muramidase and Common-Bile-Duct-Neoplasms

We describe a Paneth cell carcinoma arising within the ampulla of Vater in a 64-year-old man. The phenotype of virtually all neoplastic cells was consistent with that of Paneth cells, based on routine morphology and their strong positive immunostaining for lysozyme. Additional widespread positive immunostaining for carcinoembryonic antigen and CA 19.9 supports a totipotential cell as the origin of such neoplastic cells. This case, therefore, represents a true Paneth cell carcinoma, as opposed to inclusion of occasional neoplastic Paneth cells into a poorly differentiated adenocarcinoma. This pattern of differentiation is rare, and predictions regarding its ultimate biological behavior and malignant potential must be guarded.

Topics: Adenocarcinoma; Ampulla of Vater; Biomarkers, Tumor; CA-19-9 Antigen; Carcinoembryonic Antigen; Carcinoma; Cell Differentiation; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy, Laparoscopic; Cholelithiasis; Common Bile Duct Neoplasms; Diagnostic Errors; Humans; Male; Middle Aged; Muramidase; Neoplasm Proteins; Neoplastic Stem Cells; Pancreaticoduodenectomy; Paneth Cells; Totipotent Stem Cells

The aim of this study was to investigate the differences between the clinicopathological findings in two histologic types of carcinoma of the papilla of Vater. We histologically classified carcinoma of the papilla into two types: 1) an intestinal type that resembles tubular adenocarcinoma of the stomach or colon, and 2) a pancreaticobiliary type that is characterized by papillary projections with scant fibrous cores. We examined 53 cases of resected carcinoma of the papilla. The intestinal-type carcinomas were similar to the intestinal mucosa in that they had lysozyme-containing, Paneth or argyrophil cells, as demonstrated by the immunohistochemically positive stainings for the anti-lysozyme antibody. Although both the sizes of the two types of carcinomas and the age distributions of cases with the two types of carcinoma were almost the same, the prognosis of the cases with the intestinal type was much better than that of the cases with the pancreaticobiliary type. Histological lymph node metastasis was found significantly more often in the pancreaticobiliary type. This result was supported by the fact that small carcinomas of the intestinal type showed little or no invasion into the surrounding interstitium, as opposed to the pancreaticobiliary type, which had a strong infiltrative tendency. The pathogenesis of carcinoma of the papilla of Vater should be further evaluated, taking into consideration the existence of these two histologic types.

Topics: Adult; Aged; Aged, 80 and over; Ampulla of Vater; Carcinoma; Common Bile Duct Neoplasms; Female; Humans; Immunoenzyme Techniques; Intestinal Mucosa; Intestinal Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Muramidase; Neoplasm Invasiveness; Pancreatic Neoplasms; Prognosis; Staining and Labeling; Survival Analysis; Survival Rate

An immunoperoxidase technique has been utilized for the localization of carcinoembryonic antigen (CEA), secretory component (SC) and lysozyme ( LZ ) in normal and cancerous common bile duct tissues. Little or no CEA was found in the non-cancerous common bile duct tissues. SC was found in the surface epithelium and accessory gland epithelium and LZ was demonstrated only in the accessory glands. Some inflammatory cells were also positively stained for LZ . In adenocarcinoma, CEA was always present on the luminar border of the carcinoma cells, occasionally with intercellular and intracellular localization. LZ was absent, or only faintly detected in carcinoma. SC was generally distributed in well-differentiated adenocarcinoma cells, but showed a reduced intensity of staining with progressive dedifferentiation. These findings suggest that CEA, SC and LZ could be useful markers providing valuable information in the pathological diagnosis of bile duct carcinoma.

Topics: Adenocarcinoma; Animals; Carcinoembryonic Antigen; Common Bile Duct; Common Bile Duct Neoplasms; Histocytochemistry; Humans; Immunoenzyme Techniques; Immunoglobulin Fragments; Muramidase; Rabbits; Secretory Component