Basturk O,Tan M,Bhanot U,Allen P,Adsay V,Scott SN,Shah R,Berger MF,Askan G,Dikoglu E,Jobanputra V,Wrzeszczynski KO,Sigel C,Iacobuzio-Donahue C,Klimstra DS
Abstract
In 2010, the World Health Organization reclassified the entity originally described as intraductal oncocytic papillary neoplasm as the 'oncocytic subtype' of intraductal papillary mucinous neoplasm. Although several key molecular alterations of other intraductal papillary mucinous neoplasm subtypes have been discovered, including common mutations in KRAS, GNAS, and RNF3, those of oncocytic subtype have not been well characterized. We analyzed 11 pancreatic 'oncocytic subtype' of intraductal papillary mucinous neoplasms. Nine pancreatic 'oncocytic subtype' of intraductal papillary mucinous neoplasms uniformly exhibited typical entity-defining morphology of arborizing papillae lined by layers of cells with oncocytic cytoplasm, prominent, nucleoli, and intraepithelial lumina. The remaining two were atypical. One lacked the arborizing papilla and had flat oncocytic epithelium only; the other one had focal oncocytic epithelium in a background of predominantly intestinal subtype intraductal papillary mucinous neoplasm. Different components of this case were analyzed separately. Formalin-fixed, paraffin-embedded specimens of all cases were microdissected and subjected to high-depth-targeted next-generation sequencing for a panel of 300 key cancer-associated genes in a platform that enabled the identification of sequence mutations, copy number alterations, and select structural rearrangements involving all targeted genes. Fresh frozen specimens of two cases were also subjected to whole-genome sequencing. For the nine typical pancreatic 'oncocytic subtype' of intraductal papillary mucinous neoplasms, the number of mutations per case, identified by next-generation sequencing, ranged from 1 to 10 (median=4). None of these cases had KRAS or GNAS mutations and only one had both RNF43 and PIK3R1 mutations. ARHGAP26, ASXL1, EPHA8, and ERBB4 genes were somatically altered in more than one of these typical 'oncocytic subtype' of intraductal papillary mucinous neoplasms but not in the other two atypical ones. In the neoplasm with flat oncocytic epithelium, the only mutated gene was KRAS. All components of the intestinal subtype intraductal papillary mucinous neoplasms with focal oncocytic epithelium manifested TP53, GNAS, and RNF43 mutations. In conclusion, this study elucidates that 'oncocytic subtype' of intraductal papillary mucinous neoplasm is not only morphologically distinct but also genetically distinct from other intraductal papillary mucinous neoplasm subtypes. Considering that now its biologic behavior is also being found to be different than other intraductal papillary mucinous neoplasm subtypes, 'oncocytic subtype' of intraductal papillary mucinous neoplasm warrants being recognized separately.
摘要
2010年,世界卫生组织将胰腺肿瘤中曾称为导管内嗜酸细胞性乳头状肿瘤重新归为导管内乳头状粘液性肿瘤嗜酸细胞亚型。虽然已经发现其它亚型的导管内乳头状黏液性肿瘤的几个关键分子改变,包括常见的基因突变如KRAS、GNAS和RNF3,但是嗜酸细胞亚型还没有发现有特征性改变的基因。
我们分析了11例嗜酸细胞型胰腺导管内乳头状黏液性肿瘤,9例均表现出该肿瘤形态学定义中的树枝状突起,嗜酸性胞质,突出的核仁和上皮管腔。另外2例形态不典型。1例缺乏树枝状乳头排列,只有嗜酸性扁平上皮细胞。另1例在肠型导管内乳头状黏液性肿瘤背景上有嗜酸性上皮,我们对这例的不同组分分别进行了分析。所有标本经福尔马林固定,石蜡包埋,切片,并进行高深度的针对性新一代基因测序,检测一段由300个癌症相关基因组成的关键序列,识别序列突变、拷贝数变化,及涉及所有靶基因的结构性重排。对2例新鲜冰冻标本进行全基因组测序。对9例典型的嗜酸细胞型胰腺导管内乳头状黏液性肿瘤由新一代测序确定每例突变数,范围从1到10(中位数= 4)。这些病例没有KRAS或GNAS基因突变,只有1例有RNF43和PIK3R1基因突变。这些典型嗜酸细胞型导管内乳头状黏液性肿瘤有一个以上的ARHGAP26、ASXL1、EPHA8和ErbB4基因体细胞改变,而其它两个非典型病例则没有这个特点,嗜酸扁平上皮细胞肿瘤只有KRAS基因突变。 具有嗜酸上皮细胞的肠型导管内乳头状黏液性肿瘤的所有组分表现出TP53、GNAS和RNF43突变。
总之,本研究表明导管内乳头状黏液性肿瘤的嗜酸细胞亚型不仅在形态上,而且基因也不同于其它亚型的导管内乳头状黏液性肿瘤。目前考虑到嗜酸细胞型导管内乳头状黏液性肿瘤的生物学行为不同于其它亚型的导管内乳头状黏液性肿瘤,诊断时应明确标明亚型。
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