Evaluation of Clinical Meaning of Histological Subtypes of Intraductal Papillary Mucinous Neoplasm of the Pancreas

Kang, Mee Joo; Lee, Kyuho; Jang, Jin‐Young; Han, In Woong; Kim, Sun‐Whe

doi:10.1097/mpa.0b013e31827cddbc

Cited by 39 publications

(39 citation statements)

References 16 publications

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“…[5][6][7][8] Furthermore, studies have reported conflicting evidence on whether the histologic IPMN subtype has prognostic significance. [8][9][10][11][12] The Verona consensus meeting in 2013 recently led to the publication of guidelines for pathologic reporting of IPMN with the recommendation that pathologists provide a histologic subtype. 13 Although most previous studies used morphology and immunohistochemistry to designate the IPMN subtype, this is not necessarily implemented as standard practice.…”

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confidence: 99%

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

et al. 2016

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Intraductal papillary mucinous neoplasm is considered a precursor lesion to pancreatic adenocarcinoma. These are further classified into four histologic subtypes: gastric, intestinal, pancreatobiliary, and oncocytic. The first aim of this study was to assess the interobserver variability among five gastrointestinal pathologists in diagnosing intraductal papillary mucinous neoplasm subtypes by morphology alone. The second aim of the study was to compare intraductal papillary mucinous neoplasm subtypes, which received consensus diagnoses (≥80% agreement) with their respective mucin immunoprofiles (MUC1, MUC2, MUC5AC, MUC6, and CDX2). A consensus histologic subtype was reached in 58% of cases (29/50) among the five gastrointestinal pathologists. Overall there was moderate agreement (κ = 0.41, Po 0.01) in subtyping intraductal papillary mucinous neoplasms without the use of immunohistochemistry. The histologic subtype with the best interobserver agreement was intestinal type (κ = 0.56, Po 0.01) followed by pancreatobiliary, gastric, mixed, and oncocytic types (κ = 0.43, Po 0.01; κ = 0.38, Po 0.01; κ = 0.17, Po 0.01; κ = 0.08, Po 0.04, respectively). Both kappa values for mixed and oncocytic subtypes were likely artificially low due to the underrepresentation of these subtypes in this study and not a true indication of poor interobserver agreement. Following an intradepartmental consensus meeting between two gastrointestinal pathologists, 68% of cases (34/50) received a consensus intraductal papillary mucinous neoplasm subtype. Sixty-nine percent of cases (11/16) that did not receive a consensus intraductal papillary mucinous neoplasm subtype could be classified based on their respective immunoprofiles. Standardizing the use of immunohistochemistry with a mucin immunopanel (MUC1, MUC2, MUC5AC, and MUC6) may improve the agreement of diagnosing intraductal papillary mucinous neoplasm histologic subtypes.

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confidence: 99%

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

et al. 2016

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“…1 In a study of 283 IPMNs, Furukawa et al 6 reported a mean age of 60.3 years for 24 patients with IOPN, compared to 65.6, 64.5, and 69.2 years for gastric, intestinal, and pancreatobiliary types, respectively, and suggested an increased likelihood of earlier onset of IOPNs compared with that of the other histologic subtypes. However, other studies 9,10 have not reported a significant age difference. For example, a review by Liszka et al 10 of 24 pancreatic IOPN cases reported a mean age of 63.9 years with no significant age or sex differences between IOPN and IPMN overall.…”

Section: Clinical Featuresmentioning

confidence: 62%

Section: Gross Pathologymentioning

confidence: 91%

“…Similarly, both cases of IOPN reported by Kang et al 9 showed high-grade dysplasia. By comparison, the study by Kang et al 9 of IPMNs in general reported 18 of 213 IPMNs with high-grade dysplasia (8.5%). 9 Invasive carcinoma may arise in the setting of IOPNs, similar to other subtypes of IPMNs (Table 1).…”

Section: Gross Pathologymentioning

confidence: 91%

“…Estimates of the incidence of IOPNs range from less than 1% to 13% of IPMNs (Table 1). [6][7][8][9] IOPNs have been reported in adults ranging in age from 39 to 78 years, with a mean age of 67 years, and affect men and women equally. 1 In a study of 283 IPMNs, Furukawa et al 6 reported a mean age of 60.3 years for 24 patients with IOPN, compared to 65.6, 64.5, and 69.2 years for gastric, intestinal, and pancreatobiliary types, respectively, and suggested an increased likelihood of earlier onset of IOPNs compared with that of the other histologic subtypes.…”

Section: Clinical Featuresmentioning

confidence: 99%

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Intraductal Oncocytic Papillary Neoplasms of the Pancreas

Kallen¹,

Naini

2016

Archives of Pathology &Amp; Laboratory Medicine

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Intraductal oncocytic papillary neoplasms (IOPNs) are cystic neoplasms with intraductal growth and complex papillae composed of oncocytic cells. IOPNs have been reported both in the pancreas and biliary tree, and are most likely closely related in these 2 locations. In the pancreas, these rare tumors are now considered 1 of the 4 histologic subtypes of intraductal papillary mucinous neoplasm (IPMN). Significant differences in histology, immunophenotype, and molecular genetics have been reported between IOPNs and other IPMN subtypes. However, there are limited data regarding the clinical behavior and prognosis of IOPNs in comparison to other subtypes of IPMN. We review features of pancreatic IOPNs and discuss the differential diagnosis of other intraductal lesions in the pancreas.

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Usefulness of KL-6 in the subtyping of intraductal papillary mucinous neoplasia of the pancreas, including carcinoma, dysplasia, and hyperplasia

et al. 2014

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KL-6 is known as a useful serum biomarker of the disease activity in interstitial pneumonias. We investigated its usefulness as a biomarker for subtyping intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. IPMNs are generally divided into 4 subtypes, namely pancreatobiliary (PB), intestinal (INT), gastric (GS), and oncocytic (ONC). Aside from the KL-6 antibody, the MUC1, MUC2, MUC5AC, MUC6, and MIB-1 antibodies were also examined. Eighteen IPMN cases were examined, including 12 cases of intraductal papillary mucinous carcinomas (IPMCs) simultaneously associated with dysplasia (IPMDs) and hyperplasia (IPMHs) and 6 IPMD cases with IPMH. KL-6 antibody was positive in the 8 IPMC cases, corresponding to a MUC2-negative PB subtype, but negative in 4 IPMC cases, corresponding to the INT subtype, which is positive for MUC2. IPMD of moderate-to-severe degree positively stained for the KL-6 antibody in the IPMC cases of the PB subtype but not in those of the INT subtype. The IPMH cases were mostly negative for KL-6, similar to the mild IPMD cases. In the 6 cases of mild IPMD and/or IPMH, KL-6 and MUC2 expressions were mostly negative. In conclusion, the KL-6 antibody is immunohistochemically a good biomarker of the PB subtype of IPMC, but not the INT subtype. Identifying IPMN subtypes based on KL-6 stainability would be useful. Clinicopathological studies with more IPMC cases might be needed for further progress in this field of study.

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Evaluation of Clinical Meaning of Histological Subtypes of Intraductal Papillary Mucinous Neoplasm of the Pancreas

Abstract: Although histological subtypes are associated with the degree of dysplasia, histological subtypes have limited prognostic value for pancreatic IPMNs.

Cited by 39 publications

References 16 publications

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles

Intraductal Oncocytic Papillary Neoplasms of the Pancreas

Usefulness of KL-6 in the subtyping of intraductal papillary mucinous neoplasia of the pancreas, including carcinoma, dysplasia, and hyperplasia

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