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Histologic and immunohistochemical changes in the stented common bile duct
Elizabeth D Euscher1, William L Marsh, Joel G Lucas
1Department of Pathology, Ohio State University Medical Center, Columbus, OH, USA.
Applied Immunohistochemistry & Molecular Morphology : AIMM
|August 28, 2007
Summary
Biliary stenting in pancreatic cancer patients can cause changes in the common bile duct (CBD) that mimic malignancy. These changes are distinct from cancer and can be identified with immunohistochemistry, aiding accurate diagnosis.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Oncology
Background:
- Pancreatic cancer often requires biliary stenting to relieve obstruction.
- Stent-induced changes in the common bile duct (CBD) can be mistaken for malignancy during surgical resection.
Purpose of the Study:
- To evaluate and differentiate histologic and immunohistochemical changes in stented versus non-stented CBD margins from pancreatic cancer resections.
Main Methods:
- Histologic examination and immunohistochemical staining (Ki-67, p53, c-erbB-2) of CBD margins from stented (n=30), non-stented (n=31) pancreatic cancer resections, and normal CBDs (n=13).
- Comparison of epithelial changes, proliferation index, and protein expression between groups.
Main Results:
- All evaluated histologic changes were more frequent in stented and non-stented CBDs from cancer patients compared to normal CBDs.
- Stented CBDs showed significantly increased epithelial changes and Ki-67 proliferation compared to non-stented CBDs.
- Stented CBDs exhibited significantly lower p53 and c-erbB-2 expression than corresponding pancreatic carcinomas.
Conclusions:
- Histologic changes in stented CBDs are characteristic and usually distinguishable from malignancy.
- Immunohistochemistry can aid in differentiating stent-associated atypia from cancer in challenging cases.
- Caution is advised when interpreting CBD margin atypia in patients with prior biliary stenting.
