E-Cadherin/ -Catenin and CD10: A Limited Immunohistochemical Panel to Distinguish Pancreatic Endocrine Neoplasm From Solid Pseudopapillary Neoplasm of the Pancreas on Endoscopic Ultrasound-Guided Fine-Needle Aspirates of the Pancreas
Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA. American Journal of Clinical Pathology
(Impact Factor: 2.51).
12/2009; 132(6):831-9. DOI: 10.1309/AJCPVT8FCLFDTZWI
Pancreatic endocrine neoplasm (PEN) and solid pseudopapillary neoplasm of the pancreas (SPN) frequently pose diagnostic challenges. We sought to determine which markers could provide the best immunophenotypic characterization of PEN and SPN, allowing separation on limited cytology samples. We retrieved 22 resected PEN (n = 12) and SPN (n = 10) tumors to serve as a training set for the performance of extensive immunohistochemical staining. Based on these results, we selected a subset of antibodies for application to 25 fine-needle aspiration (FNA) samples from PEN (n = 16) and SPN (n = 9). Chromogranin A, synaptophysin, CD56, and progesterone receptor (PR) highlighted PEN cases in the training set; E-cadherin was noted in a membranous pattern. SPN cases were most immunoreactive for alpha(1)-antitrypsin, vimentin, CD10, and PR, with nuclear staining for beta-catenin; E-cadherin did not show a membranous pattern. Among all FNA samples tested, the immunohistochemical staining of E-cadherin (P = .0003), beta-catenin (P = .00004), and CD10 (P = .00006) demonstrated the greatest difference between PEN and SPN. The pattern of E-cadherin/beta-catenin expression was highly specific for distinguishing PEN from SPN. On limited FNA samples, the characteristic expression of E-cadherin/beta-catenin and the expression of CD10 can be used to distinguish PEN from SPN.
Available from: Sule Canberk
- "There are many additional stains in the literature such as CD10, progesterone receptors, cyclin D1, galectin3 etc., Neuroendocrine markers; particularly NSE, CD56 and synaptophysin can may be expressed by neoplastic cells of SPN, but Chromogranin A is uniformly negative, which along with the lack of epithelial markers help to differentiate this tumor from PEN. The combination of negative staining for cytokeratins and strong nuclear staining for β-catenin is also helpful in distinguishing this tumor from ACC and PB, which are well-known mimics of SPN. The most helpful immunocytochemical stains in distinguishing clear cell SPN from other pancreatic neoplasms and extra-pancreatic clear cell tumors are demonstrated in Table 1. "
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ABSTRACT: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor of uncertain malignant potential, predominantly affecting young adult females. We report a case of clear cell variant of SPN, which was diagnosed by fine needle aspiration biopsy. The aspirate was highly cellular and exhibited delicate branching papillary structures with central capillaries covered with several layers of plasmacytoid tumor cells. Acinar and rosette-like formations, as well as single neoplastic cells were also observed. An unusual cytologic feature was the presence of large, clear cytoplasmic vacuoles. The diagnosis of SPN was confirmed by characteristic immunocytochemical staining pattern including nuclear staining for β-catenin, cytoplasmic staining for vimentin and lack of reactivity for cytokeratin.
Available from: Ichiro Yasuda
- "In general, the neoplastic cells of an NET are immunopositive for all the neuroendocrine markers, while the tumor cells of an SPN are positive for NSE and CD56 and mostly negative for synaptophysin and chromogranin. However, it is noteworthy that a small number of SPNs express synaptophysin and chromogranin, although weakly and focally (8–10). The tumor cells in case 1 were immunopositive for synaptophysin and chromogranin in a scattered fashion and for NSE and CD56 in a diffuse manner. "
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ABSTRACT: A solid pseudopapillary neoplasm (SPN) of the pancreas has distinct histopathological features. A solid pattern of growth with pseudopapillary structures that result from degeneration is observed. On rare occasions, the tumor may vary from being entirely solid to completely cystic. The present study describes two unique cases of SPN. A 25-year-old male presented with a pancreatic tumor showing a predominantly solid pattern with no degenerative change, although the pre-operative cytological specimens that were obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed pseudopapillary structures. The second case was of an 11-year-old female who presented with a pancreatic tumor with prominent degeneration. Nests and cords of the remaining neoplastic cells were located only at the periphery, with perineural invasion. An immunohistochemical analysis revealed that the tumor cells in the two cases were positive for CD10 and β-catenin and negative for trypsin. An awareness of the broad morphological variability of SPN and an immunohistochemical panel that includes CD10, β-catenin and trypsin are useful for establishing an accurate diagnosis.
- "The tumor cells are monomorphic, oval to round, and may exhibit papillary clusters. The tumor cells may stain weakly with neuroendocrine markers, but stain positively with CD10 and beta-catenin in a nuclear pattern. Acinar cell carcinoma tumor cells contain granular amphophilic to eosinophilic cytoplasm, which stain positively with antibodies against the pancreatic enzymes trypsin and chymotrypsin. "
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ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are rare tumors of the pancreas, which are increasingly diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). In this retrospective study, we assessed the performance of EUS-FNA in diagnosing PNETs.
We identified 48 cases of surgically resected PNETs in which pre-operative EUS-FNA was performed. The clinical features, cytological diagnoses, and surgical follow-up were retrospectively reviewed. The diagnostic performance of EUS-FNA was analyzed as compared to the diagnosis in the follow-up. The cases with discrepancies between cytological diagnosis and surgical follow-up were analyzed and diagnostic pitfalls in discrepant cases were discussed.
The patients were 20 male and 28 female with ages ranging from 15 years to 81 years (mean 57 years). The tumors were solid and cystic in 41 and 7 cases, respectively, with sizes ranging from 0.5 cm to 11 cm (mean 2.7 cm). Based on cytomorphologic features and adjunct immunocytochemistry results, when performed, 38 patients (79%) were diagnosed with PNET, while a diagnosis of suspicious for PNET or a diagnosis of neoplasm with differential diagnosis including PNET was rendered in the 3 patients (6%). One case was diagnosed as mucinous cystic neoplasm (2%). The remaining 6 patients (13%) had non-diagnostic, negative or atypical diagnosis.
Our data demonstrated that EUS-FNA has a relatively high sensitivity for diagnosing PNETs. Lack of additional materials for immunocytochemical studies could lead to a less definite diagnosis. Non-diagnostic or false negative FNA diagnosis can be seen in a limited number of cases, especially in those small sized tumors.
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