Abstract

Periampullaryadenocarcinomas(PAC)areraremalignanttumorswithworstsurvivalrates due to destructive route of the disease. It comprises distal bile duct, pancreatic, ampullary and duodenaladenocarcinomathatoriginatewithinperiampullarycomplex.Theprimaryorigin ofPACinthisareaisoftendifficultprevioustothesurgeryintopancreaticobiliary(PB-PAC), intestinal(I-PAC)andmixedtype(MT-PAC)asPB-PACcarriesbadprognosis. Objective:The main aim was to study the histomorphological features and immunohistochemical (IHC)expressionofCytokeratin(CK)7and20inPACandassesstheirexpressionwithknown histopathological prognostic parameters. Method: A total number of 31 resected pancreatoduodenectomy specimens were studied in the department of Pathology, in a tertiary care center, Karnataka, India for histomorphological featureswithCK7andCK20expression.Allthestatisticalmethodswerecarriedoutthrough theSPSSforWindows(version22.0).Ap-valueof≤0.05wastakentobestatisticallysignificant. Results: The cases were categorized into PB-PAC (CK7+), I-PAC (CK20+) and MT-PAC (CK7+ and CK20+) based on histomorphological and histomolecular typing. There was a positive association between histomorphology and histomolecular typing. The difference in the proportionofhistomolecularprofilingbetweentheexpressionswasstatisticallysignificantwith p-valueof≤0.001. Conclusions: TheconcordanceinPB-PAC,I-PACandMT-PACbyusualhaematoxylinand eosin microscopy and later confirmed by the immunophenotyping advocates sub typing to be incorporated in the routine histopathology report. The importance of correctly categorizing of the PB-PAC, I-PAC and MT-PAC is mainly for the prognosis and difference in administering of the targeted chemotherapy regimens

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