Noninvasive IPMC with a Special Type of Goblet Cell

In IPMC, there is a noninvasive IPMC with a special type of goblet cell that has a clinically very good prognosis and suggests only a noninvasive carcinoma, ruling out benign lesion (normal epithelia, mucinous metaplasia, papillary hyperplasia, atypical hyperplasia) and invasive carcinoma [28]. In carbohydrate histochemistry, these goblet cells were shown to be differentiated goblet cells of the large intestine (staining with dye 8-O-acetylated N-acetyl-neuraminic acid that is a special marker of goblet cells of the large intestine: periodic acid-sodium borohydride-potassium hydroxide-periodic acid Schiff stain [29, 30] is positive). In our hospital, this staining has been performed for 10 IPMC cases, but we have found only one positive case (fig. 5). This case was operated on, and the patient survived with a stump-positive carcinoma for two years from first surgery. Then, a re-operation was performed. The histology has

Fig. 4. Clonality of benign IPMN (hyperplasia), noninvasive IPMC and IDA. a Benign IPMN (arrows exhibit goblet cells, including orange mucin). Vinyl tube aspiration of the main duct of the resected pancreas, Papanicolaou stain. X400 and b noninvasive IPMC (arrows show goblet cells, including translucent mucin). ERCP, Papanicolaou stain. X400 show a polyclonal pattern. c IDA are monoclonal-like. Scrap smear, Papanicolaou stain. X400. Mixture of goblet cells that is often observed in benign IPMN (a) and noninvasive IPMC (b) shows polyclonality. In contrast, a mixture of goblet cells is hardly found in IDA cases (c).

Fig. 4. Clonality of benign IPMN (hyperplasia), noninvasive IPMC and IDA. a Benign IPMN (arrows exhibit goblet cells, including orange mucin). Vinyl tube aspiration of the main duct of the resected pancreas, Papanicolaou stain. X400 and b noninvasive IPMC (arrows show goblet cells, including translucent mucin). ERCP, Papanicolaou stain. X400 show a polyclonal pattern. c IDA are monoclonal-like. Scrap smear, Papanicolaou stain. X400. Mixture of goblet cells that is often observed in benign IPMN (a) and noninvasive IPMC (b) shows polyclonality. In contrast, a mixture of goblet cells is hardly found in IDA cases (c).

remained noninvasive IPMC, the same as the initial histologic diagnosis. There has been no recurrence for eight years after the re-operation. The goblet cells of the large intestine were characteristic of clearly defined cytoplasmic boundaries and lucent cytoplasmic contents with lucent brush borders;it may therefore be safely said that they were classic goblet cells (fig. 6).

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