Expression of HIF-1α in A Pancreatic Ductal Adenocarcinoma in A Patient with Newly Diagnosed Type 2 Diabetes

ABSTRACT Objective: Newly diagnosed type 2 diabetes mellitus (T2DM) increases the risk of pancreatic cancer by an unknown mechanism. We report a patient diagnosed with T2DM <1 year who developed an invasive pancreatic ductal adenocarcinoma expressing hypoxia-inducible factor 1-alpha (HIF-1α). Methods: HIF-1α staining was performed using the immunohistochemistry protocol from Novus (NB100-105), with minor modifications. Results: A 47-year-old African American male with a history of T2DM for 6 months presented with abdominal pain, weight loss, elevated liver and pancreatic enzymes, and a significant raise in carcinoembryonic antigen and cancer antigen 19-9 levels. A 2.5-cm mass was found on the head of the pancreas/uncinate process. A pylorus-sparing pancreaticoduodenectomy was performed that included removal of the gallbladder and a portion of the omentum. Pathology report showed an invasive ductal adenocarcinoma of the head of the pancreas (stage IIB: pT3N1M0). Immunohistochemistry of sections of the adenocarcinoma revealed significant HIF-1α expression. Conclusion: Significant HIF-1α expression was present in a pancreatic ductal adenocarcinoma of a patient recently diagnosed with T2DM. Studies are needed to determine whether there is a potential link between HIF-1α, pancreatic cancer, and T2DM. Abbreviations: FH fumarate hydratase HIF hypoxia-inducible factor PDAC pancreatic ductal adenocarcinoma T2DM type 2 diabetes mellitus TCA tricarboxylic acid VHL von Hippel-Lindau