Intraductal papillary mucinous neoplasms often contain epithelium from multiple subtypes and/or are unclassifiable

Kurt B. Schaberg, Michael A. Dimaio, Teri A. Longacre

Research output: Contribution to journalArticle

12 Citations (Scopus)

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 (ie, "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 (eg, 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.

Original languageEnglish (US)
Pages (from-to)44-50
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume40
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Epithelium
Neoplasms
Immunohistochemistry
Stomach
Coloring Agents
Staining and Labeling
Hematoxylin
Eosine Yellowish-(YS)
Histology

Keywords

  • intraductal papillary mucinous neoplasm
  • IPMN
  • IPMN subtype
  • IPMN unclassified
  • mixed IPMN

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Intraductal papillary mucinous neoplasms often contain epithelium from multiple subtypes and/or are unclassifiable. / Schaberg, Kurt B.; Dimaio, Michael A.; Longacre, Teri A.

In: American Journal of Surgical Pathology, Vol. 40, No. 1, 01.01.2016, p. 44-50.

Research output: Contribution to journalArticle

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