Immunohistochemical distinction between intrahepatic cholangiocarcinoma and pancreatic ductal adenocarcinoma

• Published in: Human pathology 2014-02, Vol.45 (2), p.394-400
• Main Authors: Lok, Terry, BS, Chen, Lihong, MD, PhD, Lin, Fan, MD, PhD, Wang, Hanlin L., MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Biomarkers; Biomarkers, Tumor - metabolism; Calcium-Binding Proteins - analysis; Carcinoma, Pancreatic Ductal - diagnosis; Carcinoma, Pancreatic Ductal - metabolism; Carcinoma, Pancreatic Ductal - pathology; Cholangiocarcinoma - diagnosis; Cholangiocarcinoma - metabolism; Cholangiocarcinoma - pathology; CK17; Diagnosis, Differential; Gallbladder; Humans; Immunohistochemistry; IMP3; Intrahepatic cholangiocarcinoma; Keratin-17 - analysis; Liver Neoplasms - diagnosis; Liver Neoplasms - metabolism; Liver Neoplasms - pathology; Maspin; Medical research; Metastasis; Middle Aged; MUC5AC; Mucin 5AC - analysis; Neoplasm Proteins - analysis; Pancreatic cancer; Pancreatic ductal adenocarcinoma; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - metabolism; Pancreatic Neoplasms - pathology; Pathology; pVHL; S100P; Von Hippel-Lindau Tumor Suppressor Protein - analysis
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2013.10.004

Summary Distinction between primary intrahepatic cholangiocarcinoma (ICC) and metastatic pancreatic ductal adenocarcinoma (PDA) on a liver biopsy is essentially impossible histologically but has important clinical implications. In this study, 41 ICCs and 60 PDAs were immunohistochemically evaluated for the expression of S100P, pVHL, IMP3, maspin, MUC5AC, and CK17 proteins. The results showed pVHL expression in 29 (71%) ICCs but in only 3 (5%) PDAs. S100P, MUC5AC, and CK17 were frequently expressed in PDAs, seen in 57 (95%), 40 (67%), and 36 (60%) cases, respectively. In contrast, only 11 (27%), 5 (12%), and 5 (12%) ICC cases expressed these proteins. IMP3 was expressed in 37 (90%) ICC and 54 (90%) PDA cases with equal frequency. All 60 (100%) PDA and 30 (73%) ICC cases showed positive maspin immunoreactivity. A S100P−/pVHL+/MUC5AC−/CK17− staining pattern was essentially indicative of ICC, whereas the S100P+/pVHL−/MUC5AC+/CK17+ and S100P+/pVHL−/MUC5AC−/CK17+ staining patterns were suggestive of PDA. These observations demonstrate that S100P, pVHL, MUC5AC, and CK17 are a useful immunohistochemical panel that may help distinguish primary ICC from metastatic PDA.