TY - JOUR
T1 - Immunohistochemical Loss of DPC4 in Tumors With Mucinous Differentiation Arising in or Involving the Gynecologic Tract
AU - Kwon, Dong Hyang
AU - Malpica, Anais
AU - Zaleski, Michael
AU - Euscher, Elizabeth D.
AU - Ramalingam, Preetha
N1 - Funding Information:
From the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Presented in part at the 109th Annual Meeting of the United States and Canadian Academy of Pathology. February 28 to March 5, 2020. Los Angeles, CA. Supported by the Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center. The authors declare no conflict of interest. Address correspondence to Preetha Ramalingam, MD, Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, P.O. Box 85, Houston, TX 77030. E-mail: pramalingam@mdanderson.org.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - DPC4 immunohistochemistry (IHC) is usually part of the work-up of mucinous neoplasms in the ovary where the distinction between an ovarian primary and metastatic pancreaticobiliary adenocarcinoma (PanACa) must be made. Although DPC4 IHC is lost in about 55% (46%-61%) of PanACas and typically retained in most primary ovarian mucinous neoplasms, no study has evaluated the expression of this marker in a large cohort of neoplasms arising in or involving gynecologic (GYN) organs. In this study, we retrospectively analyzed the expression of DPC4 IHC in a total of 251 tumors and lesions related to the GYN tract in which DPC4 IHC stain was performed during the initial pathology evaluation. Of these, 138 were primary GYN tumors and lesions, 31 were metastatic GYN tumors involving non-GYN sites, and 83 were metastatic non-GYN tumors involving the GYN tract. We identified 27 cases with loss of DPC4 IHC expression of which 20 cases met the inclusion criteria (i.e. clinical information was available to determine the site of tumor origin). We observed that loss of DPC4 nuclear expression was most commonly seen in tumors of endocervical origin (n=7), of which 5 were gastric-type cervical adenocarcinomas (GCxACa) and 2 were usual-type cervical adenocarcinomas, either primary or metastatic. This was followed by tumors of the pancreaticobiliary tract (n=5), ovary (n=2), and appendix (n=1). In addition, 1 gastric-type vaginal adenocarcinoma (GVaACa) also showed loss of DPC4. Our findings indicate that in female patients with mucinous neoplasms involving the ovary or other sites, with loss of DPC4 by IHC, and negative pancreaticobiliary imaging, the possibility of an occult GCx/GVaACa, and rarely an ovarian primary must be considered.
AB - DPC4 immunohistochemistry (IHC) is usually part of the work-up of mucinous neoplasms in the ovary where the distinction between an ovarian primary and metastatic pancreaticobiliary adenocarcinoma (PanACa) must be made. Although DPC4 IHC is lost in about 55% (46%-61%) of PanACas and typically retained in most primary ovarian mucinous neoplasms, no study has evaluated the expression of this marker in a large cohort of neoplasms arising in or involving gynecologic (GYN) organs. In this study, we retrospectively analyzed the expression of DPC4 IHC in a total of 251 tumors and lesions related to the GYN tract in which DPC4 IHC stain was performed during the initial pathology evaluation. Of these, 138 were primary GYN tumors and lesions, 31 were metastatic GYN tumors involving non-GYN sites, and 83 were metastatic non-GYN tumors involving the GYN tract. We identified 27 cases with loss of DPC4 IHC expression of which 20 cases met the inclusion criteria (i.e. clinical information was available to determine the site of tumor origin). We observed that loss of DPC4 nuclear expression was most commonly seen in tumors of endocervical origin (n=7), of which 5 were gastric-type cervical adenocarcinomas (GCxACa) and 2 were usual-type cervical adenocarcinomas, either primary or metastatic. This was followed by tumors of the pancreaticobiliary tract (n=5), ovary (n=2), and appendix (n=1). In addition, 1 gastric-type vaginal adenocarcinoma (GVaACa) also showed loss of DPC4. Our findings indicate that in female patients with mucinous neoplasms involving the ovary or other sites, with loss of DPC4 by IHC, and negative pancreaticobiliary imaging, the possibility of an occult GCx/GVaACa, and rarely an ovarian primary must be considered.
KW - Adenocarcinoma
KW - DPC4
KW - Gastric-type cervical
KW - Gastric-type vaginal
KW - Mucinous carcinoma
KW - Ovary
KW - Pancreaticobiliary tract
KW - SMAD4
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UR - http://www.scopus.com/inward/citedby.url?scp=85102423643&partnerID=8YFLogxK
U2 - 10.1097/PGP.0000000000000754
DO - 10.1097/PGP.0000000000000754
M3 - Article
C2 - 33405429
AN - SCOPUS:85102423643
SN - 0277-1691
VL - 40
SP - 523
EP - 532
JO - International Journal of Gynecological Pathology
JF - International Journal of Gynecological Pathology
IS - 6
ER -