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Non-ampullary-duodenal carcinomas: clinicopathologic analysis of 47 cases and comparison with ampullary and pancreatic adenocarcinomas.
Mod Pathol 2017; 30(2):255-266MP

Abstract

Literature on non-ampullary-duodenal carcinomas is limited. We analyzed 47 resected non-ampullary-duodenal carcinomas. Histologically, 78% were tubular-type adenocarcinomas mostly gastro-pancreatobiliary type and only 19% pure intestinal. Immunohistochemistry (n=38) revealed commonness of 'gastro-pancreatobiliary markers' (CK7 55, MUC1 50, MUC5AC 50, and MUC6 34%), whereas 'intestinal markers' were relatively less common (MUC2 36, CK20 42, and CDX2 44%). Squamous and mucinous differentiation were rare (in five each); previously, unrecognized adenocarcinoma patterns were noted (three microcystic/vacuolated, two cribriform, one of comedo-like, oncocytic papillary, and goblet-cell-carcinoid-like). An adenoma component common in ampullary-duodenal cancers was noted in only about a third. Most had plaque-like or ulcerating growth. Mismatch repair protein alterations were detected in 13% (all with plaque-like growth and pushing-border infiltration). When compared with ampullary (n=355) and pancreatic ductal (n=227) carcinomas, non-ampullary-duodenal carcinomas had intermediary pathologic features with mean invasive size of 2.9 cm (vs 1.9, and 3.3) and 59% nodal metastasis (vs 45, and 77%). Its survival (3-, 5-year rates of 57 and 57%) was similar to that of ampullary-duodenal carcinomas (59 and 52%; P=0.78), but was significantly better than the ampullary ductal (41 and 29%, P<0.001) and pancreatic (28 and 18%, P<0.001) carcinomas. In conclusion, non-ampullary-duodenal carcinomas are more histologically heterogeneous than previously appreciated. Their morphologic versatility (commonly showing gastro-pancreatobiliary lineage and hitherto unrecognized patterns), frequent plaque-like growth minus an adenoma component, and frequent expression of gastro-pancreatobiliary markers suggest that many non-ampullary-duodenal carcinomas may arise from Brunner glands or gastric metaplasia or heterotopic pancreatobiliary epithelium. The clinical behavior of non-ampullary-duodenal carcinoma is closer to that of ampullary-duodenal subset of ampullary carcinomas, but is significantly better than that of ampullary ductal and pancreatic cancers. The frequency of mismatch repair protein alterations suggest that routine testing should be considered, especially in the non-ampullary-duodenal carcinomas with plaque-like growth and pushing-border infiltration.

Authors+Show Affiliations

Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.Department of Molecular Medicine, San Matteo Hospital, University of Pavia, Pavia, Italy.Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan.Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan.Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27739441

Citation

Xue, Yue, et al. "Non-ampullary-duodenal Carcinomas: Clinicopathologic Analysis of 47 Cases and Comparison With Ampullary and Pancreatic Adenocarcinomas." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 30, no. 2, 2017, pp. 255-266.
Xue Y, Vanoli A, Balci S, et al. Non-ampullary-duodenal carcinomas: clinicopathologic analysis of 47 cases and comparison with ampullary and pancreatic adenocarcinomas. Mod Pathol. 2017;30(2):255-266.
Xue, Y., Vanoli, A., Balci, S., Reid, M. M., Saka, B., Bagci, P., ... Adsay, V. (2017). Non-ampullary-duodenal carcinomas: clinicopathologic analysis of 47 cases and comparison with ampullary and pancreatic adenocarcinomas. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 30(2), pp. 255-266. doi:10.1038/modpathol.2016.174.
Xue Y, et al. Non-ampullary-duodenal Carcinomas: Clinicopathologic Analysis of 47 Cases and Comparison With Ampullary and Pancreatic Adenocarcinomas. Mod Pathol. 2017;30(2):255-266. PubMed PMID: 27739441.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-ampullary-duodenal carcinomas: clinicopathologic analysis of 47 cases and comparison with ampullary and pancreatic adenocarcinomas. AU - Xue,Yue, AU - Vanoli,Alessandro, AU - Balci,Serdar, AU - Reid,Michelle M, AU - Saka,Burcu, AU - Bagci,Pelin, AU - Memis,Bahar, AU - Choi,Hyejeong, AU - Ohike,Nobuyike, AU - Tajiri,Takuma, AU - Muraki,Takashi, AU - Quigley,Brian, AU - El-Rayes,Bassel F, AU - Shaib,Walid, AU - Kooby,David, AU - Sarmiento,Juan, AU - Maithel,Shishir K, AU - Knight,Jessica H, AU - Goodman,Michael, AU - Krasinskas,Alyssa M, AU - Adsay,Volkan, Y1 - 2016/10/14/ PY - 2016/04/20/received PY - 2016/08/28/revised PY - 2016/08/31/accepted PY - 2016/10/16/pubmed PY - 2018/2/23/medline PY - 2016/10/15/entrez SP - 255 EP - 266 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod. Pathol. VL - 30 IS - 2 N2 - Literature on non-ampullary-duodenal carcinomas is limited. We analyzed 47 resected non-ampullary-duodenal carcinomas. Histologically, 78% were tubular-type adenocarcinomas mostly gastro-pancreatobiliary type and only 19% pure intestinal. Immunohistochemistry (n=38) revealed commonness of 'gastro-pancreatobiliary markers' (CK7 55, MUC1 50, MUC5AC 50, and MUC6 34%), whereas 'intestinal markers' were relatively less common (MUC2 36, CK20 42, and CDX2 44%). Squamous and mucinous differentiation were rare (in five each); previously, unrecognized adenocarcinoma patterns were noted (three microcystic/vacuolated, two cribriform, one of comedo-like, oncocytic papillary, and goblet-cell-carcinoid-like). An adenoma component common in ampullary-duodenal cancers was noted in only about a third. Most had plaque-like or ulcerating growth. Mismatch repair protein alterations were detected in 13% (all with plaque-like growth and pushing-border infiltration). When compared with ampullary (n=355) and pancreatic ductal (n=227) carcinomas, non-ampullary-duodenal carcinomas had intermediary pathologic features with mean invasive size of 2.9 cm (vs 1.9, and 3.3) and 59% nodal metastasis (vs 45, and 77%). Its survival (3-, 5-year rates of 57 and 57%) was similar to that of ampullary-duodenal carcinomas (59 and 52%; P=0.78), but was significantly better than the ampullary ductal (41 and 29%, P<0.001) and pancreatic (28 and 18%, P<0.001) carcinomas. In conclusion, non-ampullary-duodenal carcinomas are more histologically heterogeneous than previously appreciated. Their morphologic versatility (commonly showing gastro-pancreatobiliary lineage and hitherto unrecognized patterns), frequent plaque-like growth minus an adenoma component, and frequent expression of gastro-pancreatobiliary markers suggest that many non-ampullary-duodenal carcinomas may arise from Brunner glands or gastric metaplasia or heterotopic pancreatobiliary epithelium. The clinical behavior of non-ampullary-duodenal carcinoma is closer to that of ampullary-duodenal subset of ampullary carcinomas, but is significantly better than that of ampullary ductal and pancreatic cancers. The frequency of mismatch repair protein alterations suggest that routine testing should be considered, especially in the non-ampullary-duodenal carcinomas with plaque-like growth and pushing-border infiltration. SN - 1530-0285 UR - https://www.unboundmedicine.com/medline/citation/27739441/Non_ampullary_duodenal_carcinomas:_clinicopathologic_analysis_of_47_cases_and_comparison_with_ampullary_and_pancreatic_adenocarcinomas_ L2 - http://dx.doi.org/10.1038/modpathol.2016.174 DB - PRIME DP - Unbound Medicine ER -