title: Depressed adenoma of the duodenum in patients with familial adenomatous polyposis: endoscopic and immunohistochemical features.
abstract: BACKGROUND
  Depressed neoplastic lesions of the colorectum have been specified in patients with familial adenomatous polyposis (FAP). The aim of this study was to characterize endoscopic, histologic, and immunohistochemical features of depressed adenoma of the duodenum in patients with FAP.
  
  
  METHODS
  Duodenoscopy was performed on 25 patients with FAP, and the neoplastic nonampullary lesions were classified as polypoid or depressed adenomas. The grade of dysplasia, the proliferative activity determined by Ki-67 labeling index (LI), and the grade of p53 expression were compared between polypoid and depressed neoplasia.
  
  
  RESULTS
  Ten subjects had depressed nonampullary adenoma, whereas polypoid adenoma was found in the remaining 15 subjects. Moderate dysplasia was more frequent in depressed adenoma than in polypoid adenoma (70% vs. 27%, P = 0.04). Whereas p53 expression was not different between the two adenoma groups, the LI was significantly higher in depressed adenoma than in polypoid adenoma (59.7 +/- 9.5 vs. 47.5 +/- 10.7, P < 0.01).
  
  
  CONCLUSIONS
  Depressed adenoma of the duodenum is a distinctive phenotype of duodenal neoplasm in patients with FAP. The high proliferative activity of depressed adenoma suggests that there may be a need to survey FAP patients with such lesions intensively.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Matsumoto
authors.forename: M
authors.initials: M
authors.lastname: Iida
authors.forename: S
authors.initials: S
authors.lastname: Nakamura
authors.forename: K
authors.initials: K
authors.lastname: Hizawa
authors.forename: M
authors.initials: M
authors.lastname: Mizuno
authors.forename: T
authors.initials: T
authors.lastname: Yao
authors.forename: M
authors.initials: M
authors.lastname: Tsuneyoshi
authors.forename: M
authors.initials: M
authors.lastname: Fujishima
mesh_terms: D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D011125:Adenomatous Polyposis Coli / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D000328:Adult; D004379:Duodenal Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
chemical_list: D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53