CA19-9 and CK immunohistochemical expression in pancreatic and ampulla of vater carcinomas (A clinicopathological study

Abstract

Background: Pancreatic carcinoma is one the most lethal malignancies and the Prognosis for patients with locally advanced or metastatic disease is poor. The 5-year survival rate is about 4%, which is the lowest of any cancer and median survival is 6 months. The high mortality rate is largely due to the typically advanced stage of the cancer at the time of diagnosis and treatment. Resection is the only current treatment resulting in cure for pancreatic carcinoma. However, due to the initiation and progression of this cancer without symptoms, only about 10% to 15% of patients present with localized disease amenable to potentially curative resection. Chemotherapy increases survival and up to date, the use of palliative chemotherapy is increasing due to the availability of more drugs and a wider range of indications. CA 19–9 is the marker most widely used clinically as elevated in approximately 75% of patients with pancreatic carcinoma with reported sensitivities ranging from 70% to 90% and specificities ranging from 68% to 91% with great support of CK marker in excluding or confirm diagnosis.

Objectives:  Evaluation of CA19-9 and CK HMW markers expression in pancreatic and ampulla of vater carcinoma immunohistochemically & to correlate the immunohistochemical expression of CA19-9 and CK HMW markers with carcinoma location.

Material and method:-  36 samples of whipple operations and partial pancreatectomy whom already diagnosed as pancreatic carcinoma from 2009-2013 whom visit and admitted to GIT hospital in Baghdad medical city. A tissue sample block from mass that already processed and identified by dissection report from data base of histopathology Lab was collected for staining by immunohistochemical method with C19.9 and CK marker.

Results:-36 patients - 24 male and 12 females, Mean age (45+2.02) range (28-65) year with Male: Female ratio is (2:1) As differentiation of malignant cell in this study it was higher level with grade II (60%)  For TNM classification the result was dominantly staging as T3. IHC staining of CK19-9:-in present study we have 75% of patient samples with positive result. .Present study show that 4 patient's samples of total 6 positive CK/IHC staining was pancreatic carcinoma while only 2 of total positive was ampulla carcinoma.  

Conclusion:-CA19-9 is pancreatic tumor associated marker but cannot used for screening and association with clinical findings. Meanwhile CK tissue immunolabling  mostly helpful in diagnosis of ampullary and pancreatic carcinoma and CK immunohistochemical staining can be used as exclusion aid in diagnosis of pancreaticcarcinoma.