Unique immunohistochemical profiles of MUC5AC, MUC6, P53, and Ki67 in gastric atypical hyperplasia and dysplasia

Lanfang Miao; Yuanyuan Sun; Mei Guo; Haijun Yang; Xianjuan Du; Junkuo Li; Jingwei Shen; Xiaomin Wang; Ruixue Lei

doi:10.62347/JVIX8887

Unique immunohistochemical profiles of MUC5AC, MUC6, P53, and Ki67 in gastric atypical hyperplasia and dysplasia

Int J Clin Exp Pathol. 2024 Mar 15;17(3):63-71. doi: 10.62347/JVIX8887. eCollection 2024.

Authors

Lanfang Miao¹, Yuanyuan Sun¹, Mei Guo¹, Haijun Yang¹, Xianjuan Du¹, Junkuo Li¹, Jingwei Shen¹, Xiaomin Wang², Ruixue Lei¹

Affiliations

¹ Department of Pathology, Anyang Tumor Hospital/The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology Anyang 455000, Henan, China.
² Department of Radiotherapy, Anyang Tumor Hospital/The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology Anyang 455000, Henan, China.

Abstract

Objectives: Differentiating gastric atypical hyperplasia (AH) from dysplasia, including low-grade dysplasia (LGD) and high-grade dysplasia (HGD), poses significant challenges in small biopsies and specimens with technical artifacts. This study aims to establish objective diagnostic criteria for these conditions through combined morphologic and immunohistochemical (IHC) analyses.

Methods: Between January 2018 and September 2020, a total of 123 gastric mucosa biopsy specimens were collected at Anyang Tumor Hospital. According to the WHO Classification of Digestive System Tumors (5^th edition), specimens were categorized into three groups: AH (n=48), LGD (n=30), and HGD (n=45). Morphologic characteristics were assessed, and IHC staining for MUC5AC, MUC6, MUC2, CD10, P53, and Ki67 was performed, followed by statistical analysis.

Results: Histologically, AH was predominantly marked by a pronounced inflammatory background (60.42%), intestinal metaplasia (64.58%), indistinct boundaries (83.33%), and a distinct maturation gradient (97.72%). AH nuclei were typically circular (97.92%), with a high nucleus-to-cytoplasm ratio (64.58%), prominent nucleoli (47.92%), and preserved polarity (89.58%). In contrast, LGD and HGD typically exhibited well-defined boundaries with an absent maturation gradient. LGD nuclei were rod-shaped (96.67%), with a low nucleus-to-cytoplasm ratio (96.67%) and preserved polarity (100%), whereas HGD demonstrated a loss of cellular polarity (77.78%). IHC findings revealed a consistent maturation gradient in AH, with polarized MUC5AC and MUC6 expression, significantly reduced in LGD (86.67%), and absent in HGD. P53 expression in HGD showed a predominant 'mutation-type pattern' (66.67%), contrasting with 'wild-type pattern' expression in AH and LGD (100%, 93.33%). Ki67 expression patterns varied from a 'pit neck pattern' in AH (95.83%) to a 'polarity pattern' in LGD (76.67%) and a 'diffuse pattern' in HGD (57.78%). The expression patterns of MUC5AC, MUC6, CD10, P53, and Ki67 varied significantly across the three groups (P<0.001).

Conclusions: The integration of histomorphological features and expression profiles of MUC5AC, MUC6, P53, and Ki67 is instrumental in diagnosing gastric atypical hyperplasia and dysplasia.

Keywords: Gastric mucosal biopsy; atypical hyperplasia; dysplasia; histomorphology; immunohistochemistry; pathological diagnosis.