Invasive IPMC with Two Cell Types Noninvasive and Invasive Components

Invasive IPMC with a Mucinous Noncystic Carcinoma Invasive Component

Among invasive IPMC, noninvasive component cells have papillary-cohesive clusters, suspicious of malignancy, and polyclonal-like cytoplasm (fig. 7a), while invasive component cells (mucinous noncystic carcinoma) have a

Fig. 5. Noninvasive IPMC with special type goblet cells. a Periodic acid-sodium boro-hydride-potassium hydroxide-periodic acid Schiff (a special marker of goblet cells of the large intestine) stains pink (arrows). Periodic acid-sodium borohydride-potassium hydroxide-periodic acid Schiff stain. X200. b The cells that differentiated the goblet cells of the large intestine are classic goblet cells. This patient survived with carcinoma for two years after first surgery, and was then re-operated on. The histology at re-operation remained noninvasive IPMC, the same as the initial histology. There has been no recurrence for eight years after the re-operation HE. X200.

Fig. 5. Noninvasive IPMC with special type goblet cells. a Periodic acid-sodium boro-hydride-potassium hydroxide-periodic acid Schiff (a special marker of goblet cells of the large intestine) stains pink (arrows). Periodic acid-sodium borohydride-potassium hydroxide-periodic acid Schiff stain. X200. b The cells that differentiated the goblet cells of the large intestine are classic goblet cells. This patient survived with carcinoma for two years after first surgery, and was then re-operated on. The histology at re-operation remained noninvasive IPMC, the same as the initial histology. There has been no recurrence for eight years after the re-operation HE. X200.

b a sheet-solid loose clusters with monoclonal-like cytoplasm and are conclusive for malignancy (fig. 7b). The histology is shown in figure 8 (at left: noninvasive IPMC, at right: mucinous noncystic carcinoma).

Invasive IPMC with an IDA Invasive Component

Among invasive IPMC, noninvasive component cells are small nuclei (about 10 |xm in short diameter), with euchromatin, strongly suspicious of malignancy, clearly defined cytoplasmic borders, sheet-papillary-cohesive clusters, and a monoclonal-like appearance (upper part of fig. 9). Invasive component (IDA) cells are coarsely granular chromatin, are in a sheet-like arrangement, have large nuclei (> 15 |xm at the shortest diameter), are conclusive for malignancy, and are monoclonal (lower portion of fig. 9). The histology is shown in fig. 10 (at right: noninvasive IPMC, at left: IDAP).

Fig. 6. Noninvasive IPMC with special type goblet cells. Cytology of the case in figure 5. a, b The cells differentiating to goblet cells of the large intestine appear to have characteristic clearly defined cytoplasmic boundaries, lucent cytoplasmic contents and lucent brush borders (arrows). It is safe to say that they were indeed classic goblet cells. ERCP, Papanicolaou stain. X400.

Fig. 6. Noninvasive IPMC with special type goblet cells. Cytology of the case in figure 5. a, b The cells differentiating to goblet cells of the large intestine appear to have characteristic clearly defined cytoplasmic boundaries, lucent cytoplasmic contents and lucent brush borders (arrows). It is safe to say that they were indeed classic goblet cells. ERCP, Papanicolaou stain. X400.

In the spread of IDAP, there are two types of intraductal spread [5, 31], noninvasive and ordinary invasive spread [1, 7, 23, 31, 32], and PanIN-31 is detected as noninvasive intraductal spread [5, 31]. PanIN-3 is commonly found in association with IDAP [33-35], and the lesions are present in 30-50% of pancreata with IDAP [33, 36-39]. This association alone suggests that at least the higher grades of PanIN can be precursors of invasive carcinoma [40]. PanIN-3 was established as a term for high grade pancreatic intraepithelial neoplasia in substitution for SD/CIS by the World Health Organization (WHO) [1], because it is very difficult, if not impossible, to draw a clear distinction between SD and CIS [1]. IDAP with intraductal spread is frequently of a well-differentiated type [23, 31] and shows a tendency, although not significant, to be associated with longer survival than those without intraductal spread [31]. Accordingly, if PanIN-3 is found in IDAP samples, it may be expected that the pancreatic cancer will have a better prognosis than IDAP without PanIN-3, a

Fig. ZInvasive IPMC (Invasive components mucinous noncystic carcinoma). a Noninvasive IPMC has a relatively clearly defined cytoplasmic border and a mixture of goblet cells, and is polyclonal-like (arrow cells stain pale red, the remaining cells stain green). Scrap smear, Papanicolaou stain. X400. b Invasive components are a mucinous non-cystic carcinoma, with a poorly defined cytoplasmic border and are monoclonal-like appearance. a and b are the same magnification. Scrap smear, Papanicolaou stain. X400.

Fig. ZInvasive IPMC (Invasive components mucinous noncystic carcinoma). a Noninvasive IPMC has a relatively clearly defined cytoplasmic border and a mixture of goblet cells, and is polyclonal-like (arrow cells stain pale red, the remaining cells stain green). Scrap smear, Papanicolaou stain. X400. b Invasive components are a mucinous non-cystic carcinoma, with a poorly defined cytoplasmic border and are monoclonal-like appearance. a and b are the same magnification. Scrap smear, Papanicolaou stain. X400.

a provided that the tumor size, site and stage are similar. However, there are no reports on a differential diagnosis between PanIN-3 and IDAP except for one report showing that 'there was no cytologic difference between CIS and invasive carcinoma' [41]. PanINs and IPMNs histologically share many fundamental features [27, 40, 42, 43]. In fact, a given focus of intraductal neoplasia may be almost impossible to classify by morphology alone [40]. This is because both are equally inherently intraductal, both are composed predominantly of columnar, mucin-producing cells that may grow in a flat configuration or produce papillae, both exhibit a range of cytologic and architectural atypia, both are recognized as precursors to invasive adenocarcinoma, and both sequentially accumulate similar genetic alterations with increasing cytoarchitectural atypia [44, 45]. These features confirm that cytologic features of PanIN-3 are similar to those of IPMC.

Fig. 8. Invasive IPMC (Invasive components mucinous noncystic carcinoma). Histology corresponds to figure 7. The left side corresponds to noninvasive IPMC, and the right side to the invasive component (mucinous noncystic carcinoma) HE. X200.

Was this article helpful?

0 0

Post a comment