Metabolic characteristics of solid pseudopapillary neoplasms of the pancreas: their relationships with high intensity 18F-FDG PET images
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Minhee Park1,*, Ho Kyoung Hwang2,4,*, Mijin Yun3,4, Woo Jung Lee2,4, Hoguen Kim1 and Chang Moo Kang2,4
1Departments of Pathology and BK21 PLUS for Medical Science, Yonsei University College of Medicine, Seoul, Korea
2Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
3Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
4Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
*These authors contributed equally to this work
Hoguen Kim, email: firstname.lastname@example.org
Chang Moo Kang, email: email@example.com
Keywords: solid pseudopapillary neoplasm; metabolomics; metabolism; 18F-FDG-PET; pancreatectomy
Received: October 05, 2017 Accepted: November 14, 2017 Published: January 03, 2018
Objective: We aimed to investigate the metabolic characteristics of Solid pseudopapillary neoplasms (SPNs) in relation signal intensities on 18F-FDG PET scans.
Summary Background Data: SPNs of the pancreas commonly show high uptake of 18F-FDG. However, the metabolic characteristics underlying the high 18F-FDG uptake in SPNs are not well characterized.
Materials and Methods: mRNA expressions for glucose metabolism were analyzed in five SPNs, five pancreatic ductal adenocarcinomas (PCAs), and paired normal pancreatic tissues. Among the proteins involved in glucose metabolism, the expressions of five proteins (GLUT1, HK1, PFKM, ENO2, and PKM2) were evaluated in 36 SPNs by immunohistochemistry. Clinical patterns of SPN on PET scans were classified according to the proportion of 18F-FDG uptake within the whole tumor volume (hot: ≥ 70%, mixed: 30 ≤ < 70, and defective: < 30%). PET-based parameters, including maximum standardized uptake value (SUVmax) and metabolic tumor volume (TMV2.5), were evaluated.
Results: Hot (n = 19), mixed (n = 5), and defective (n = 12) 18F-FDG uptake patterns were noted in the 36 patients. Radiologic tumor size and SUVmax differed significantly according to these patterns (ANOVA, p < 0.05). GLUT1, HK1, PFKM, ENO2, and PKM2 were highly expressed in SPNs at both the mRNA and protein levels. Defective type SPNs showed lower expression of HK1 (p = 0.014), PKM2 (p = 0.028), and Ki-67 (p = 0.070) with frequent intra-tumoral necrosis (p = 0.007). High Ki-67 expression (≥ 3%) was associated with high SUVmax in pancreatic SPNs (p = 0.002).
Conclusions: SPN cells harbor an active molecular capacity for increased glucose metabolism. Especially, defective type SPNs were associated with low metabolic activity and related to low Ki-67 index.
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