Carcinogenetic Progression of Pancreatic Mucinous Cystic Neoplasm Is of Aggressive Pancreatobiliary Lineage
Kee-Taek Jang, Yoon La Choi, Charles Hill, Edward Stelow, Dustin M Walters, Olca Basturk, Pelin Bagci, Giuseppe Zamboni, David Klimstra, Ralph H Hruban, Volkan Adsay. SMC, Seoul, Korea; Emory University, Atlanta, GA; UVA, Charlottesville, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; UV, Verona, Italy; Johns Hopkins University, Baltimore, MD
Background: Mucinous cystic neoplasm (MCN) is one of the precursors of invasive pancreatic carcinoma. The molecular alterations that take place during the progression of MCNs, however, have not been fully elucidated, with most of the literature focusing on the non-invasive examples.
Design: Immunolabeling of mucin core proteins (MUC1, MUC2, MUC 5AC, MUC6, CDX2), p53 and DPC4 were examined in 40 MCNs, consisting of 9 low-grade (LG), 8 high-grade (HG) and 23 with an associated invasive carcinoma. Mutational analysis for BRAF and KRAS was performed in 15 (4LG, 6HG, 5 invasive).
Results: Gastric lineage markers (MUC5AC and MUC6) were detected only in the cystic/LG areas and were virtually absent in papillary/HG components or invasion. Intestinal differentiation markers were not detected in carcinogenetic spectrum of MCNs, with the exception of metaplastic goblet cells highlighted by MUC2, and rare areas of cystic/LG components of the tumors showing weak CDX2 labeling. MUC1 (pancreatobiliary lineage marker) was expressed only in advanced lesions [50% (4/8) HG and 92% (20/23) of invasive]. Similarly, p53, if present, was detected only in advanced lesions; 25% (2/8) of HG and 39% (9/23) of invasive carcinoma. DPC4 stain was retained in most MCN cases except for 4 (17%) of invasive carcinoma. Immunophenotypic changes are summarized in Table 1. No BRAF mutations were identified, but KRAS was mutated in advanced lesions: 5/6 HG and 5/5 invasive (Table 2).
|Low-grade (n=9)||0||0||0||4/9 (44%)||4/9 (44%)||0||8/9 (89%)|
|High-grade/CIS (n=8)||4/8 (50%)||1/8 (13%)||1/8 (13%)||0||2/8 (25%)||2/8 (25%)||7/8 (88%)|
|Invasive ca (n=23)||20/23 (92%)||0||0||2/23 (9%)||1/23 (4%)||9/23 (39%)||19/23 (83%)|
|Low-grade (n=4)||High-grade (n=6)||Invasive ca. (n=5)|