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Pancreatic acinar cell clusters in pediatric gastric mucosa
S Krishnamurthy1, M J Integlia, R J Grand
1Department of Pathology, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Insights
Clusters of pancreatic acinar cells (CPACs) were found in the gastric antral mucosa of children, a novel finding. These cells expressed pancreatic exocrine markers and some had hybrid amphicrine features.
Area of Science:
- Gastroenterology
- Pediatric Pathology
- Cell Biology
Background:
- Clusters of pancreatic acinar cells (CPACs) are documented in adult gastric mucosa.
- CPACs have not been previously described in pediatric gastric biopsies.
Purpose of the Study:
- To investigate the presence and characteristics of CPACs in pediatric gastric mucosal biopsies.
- To determine if CPACs exhibit pancreatic exocrine marker expression and amphicrine features in children.
Main Methods:
- Retrospective review of 283 pediatric gastric mucosal biopsies (antral and corpus).
- Immunohistochemical staining for pancreatic exocrine markers (trypsin, chymotrypsin, alpha-amylase, lipase) and regulatory substances.
- Double immunostaining for chromogranin/trypsin and mucin/trypsin; ultrastructural examination in one case.
Main Results:
- CPACs detected in 10 of 239 antral biopsies, exclusively in the antrum.
- CPACs were positive for all tested pancreatic exocrine markers.
- Hybrid (amphicrine) cells coexpressing chromogranin and trypsin were observed in all CPACs; some cells contained zymogen and neurosecretory granules.
Conclusions:
- This study reports CPACs in pediatric gastric antral mucosa for the first time.
- The presence of hybrid cells suggests CPACs arise from aberrant stem cell differentiation.
- CPACs in the antrum may be due to sampling bias, but their unique cellular features are significant.
Abstract:
Although clusters of pancreatic acinar cells (CPACs) have been reported in gastric mucosa of adults, they have not been described in children. We reviewed 283 pediatric gastric (239 antral and 44 corpus) mucosal biopsies during a 2-year period and detected CPACs in 10 antral biopsy samples. These biopsy samples were stained immunohistochemically for pancreatic exocrine markers (trypsin, chymotrypsin, alpha-amylase, and lipase) and a panel of regulatory substances (insulin, glucagon, somatostatin, pancreatic polypeptide, gastrin, and serotonin). Double immunostaining for colocalization of chromogranins and trypsin as well as mucin and trypsin also were performed on all cases. CPACs were seen in antral mucosa in a background of either normal or minimally inflamed mucosa, without any atrophy or metaplasia, and were positive for all pancreatic exocrine markers. Stray chromogranin-positive cells in the CPACs were also immunopositive for somatostatin, gastrin, or serotonin. All CPACs showed a few hybrid (amphicrine) cells that coexpressed both chromogranin and trypsin. In one case, ultrastructural examination showed such cells to contain both zymogen and neurosecretory granules. Although the presence of CPACs exclusively in the antrum is most likely the result of a sampling bias, the presence of hybrid cells with an amphicrine phenotype suggests that CPACs probably result from an aberration of stem cell differentiation.