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Intraductal oncocytic papillary neoplasms of the pancreas and bile ducts: a description of five new cases and review based on a systematic survey of the literature

  • Review article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background

Intraductal oncocytic papillary neoplasms (IOPN) are rare tumors of the pancreatic and biliary ductal system. It is not absolutely clear if the molecular and clinicopathologic characteristics of IOPN differ significantly from other related lesions, namely intraductal papillary mucinous neoplasms (IPMN). Therefore it is not clear if it is reasonable to consider IOPN as a separate diagnostic and clinical entity.

Methods

In order to describe the clinicopathologic characteristics of IOPN and to compare them with the IPMN profile, we performed a systematic review of the literature and additionally studied five previously unreported IOPN cases.

Results

IOPN differ from IPMN by lack of K-ras gene mutations in all studied cases. Several differences in the clinical and biological profile between IOPN and IPMN exist, but they are of quantitative rather than of qualitative nature. Additionally, pancreaticobiliary or gastric-foveolar IPMN components may coexist with IOPN component within a single lesion, which suggests at least a partial relation of the pathogenetic pathways of IPMN and IOPN. Importantly, the pathogenesis of accumulation of mitochondria and oxyphilic appearance of IOPN remains unknown.

Conclusions

At present, there are no reliable criteria other than histopathological picture and K-ras gene status to differentiate IOPN from IPMN. In particular, no clear differences in optimal treatment options and prognosis between these tumors are known. Further studies are needed to clarify the biology of IOPN and to establish their position in clinicopathologic classifications of pancreatic tumors.

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Authors and Affiliations

  1. Department of Histopathology, Medical University of Silesia, ul. Medyków 18, 40-754, Katowice, Poland

    Łukasz Liszka, Jacek Pająk & Ewa Zielińska-Pająk

  2. Department of Epidemiology, Medical University of Silesia, ul. Medyków 18, 40-754, Katowice, Poland

    Łukasz Krzych

  3. Department of Pathology, Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR, UK

    Dariusz Gołka

  4. Department of Gastrointestinal Surgery, Medical University of Silesia, ul. Medyków 18, Katowice, 40-754, Poland

    Sławomir Mrowiec & Paweł Lampe

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  1. Łukasz Liszka
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Correspondence to Łukasz Liszka.

Electronic supplementary material

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Fig. 1. Details of neoplastic cells of a noninvasive lesion. Cytoplasm is eosinophilic and granular. Round nuclei with single distinct nucleoli. Significant nuclear atypia, mitotic figures, pseudostratification and stratification of cells indicate high-grade lesion (noninvasive carcinoma, invasive component not visualized in this field). Hematoxylin and eosin. Magnification 100x. (JPG 465 kb)

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Fig. 2. In some cases cells with abundant mucin resembling gastric foveolar cells (left) may be found. Hematoxylin and eosin. Magnification 100x. (JPG 484 kb)

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Fig. 3. Intraductal solid tumor nodule composed of oncocytic cells forming glandular structures, sometimes with micropapillary projections (center). Some cells have large, hyperchromatic nuclei (center). Hematoxylin and eosin. Magnification 100x. (JPG 547 kb)

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Fig. 4. Some portions of the noninvasive component may resemble pancreatic intraepithelial neoplasia. Two ducts lined with oncocytes with significant nuclear atypia, forming micropapillae. Hematoxylin and eosin. Magnification 100x. (JPG 517 kb)

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Fig. 5. In some areas the intraductal component may be flat and devoid of papillae. As noted earlier, abundant supranuclear mucin may be found in some cells. Note numerous inflammatory cells in edematous stroma. Hematoxylin and eosin. Magnification 200x. (JPG 364 kb)

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Fig. 6. Abundance of mitochondria in oncocytic cells visualized with phosphotungstic acid-hematoxylin stain. Magnification 200x. (JPG 435 kb)

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Fig. 7. Granular cytoplasmic staining with HepPar1 antibody in oncocytic cells is not a proof of hepatoid differentiation. Magnification 400x. (JPG 248 kb)

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Fig. 8. Another example of invasive carcinoma derived from intraductal oncocytic papillary neoplasm. Fused glands form cribriform structures. Hematoxylin and eosin. Magnification 100x. (JPG 460 kb)

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Fig. 9. In this case of invasive adenocarcinoma associated with intraductal oncocytic papillary neoplasm, glands are formed of cuboidal cells with less pronounced eosinophilia. Distinct nucleoli are clearly visible. Note desmoplastic stroma surrounding glands. Hematoxylin and eosin. Magnification 100x. (JPG 413 kb)

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Fig. 10. Metastasis of invasive carcinoma with oncocytic features to the lymph node. Distended glands lined by oncocytic cells forming micropapillae. Hematoxylin and eosin. Magnification 40x. (JPG 548 kb)

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Fig. 11. Mixed carcinoma derived from intraductal oncocytic papillary neoplasm was composed of colloid component and less pronounced tubular component (not presented in the figure). Colloid carcinoma was composed of neoplastic cells floating in the abundant pools of mucin. The invasive component retained its oncocytic appearance [eosinophilic cytoplasm and round nuclei with prominent nucleoli (right)]. The intraductal portion of the neoplasm (left) is seen in proximity to the invasive lesion. Hematoxylin and eosin. Magnification 100x. (JPG 373 kb)

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Fig. 12. In consecutive sections stained with phosphotungstic acid-hematoxylin, the oncocytic nature of both intraductal and invasive component may be seen. Magnification 100x. (JPG 396 kb)

Supplementary material 13 (DOC 114 kb)

Supplementary material 14 (DOC 107 kb)

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Liszka, Ł., Pająk, J., Zielińska-Pająk, E. et al. Intraductal oncocytic papillary neoplasms of the pancreas and bile ducts: a description of five new cases and review based on a systematic survey of the literature. J Hepatobiliary Pancreat Sci 17, 246–261 (2010). https://doi.org/10.1007/s00534-010-0268-2

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