Cancer-associated alterations of blood group antigen expression in the human pancreas

Certain alterations of blood group substance (BGS) expression have been observed in gastrointestinal cancer tissues. However, in the pancreas little is known about BGS expression by normal or malignant tissue. The present immunohistochemical study analyzed simultaneously the expression of A, B, H, Lewisa (Lea), and Lewisb (Leb) antigens in specimens of normal pancreas, chronic pancreatitis, and pancreatic carcinoma (primary and metastatic). In normal pancreas all five antigens were expressed in ducts, ductules, and acini, but not in islets. Acinar cells expressed A, B, H, and Leb in supranuclear cytoplasm, whereas Lea was found mainly on centroacinar cells. Only BGSs that were appropriate for the host's blood type were expressed, except for one case of Lea deletion. BGS expression by chronic pancreatitis tissue closely resembled that by normal tissue. In primary pancreatic cancer two cancer-associated alterations were noted that were not found in either normal pancreas or chronic pancreatitis. Deletion of an expected A, B, H, or Leb antigen occurred in approximately 25% of cases, particularly in more poorly differentiated cancers. Incompatible expression of an unexpected A or B antigen occurred in 33% of cases, regardless of degree of differentiation. Metastatic pancreatic cancers also exhibited BGS deletion and incompatibility. In both primary and metastatic cancers the incidence of incompatible A or B expression was higher in cancers from the United States than in cancers from Japan, but the incidence of BGS deletion was similar between the two countries. It was concluded that deletion of A, B, H, or Leb antigens and incompatible expression of A or B antigens are cancer-associated events in the pancreas.