Clinicopathological Study of Carcinoma of the Ampulla of Vater with Special Reference to MUC1, MUC2 and MUC5AC Expression

Overview

Journal J Clin Diagn Res

Specialty General Medicine

Date 2017 Jun 30

PMID 28658766

Authors

Maithili Mandar Kulkarni

Siddhi Gaurish Sinai Khandeparkar

Avinash R Joshi

Aniket Kakade

Lokesh Fegade

Ketan Narkhede

Affiliations

Soon will be listed here.

Abstract

Introduction: The ampulla of Vater consists of papilla, common channel, distal common bile duct and the distal main pancreatic duct. Ampullary carcinomas arise from two different types of mucosa, reflecting their broad histomorphological spectrum. Adenocarcinomas originating in the ampulla of Vater are classified as having either 'Intestinal' or 'Pancreatobiliary' type of differentiation. Pancreatobiliary type has consistently shown a worse prognosis. Various types of mucins are distributed in normal tissues and gastrointestinal tumours. MUC1, MUC2 and MUC5AC are known to be the most important amongst all.

Aim: To study clinicopathological features of different types of carcinoma of ampulla with MUC1, MUC2 and MUC5AC expression.

Materials And Methods: We included 20 cases of ampullary adenocarcinoma in this study, diagnosed after radical surgery. The histopathological slides were reviewed and the tumours were classified into intestinal type, pancreatobilliary and other types. Representative block of tumours was subjected to immunohistochemical (IHC) study with MUC1, MUC2 and MUC5AC antibodies. Results were subsequently analysed.

Results: Pancreaticobiliary type of ampullary carcinoma cases predominated (50%) over intestinal type (25%). Carcinomas of "other types" included one case each of mucinous carcinoma, adenosquamous carcinoma and undifferentiated carcinoma and well differentiated neuroendocrine tumours. Pancreatobiliary type of carcinomas was associated with higher tumour stage and grade and lymph node metastasis. All the pancreatobiliary type expressed MUC1 and all intestinal type carcinomas expressed MUC2. MUC 5AC expression was seen predominantly in pancreatobiliary type of ampullary carcinomas.

Conclusion: Mucin markers are associated with two different subtypes of ampullary carcinomas which have different prognosis. Immunohistochemical study of mucin expression can define the different types of carcinomas of ampulla of Vater with better objective criteria.

References

Zhou H, Schaefer N, Wolff M, Fischer H . Carcinoma of the ampulla of Vater: comparative histologic/immunohistochemical classification and follow-up. Am J Surg Pathol. 2004; 28(7):875-82. DOI: 10.1097/00000478-200407000-00005. View

Singh A, Chaturvedi P, Batra S . Emerging roles of MUC4 in cancer: a novel target for diagnosis and therapy. Cancer Res. 2007; 67(2):433-6. DOI: 10.1158/0008-5472.CAN-06-3114. View

Fischer H, Zhou H . Pathogenesis of carcinoma of the papilla of Vater. J Hepatobiliary Pancreat Surg. 2004; 11(5):301-9. DOI: 10.1007/s00534-004-0898-3. View

Saitou M, Goto M, Horinouchi M, Tamada S, Nagata K, Hamada T . MUC4 expression is a novel prognostic factor in patients with invasive ductal carcinoma of the pancreas. J Clin Pathol. 2005; 58(8):845-52. PMC: 1770880. DOI: 10.1136/jcp.2004.023572. View

Lee M, Lee H, Kim W, Choi Y, Yang M . Expression of mucins and cytokeratins in primary carcinomas of the digestive system. Mod Pathol. 2003; 16(5):403-10. DOI: 10.1097/01.MP.0000067683.84284.66. View

Kumari N, Prabha K, Singh R, Baitha D, Krishnani N . Intestinal and pancreatobiliary differentiation in periampullary carcinoma: the role of immunohistochemistry. Hum Pathol. 2013; 44(10):2213-9. DOI: 10.1016/j.humpath.2013.05.003. View

Westgaard A, Schjolberg A, Cvancarova M, Eide T, Clausen O, Gladhaug I . Differentiation markers in pancreatic head adenocarcinomas: MUC1 and MUC4 expression indicates poor prognosis in pancreatobiliary differentiated tumours. Histopathology. 2009; 54(3):337-47. PMC: 2680278. DOI: 10.1111/j.1365-2559.2009.03227.x. View

Hollingsworth M, Swanson B . Mucins in cancer: protection and control of the cell surface. Nat Rev Cancer. 2003; 4(1):45-60. DOI: 10.1038/nrc1251. View

Cheever M, Allison J, Ferris A, Finn O, Hastings B, Hecht T . The prioritization of cancer antigens: a national cancer institute pilot project for the acceleration of translational research. Clin Cancer Res. 2009; 15(17):5323-37. PMC: 5779623. DOI: 10.1158/1078-0432.CCR-09-0737. View

10.

Westgaard A, Tafjord S, Farstad I, Cvancarova M, Eide T, Mathisen O . Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer. 2008; 8:170. PMC: 2430209. DOI: 10.1186/1471-2407-8-170. View

11.

Fischer H, Zhou H . [Pathogenesis and histomorphology of ampullary carcinomas and their precursor lesions. Review and individual findings]. Pathologe. 2003; 24(3):196-203. DOI: 10.1007/s00292-003-0617-x. View

12.

Harsha H, Kandasamy K, Ranganathan P, Rani S, Ramabadran S, Gollapudi S . A compendium of potential biomarkers of pancreatic cancer. PLoS Med. 2009; 6(4):e1000046. PMC: 2661257. DOI: 10.1371/journal.pmed.1000046. View

13.

Ang D, Shia J, Tang L, Katabi N, Klimstra D . The utility of immunohistochemistry in subtyping adenocarcinoma of the ampulla of vater. Am J Surg Pathol. 2014; 38(10):1371-9. DOI: 10.1097/PAS.0000000000000230. View

14.

Moschovis D, Bamias G, Delladetsima I . Mucins in neoplasms of pancreas, ampulla of Vater and biliary system. World J Gastrointest Oncol. 2016; 8(10):725-734. PMC: 5064050. DOI: 10.4251/wjgo.v8.i10.725. View

15.

Kimura W, Futakawa N, Yamagata S, Wada Y, Kuroda A, Muto T . Different clinicopathologic findings in two histologic types of carcinoma of papilla of Vater. Jpn J Cancer Res. 1994; 85(2):161-6. PMC: 5919425. DOI: 10.1111/j.1349-7006.1994.tb02077.x. View

16.

Kitamura H, Yonezawa S, Tanaka S, Kim Y, Sato E . Expression of mucin carbohydrates and core proteins in carcinomas of the ampulla of Vater: their relationship to prognosis. Jpn J Cancer Res. 1996; 87(6):631-40. PMC: 5921137. DOI: 10.1111/j.1349-7006.1996.tb00270.x. View

17.

Matsubayashi H, Watanabe H, Yamaguchi T, Ajioka Y, Nishikura K, Kijima H . Differences in mucus and K-ras mutation in relation to phenotypes of tumors of the papilla of vater. Cancer. 1999; 86(4):596-607. View

18.

Wang T, Liang Y, Hu P, Cheng Y . Mucins differently expressed in various ampullary adenocarcinomas. Diagn Pathol. 2011; 6:102. PMC: 3214147. DOI: 10.1186/1746-1596-6-102. View