BACKGROUND: Maspin is a serpin family of protease inhibitors. Althouth maspin has been considered a tumor suppressor that inhibits the motility, invasion, and metastasis of breast and prostatic cancer cells, there are many conflicting reports about maspin expression and cancer prognosis. METHODS: To investigate whether the expression of maspin could be used as a prognostic marker in pancreatic cancer, 72 paraffin-embedded pancreatic ductal adenocarcinomas were analyzed using immunohistochemistry. We examined the prognostic value of maspin as well as its relationship with clinicopathological features. RESULTS: Maspin expression was observed in all pancreatic ductal adenocarcinoma. Unlike cancer tissues, however, faint or no expression was observed in the corresponding normal pancreatic tissues. In the Cox proportional hazard model, high maspin expression predicted a high hazard rate. Maspin expression had a positive correlation with tumor stage, but there were also no statistically significant relationships between maspin expression and other clinicopathological features. CONCLUSION: These findings suggest maspin expression to have biological relevance in the progression of pancreatic cancers, with potential use as a prognostic marker for pancreatic neoplasm with epithelial origin.
Adolescent ; Adult ; Aged ; Biological Markers ; Carcinoma, Pancreatic Ductal/*metabolism/surgery ; Female ; Human ; Immunohistochemistry ; Male ; Middle Aged ; Pancreatic Neoplasms/*metabolism/surgery ; Prognosis ; Proteins/*metabolism ; Serpins/*metabolism

BACKGROUND: Since pancreatic cancer metastasizes early regardless of the size of the primary tumor, it is suggested that angiogenic factor is upregulated in this disease. Among the angiogenic factors, vascular endothelial growth factor (VEGF) is the most potent and specific growth factor. The aim of this study is to elucidate the prognostic value of VEGF expression in pancreatic cancers. METHODS: We analyzed the VEGF expression using immunohistochemistry in 72 resected pancreatic ductal adenocarcinomas. We examined the prognostic value of the VEGF expression along with its relationship with the clinicopathological features. RESULTS: VEGF expression and mutant p53 expression were not associated with microvessel density. VEGF expression was positively associated with mutant p53 expression. There were no statistically significant relationships between the VEGF expression and other clinicopathological features, such as age, sex, CA19-9, tumor size, location, tumor differentiation, and stage. VEGF expression was not associated with patient survival. CONCLUSION: VEGF expression was not associated with the microvessel density and patient survival in pancreatic ductal adenocarcinoma.
Adolescent ; Adult ; Aged ; Biological Markers ; Carcinoma, Pancreatic Ductal/*metabolism/surgery ; Female ; Human ; Immunohistochemistry ; Male ; Middle Aged ; Pancreatic Neoplasms/*metabolism/surgery ; Prognosis ; Survival Analysis ; Vascular Endothelial Growth Factor A/*metabolism

OBJECTIVETo study the pathologic features, diagnosis, differential diagnosis and molecular characteristics of colloid carcinoma of the pancreas.

METHODSThe clinical findings, morphologic features, immunophenotype and K-ras gene alterations were investigated in 4 cases of pancreatic colloid carcinoma.

RESULTSIn the 4 cases of colloid carcinoma of the pancreas, three tumors were located in the head of the pancreas, one was located in the body and tail. The average age was 56.5 years old. The presenting symptom was abdominal pain in 2 cases, increased level of U-GLU in 1 patient, and an accidental finding presented in 1 patient. Grossly, 3 cases were cystic and solid, with mucin in the cyst; 1 case was solid. Microscopically, the colloid carcinoma was characterized by large pools of extracellular mucin, containing neoplastic cells, which were in the pattern of cuboidal, cribriform or irregular clusters, or formed an incomplete lining separating mucin pools from the stroma. Three cases developed from pre-existing pancreatic ductal adenocarcinoma (IPMN), intestinal-type, and 1 from IPMN, pancreatobiliary-type. Immunohistochemical studies showed that MUC2 was positive in 3 cases, and MUC1 in 1 case. K-ras gene mutation was identified in 2 cases, showing a single-amino-acid substitution in codon 12, as Gly12Asp (GGT > GAT) and Gly12Arg (GGT > CGT).

CONCLUSIONSPancreatic colloid carcinoma is a rare variant of pancreatic ductal adenocarcinoma, which is associated with IPMN and mucinous cystic neoplasms. Positive MUC2 staining and absent MUC1 expression are commonly found, and K-ras gene mutation is occasionally identified in these tumors.

Adenocarcinoma, Mucinous ; genetics ; metabolism ; pathology ; surgery ; Adult ; Aged ; Carcinoma, Pancreatic Ductal ; pathology ; Diagnosis, Differential ; Exons ; Female ; Genes, ras ; Humans ; Male ; Middle Aged ; Mucin-1 ; metabolism ; Mucin-2 ; metabolism ; Mutation ; Pancreatic Neoplasms ; genetics ; metabolism ; pathology ; surgery

Adenocarcinoma, Mucinous ; metabolism ; pathology ; surgery ; Aged ; Biomarkers, Tumor ; metabolism ; Carcinoembryonic Antigen ; metabolism ; Carcinoma, Pancreatic Ductal ; metabolism ; pathology ; surgery ; Carcinoma, Papillary ; metabolism ; pathology ; surgery ; Cystadenocarcinoma, Mucinous ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Duodenal Neoplasms ; metabolism ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Mucin-2 ; Mucins ; metabolism ; Neoplasm Invasiveness ; Pancreatic Neoplasms ; metabolism ; pathology ; surgery ; Pancreaticoduodenectomy

OBJECTIVETo study the pathologic features, diagnosis, differential diagnosis and molecular characteristics of intraductal tubulopapillary neoplasm of the pancreas (ITPN).

METHODSThe clinical findings, morphologic features, immunophenotype (by EnVision method) and KRAS gene alterations (by reverse transcriptase-polymerase chain reaction) of 6 cases of ITPN encountered during the period from January, 2001 to June, 2010 were analyzed.

RESULTSThere were altogether 2 males and 4 females. The mean age of the patients was 64 years. Gross examination showed that the tumors were located in large pancreatic ducts and appeared as polypoid nodules with ductal obstruction. Solid tumor nodules associated with adjoining dilated ducts were identified in one case. Histologically, the tumors were characterized by tubulopapillary growth pattern without luminal mucin. The tumor cells showed high-grade nuclear atypia with scanty intracytoplasmic mucin. Intraductal necrotic foci were frequently observed. Immunohistochemical study showed that the tumor cells expressed CK7 and CK19. Focal positivity for MUC5AC was demonstrated. Two cases expressed MUC1. The staining for MUC2 was negative. KRAS gene mutations were identified in 2 cases, with a single-amino-acid substitution in codon 12 (35G > A and 35G > T/34G > A).

CONCLUSIONSITPN is a newly described pancreatic intraductal neoplasm and different from intraductal papillary mucinous neoplasm. ITPN is characterized by intraductal tubulopapillary growth pattern, severe cytologic atypia and scanty mucin secretion.

Aged ; Amino Acid Substitution ; Carcinoma, Pancreatic Ductal ; genetics ; metabolism ; pathology ; surgery ; Carcinoma, Papillary ; genetics ; metabolism ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Keratin-19 ; metabolism ; Keratin-7 ; metabolism ; Ki-67 Antigen ; metabolism ; Male ; Middle Aged ; Mucin 5AC ; metabolism ; Mucin-1 ; metabolism ; Pancreatectomy ; Pancreatic Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo investigate clinicopathological features of fibrous mass-forming chronic pancreatitis (FMCP), to compare clinicopathological and immunohistochemical characteristics between autoimmune pancreatitis (AIP) and fibrous mass-forming non-autoimmune pancreatitis (nAIP) and to provide evidence for pathological diagnosis, differential diagnosis and clinical treatment strategy.

METHODSClinicopathological features were analyzed in 81 cases of FMCP. Infiltrating IgG4(+) plasmacytes were counted by immunohistochemical staining.

RESULTSAmong 81 cases of FMCP, 20 cases were diagnosed as AIP and 61 cases were interpreted as nAIP. AIP was more common in males over 50 years, whereas nAIP was seen in much younger patients (P = 0.001). The amount of inflammatory cells in the stroma of AIPs was remarkable higher than that in nAIPs (P = 0.002). The incidence of neuritis in AIPs (100%, 20/20) was also higher compared with that of nAIPs (75.4%, 46/61; P = 0.017). Storiformed-fibrosis was more common in AIPs (95.0%, 19/20) than in nAIPs (1.6%, 1/61;P = 0.000). Pancreatic intraepithelial neoplasia (PanIN) was observed in 50.0%(10/20) of AIPs and 32.8%(20/61) of nAIPs, with a greater severity observed in AIPs (P = 0.031). Tubular complex (TC) was more commonly observed in AIPs (65.0%, 13/20) than nAIPs (26.2%, 16/61;P = 0.002). Among 81 cases of FMCP, 61 cases had less than 11 IgG4(+) plasmacytes /HPF, 7 cases had 10-30/HPF and 13 cases had over 30/HPF.

CONCLUSIONSFMCPs include both AIP and nAIP. AIP has distinct pathological features and the presence of IgG4(+) plasmacyte is an important diagnostic parameter. FMCP appears to be an important precancerous lesion of pancreatic ductal adenocarcinoma. Surgery may be considered for patients with FMCP due to its mass-forming nature. In contrast, patients with AIP are treated medically due to its steroid-responsiveness. Therefore, accurate and timely diagnosis of AIP is of clinical relevance to avoid unnecessary surgical complications and to prevent progression of the disease.

Adult ; Aged ; Autoimmune Diseases ; immunology ; pathology ; surgery ; Carcinoma, Pancreatic Ductal ; immunology ; pathology ; surgery ; Diagnosis, Differential ; Female ; Fibrosis ; Humans ; Immunoglobulin G ; metabolism ; Male ; Middle Aged ; Pancreas ; pathology ; Pancreatic Neoplasms ; immunology ; pathology ; surgery ; Pancreatitis, Chronic ; immunology ; pathology ; surgery ; Plasma Cells ; immunology ; Precancerous Conditions ; immunology ; pathology ; surgery ; Young Adult

OBJECTIVETo investigate the factors influencing recurrence and metastasis following curative resection of pancreatic ductal adenocarcinoma and analyze the prognosis.

METHODSThe clinicopathological and follow-up data of 56 patients who underwent curative resection for pancreatic ductal adenocarcinoma between Jan. 1997 and Dec. 2006 in this hospital were analyzed retrospectively.

RESULTSThe recurrence rate after curative resection was 73.2% (41/56). The recurrence rate after operation at the time of 3 months, half year, 1 year and 2 years was 26.8% (15/56), 51.8% (29/56), 64.3% (36/56) and 69.6% (39/56), respectively. Hepatic metastasis and local recurrence accounted for 36.6% and 31.7% of the cases, respectively. The 3-year accumulated survival of this group was 22.7%. The symptom presenting time, back pain, preoperative level of CA19-9, tumor size, AJCC stage and T stage were correlated with metastasis/recurrence. Univariate analysis revealed that the preoperative level of CA19-9, T stage and the tumor size were prognostic factors. Cox regression analysis revealed that only tumor size was an independent prognostic factor.

CONCLUSIONThe metastasis or recurrence mostly occurs within 2 years after curative resection, and the liver is the most common site of metastasis. High recurrence rate is the major reason causing the failure of curative resection and short survival time after operation. The symptom presenting time, back pain, preoperative level of CA19-9, tumor size, AJCC stage and T stage are correlated with metastasis/recurrence. The tumor size is an independent prognostic factor.

Adult ; Aged ; CA-19-9 Antigen ; metabolism ; Carcinoma, Pancreatic Ductal ; immunology ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; immunology ; pathology ; surgery ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Tumor Burden