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“Pancreatic Mucoepidermoid Carcinoma” Is not a Pancreatic Counterpart of CRTC1/3-MAML2 Fusion Gene-related Mucoepidermoid Carcinoma of the Salivary Gland, and May More Appropriately be Termed Pancreatic Adenosquamous Carcinoma With Mucoepidermoid Carcinoma-like Features

Saeki, Kiyoshi, MD*; Ohishi, Yoshihiro, MD, PhD*; Matsuda, Ryota, MD*; Mochidome, Naoki, MD*; Miyasaka, Yoshihiro, MD, PhD; Yamamoto, Hidetaka, MD, PhD*; Koga, Yutaka, MD, PhD*; Maehara, Yoshihiko, MD, PhD; Nakamura, Masafumi, MD, PhD; Oda, Yoshinao, MD, PhD*

The American Journal of Surgical Pathology: November 2018 - Volume 42 - Issue 11 - p 1419–1428
doi: 10.1097/PAS.0000000000001135
Original Articles

Mucoepidermoid carcinoma (MEC)” has been accepted as a synonym for pancreatic adenosquamous carcinoma (ASC). Pancreatic ASC can show salivary gland-type MEC-like morphology. CRTC1/3-MAML2 fusion gene is a characteristic molecular feature of MEC of the salivary gland. We conducted this study to clarify whether the pancreatic ASC with salivary gland-type MEC-like morphology (Pan-MEC) is a pancreatic counterpart of salivary gland-type MEC (Sal-MEC). We retrospectively analyzed 37 pancreatic ASCs including 16 Pan-MECs and 21 tumors without MEC-like features (ASC-NOS [not otherwise specified]), and we investigated (1) clinicopathologic features, (2) the presence of CRTC1/3-MAML2 fusion gene by reverse transcription polymerase chain reaction, (3) the presence of rearrangement of MAML2 gene by fluorescence in situ hybridization, and (4) mucin core proteins by immunohistochemistry. We also compared 16 Pan-MECs with 20 Sal-MECs by immunohistochemistry for mucin core protein. There were no significant differences of any clinicopathologic characteristics and survival analysis between the Pan-MECs and ASCs-NOS. Of note, the pancreatic ASCs (including Pan-MEC and ASC-NOS) were significantly more aggressive than conventional pancreatic ductal adenocarcinoma. In addition, all Pan-MECs were histologically high-grade. CRTC1/3-MAML2 fusion gene and MAML2 gene rearrangement were not detected in any ASCs including Pan-MECs. There were significant differences of MUC5AC and MUC6 between the Pan-MECs and Sal-MECs, but no significant differences of mucin core protein between the Pan-MECs and pancreatic ASCs-NOS. Pan-MEC is histologically and biologically high-grade and unrelated to CRTC1/3-MAML2 fusion gene, unlike Sal-MEC which is related to CRTC1/3-MAML2 fusion gene. Pan-MEC is not a pancreatic counterpart of CRTC1/3-MAML2 fusion gene-related Sal-MEC.

Departments of *Anatomical Pathology

Surgery and Oncology

Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

K.S. and Y.Ohishi: designed and performed the research, analyzed the data, and wrote the paper. K.S.: performed the immunohistochemical staining and fusion gene transcripts analysis. K.S. and Y.Ohishi: performed the slide review and analyzed the data. R.M., N.M., Y.M., H.Y., Y.K., Y.M., and M.N.: analyzed the data and contributed to the collection of samples and research design. Y.Oda: designed the research and gave final approval of the manuscript.

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Yoshinao Oda, MD, PhD, Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan (e-mail:

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