Journal of Surgical Oncology 4958-62 (1992)

lmmunohistochemical Characteristics of Adenosquamous Carcinoma of the Pancreas KOlCHl MOTOJIMA, MD, TSUTOMU TOMIOKA, MD, NORlHlRO KOHARA, MD, TSUKASA TSUNODA, MD, AND TAKASHI KANEMATSU, MLI From the Second Department of Surgery, University of' Nagasaki School of Medicine, Nagasaki, lapan

Six patients with adenosquamous carcinoma (ASqC) of the pancreas were studied clinicopathologically and immunohistochemically . In five of six ASqC tumors, both malignant squamous and glandular elements were reactive with CA 19-9, ST 439, and keratin antibodies. In contrast, a portion of the glandular element in the remaining one ASqC was reactive with CA 19-9 and ST 439 antibodies, but that of the squamous cell carcinoma (SqCC) was not reactive. However, SqCC of this tumor was intensely reactive with keratin antibody. These immunohistochemical results suggest that the histogenesis in one ASqC tumor was different from that of the other 5 ASqCs, and that this tumor may be a collision tumor rather than transformation to SqCC from adenocarcinoma, which is a very rare pattern of histogenesis in ASqC. The patients with ASqC of the pancreas showed shorter survivals following operations because of systemic metastasis including liver metastasis. KEYWORDS:pancreatic carcinoma, adenosquamous carcinoma, monoclonal antibody

INTRODUCTION Carcinoma containing both squamous and glandular elements is found in the many digestive organs in which adenocarcinomas are predominantly found. The definition of adenosquamous carcinoma (ASqC) of the pancreas has been poorly described [ 1-31, The histologic classification, even for lung tumors, by the World Health Organization (WHO) indicated simply that ASqC is composed of both squamous cell carcinomatous and adenocarcinomatous components, and these criteria were not sufficiently detailed [4]. The incidence of ASqC varied from 3.0-1 I . 1% in previously published reports [I-31. Although there are several theories regarding the histogenesis of ASqC, the histogenesis of ASqC of the pancreas remains unclear. In this paper, we report the clinical and immunohistochemical characteristics in six cases of ASqC of the pancreas to investigate the histogenesis of these carcinomas.

PATIENTS AND METHODS Patients Two-hundred and two patients were diagnosed with primary pancreatic carcinoma at the Second Department of Surgery, Nagasaki University Hospital in the period 0 1992 Wiley-Liss, Inc.

from 1971-1988. Of the 202 patients, 57 had undergone surgical resection. Of the remaining 145 patients, 85 had histologic evidence of pancreatic malignancy from biopsy or autopsy specimens. Six patients with ASqC were reviewed from the files of our department. Formalinfixed and paraffin-embedded tumor samples were available for all these cases. Each paraffin block was sliced into 5 pm thick sections. After staining with hematoxylin and eosin (HE), tissues were examined microscopically. Selected sections were stained with periodic acid Schiff (PAS), mucicarmine and alcian blue for mucin staining, and then were used for immunohistochemical study.

Immunohistochemical Study For immunoperoxidase study, the avidin-biotin complex (ABC) (Vectastain ABC kit, Burlingame, CA) method was used. The primary monoclonal antibodies (MAbs) directed against carbohydrate antigen (CA 19-9) (Dakopatts, Copenhagen, Denmark) [5,6] and NCC-ST4-39 (ST 439) (Nihon Kayaku Co., Tokyo) [7,8] which is Accepted for publication October 16, 109 I . Address reprint requests to Koichi Motojima, MD, Second Department of Surgery, University of Nagasaki School of Medicine, 7-1 Sakamoto-machi ,Nagasaki, 852, Japan.

Adenosquamous Carcinoma of the Pancreas

59

TABLE I. Clinical Findings of Patients With ASaC Case

Age1 sex

I

53 F

2

52 M

3

Symptoms

Tumor Locationlsize (cm)

Surgical procedure

Tumor stage

Material for diagnosis

Bypass

IV

Biopsy

IV

6

Distal pancreatectomy Pancreatoduodenectomy Pancreatoduodenectomy None

IV

Resected specimen Resected specimen Resected specimen Autopsy

5

IORa

IV

Autopsy

10

Tail Body and tail Head

7

75 M

Abdominal pain Abdominal pain Jaundice

4

75 F

Jaundice

Head

6

5

81 F

6

64 F

Abdominal pain Abdominal Dain

Body and tail Head

3

I1

IV

Outcome death cause Dead 2 months systemic metastasis Dead 3 months systemic metastasis Dead 10 months liver metastasis Dead 8 months liver metastasis Dead 2 months liver metastasis Dead 4 months liver metastasis

aIOR = intraoperative radiation.

TABLE 11. Amounts of Adenosquamous and Squamous Elements in Primarv and Metastatic Tumors* Amounts of both foci Case 1 2

3 4 5 6

Primarv Ade>Sq Ade

Immunohistochemical characteristics of adenosquamous carcinoma of the pancreas.

Six patients with adenosquamous carcinoma (ASqC) of the pancreas were studied clinicopathologically and immunohistochemically. In five of six ASqC tum...
1MB Sizes 0 Downloads 0 Views