), and intraductal papillary mucinous carcinoma (IPMC). Regarding endocrine tumors (including both benign and malignant tumors), so far there seemed to be no useful HE findings to diagnose malignant ones, although we found several cases of endocrine tumor with ductal differentiation. MUC1 was thought to be a good marker for malignancy in PanIN lesions. All cases of PanIN was negative for MUC2. On the other hand, in cases of pancreatic cancers, most cases revealed positive staining of p53 and MIB-1, and the nuclear atypia was obvious in such cases. There were several cases of well differentiated adenocarcinoma showing less atypical features. In such cases, intraglandular necrotic debris was a diagnostic clue to adenocarcinoma.