Pancreatic involvement in von Hippel-Lindau disease. The Groupe Francophone d'Etude de la Maladie de von Hippel-Lindau.

BACKGROUND & AIMS: Pancreatic involvement in von Hippel-Lindau (VHL) disease, a genetic disorder with a dominant mode of inheritance affecting various organs, has rarely been studied. We assessed the prevalence, type of lesions, natural history, and impact of pancreatic involvement in patients with VHL. METHODS: A total of 158 consecutive patients from 94 families with VHL disease were studied in a prospective French collaborative study. All patients underwent systematic screening for VHL lesions, including computerized tomography (CT) scanning of the pancreas reviewed by an experienced radiologist. Clinical data, investigations, and treatments performed were also reviewed. RESULTS: Pancreatic involvement was observed in 122 patients (77.2%) and included true cysts (91.1%), serous cystadenomas (12.3%), neuroendocrine tumors (12.3%), or combined lesions (11.5%). The pancreas was the only organ affected in 7.6% of patients. Patients with pancreatic lesions had fewer pheochromocytomas than those without (14/122 vs. 16/36; P<0.0001), and patients with neuroendocrine pancreatic tumors had renal involvement less often than those without (8/99 vs. 6/20; P = 0.013). None of the patients with neuroendocrine tumors had symptoms of hormonal hypersecretion. Pancreatic lesions evolved in half of patients but required specific treatment in only 10 (8.2%) when they were symptomatic or for the resection of large neuroendocrine tumors. CONCLUSIONS: Pancreatic involvement is seen in most patients with VHL disease. Although symptoms are rare, specific treatment of pancreatic lesions is required in selected patients, mainly those with neuroendocrine tumors.

Detection of gastric mucins (M1 antigens) in cyst fluid for the diagnosis of cystic lesions of the pancreas.

Mucinous cystic tumors of the pancreas must be distinguished from other cystic lesions because of their potential malignancy. Our purpose was to assess the reliability of gastric M1 mucin analysis in the fluid of cystic lesions of the pancreas in comparison or association with carcinoembryonic antigen. M1 mucin and carcinoembryonic antigen were measured in cyst fluid obtained preoperatively by fine-needle aspiration. The lesions consisted of 12 serous cystadenomas, 9 mucinous cystadenomas, 8 cystadenocarcinomas and 6 intraductal mucinous hypersecreting neoplasms. Thirty pancreatic pseudocysts complicating well-documented chronic pancreatitis were also examined. In addition, M1 mucins were localized by immunoperoxidase staining in fetal and normal adult pancreas and in mucinous and serous tumors. Carcinoembryonic values of > 20 ng/ml and M1 mucin values of > 50 U M1/ml represented 82 and 78% sensitivity, respectively, as well as 100% specificity for distinguishing mucinous lesions from serous cystadenomas; the sensitivity for this purpose was 100% using these criteria in combination. Carcinoembryonic antigen values of > 300 ng/ml and M1 mucin values of > 1,200 U M1/ml represented 56 and 30% sensitivity, respectively, as well as 100% specificity for distinguishing mucinous lesions from pseudocysts; the sensitivity for this purpose was 60% using these criteria in combination. By immunohistology, M1 mucins were detected in the wall of mucinous lesions but not in fetal and normal adult pancreas and in serous cystadenomas. Measurement of M1 mucin antigen in cyst fluid could thus improve the diagnosis of mucinous cystic lesions of the pancreas.

[Immunochemical evidence of a mutated p53 protein expressed in human colorectal adenocarcinoma]. / Mise en évidence immunochimique de l'expression d'une protéine p53 mutée dans les adénocarcinomes colorectaux humains.

Evidence is accumulating that the p53 anti-oncogene is a key gene in the genesis of carcinoma in human colon and rectum. Although mutations of the p53 gene have been shown to be frequent, the protein was present in only approximately 50 percent of specimens examined. However only one monoclonal antibody recognizing an epitope present on wild-type p53 had been used. We studied the p53 expression in a series of 16 colorectal carcinoma specimens using 3 different monoclonal antibodies (pAb 421, 1801, 240). Specific immunofluorescent staining was quantified by dual parameter (DNA/p53) flow cytometry. Two different types of preparations were compared in order to verify the conservation of the antigen. Nuclear suspensions prepared from frozen tumor fragments were shown to produce results equivalent to those of whole cell preparations originating from fresh surgical specimens. The p53 protein was detected in 9 of the 16 cancers with pAb 421 and 240 monoclonal antibodies (8 of which were also positive for pAb 1801 antibody). Four additional tumors were considered positive for pAb 240 antibody alone. Overall, 13/16 cancer specimens were shown to present immunoreactivity for pAb 240 antibody. Topography of staining was investigated by immunohistochemistry with peroxidase methods. Eight cases were informative, 6 of which presented nuclear staining compatible with the cytometry results. There was one discordant case i.e. pAb 240 antibody being positive on cytometry and entirely negative on immunohistochemistry. This small series allowed us to show that 81 percent of tumor samples stained with monoclonal antibody pAb 240, considered to be specific to mutated protein, and that some tumors express a p53 protein which is not detected with terminal sequence-specific antibodies.