[1589] Diagnostic Utility of CD10 in Benign and Malignant Bile Duct Lesions.

Maria Tretiakova, Maria Westerhoff, Tatjana Antic, Jeffrey Mueller, Eric Himmelfarb, Hanlin Wang, Shu-Yuan Xiao. University of Chicago, IL; Cedars-Sinai Medical Center, Los Angeles

Background: CD10, a cell surface enzyme with neutral metalloendopeptidase activity, is widely accepted as a useful brush border marker of the small intestine. In a few reports it was also shown that CD10 is present in normal bile duct and gallbladder epithelium. However, the expression profile of CD10 in benign and malignant bile duct epithelial lesions has not been studied.
Design: A total of 16 biopsies, 9 resections and 7 cell blocks prepared from fine needle aspiration biopsies from 32 patients were included in our study. The majority of cases contained normal intact biliary epithelium (27/32, 84%), and multiple lesions of both benign and malignant nature in various combinations. Benign lesions included reactive atypia (n=8), low-grade dysplasia of unknown significance (n=9), and adenoma (n=1). Malignant lesions included high grade dysplasia (n=20) and adenocarcinoma (n=15) (see table). All specimens were examined by immunohistochemistry for CD10 (Novocastra Labs, dilution 1:20).
Results: Normal biliary epithelium was strongly positive in all cases with characteristic continuous staining of the brush border. Benign lesions were also CD10 positive in all cases except for one, but the staining pattern was discontinuous with positive cells varying from 20 to 60%. None of malignant lesions showed reactivity with CD10 except for one case of high grade dysplasia with focal staining (see table). Pearson chi square statistical analysis showed significant difference in CD10 expression between all study groups (p<0.001). Importantly, presence of inflammatory cells did not obscure interpretation and served as an internal positive control.

CD10 positivity in 53 benign and malignant biliary lesions
LocalizationBenign (n=18)Malignant (n=35)
Intrahepatic bile ducts1/10/4
Extrahepatic bile ducts15/161/29
Total17/18 (94%)1/35 (3%)

Conclusions: The histopathologic distinction between benign and malignant bile duct epithelial lesions on biopsies and cytology specimens can be extremely challenging because of limited material, crush artifact, and frequent inflammatory/reactive changes. In our study, continuous strong CD10 reactivity of normal epithelium was contrasted by discontinuous CD10 expression in benign lesions and absence of CD10 in malignant lesions. This lack of CD10 expression is associated with microvilli loss during malignant transformation of biliary epithelial cells; hence, CD10 can serve as a useful marker to aid in the evaluation of bile duct biopsies.
Category: Liver & Pancreas

Monday, February 28, 2011 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 207, Monday Morning


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