title: Comparison between the location and the histomorphological/immunohistochemical characteristics of noninvasive neoplasms of the ampulla of Vater.
abstract: To determine useful factors when selecting an appropriate procedure for noninvasive ampullary neoplasia, we investigated the relationship between the location and the histomorphological/immunohistochemical characteristics of 56 noninvasive ampullary neoplasms obtained by endoscopic papillectomy (EP). All subjects were classified according to histomorphology and location of neoplasms, and we evaluated the characteristics of each classified group using complementary immunohistochemical procedures. The CK20-positive rates of each location type were also evaluated. Subjects presented with 52 intestinal-type adenomas (low/high grade, 32:20) and 4 noninvasive pancreatobiliary papillary neoplasms (low/high grade, 1:3). Twenty-seven periampullary (peri-AMP)-type tumors and 23 extended-type tumors comprised the intestinal type, and the intra-ampullary (intra-AMP) type was composed of 4 pancreatobiliary and 2 intestinal histomorphological types. The CK20-positive rates of these 3 location types differed significantly (peri-AMP type, 50.6% ± 21.0%; extended type, 35.4% ± 18.6%; intra-AMP type, 6.9% ± 6.3%). The CK20-positive rate for intestinal-type tumors of the intra-AMP location type was lower than that of the peri-AMP location type. Intestinal-type tumors without CDX2 expression included extended and intra-AMP types, which are tumors that may show positive vertical margins when EP is performed. In this study, we found that an understanding of pancreatobiliary-type histology is an important aspect for the investigation of tumors involving the common channel of the ampulla. Furthermore, immunostaining of CDX2 and CK20 provides beneficial information if considering whether to perform an EP.
authors: Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo 143-8541, Japan.
authors: Yoshiro
authors: Y
authors: Yamamoto
authors: Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan. Electronic address: tetsuo.nemoto@med.toho-u.ac.jp.
authors: Tetsuo
authors: T
authors: Nemoto
authors: Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan.
authors: Yoichiro
authors: Y
authors: Okubo
authors: Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan.
authors: Yasuhiro
authors: Y
authors: Nihonyanagi
authors: Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan.
authors: Takao
authors: T
authors: Ishiwatari
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo 143-8541, Japan.
authors: Kensuke
authors: K
authors: Takuma
authors: Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan.
authors: Naobumi
authors: N
authors: Tochigi
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo 143-8541, Japan.
authors: Naoki
authors: N
authors: Okano
authors: Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan.
authors: Megumi
authors: M
authors: Wakayama
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo 143-8541, Japan.
authors: Yoshinori
authors: Y
authors: Igarashi
authors: Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan.
authors: Kazutoshi
authors: K
authors: Shibuya
mesh_terms: D000236:Adenoma / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000378:metabolism / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D000071616:CDX2 Transcription Factor; D002278:Carcinoma in Situ / Q000145:classification / Q000378:metabolism / Q000473:pathology; D003138:Common Bile Duct Neoplasms / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D005260:Female; D018398:Homeodomain Proteins / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D007414:Intestinal Neoplasms / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D053554:Keratin-20 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010190:Pancreatic Neoplasms / Q000145:classification / Q000378:metabolism / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor; D000071616:CDX2 Transcription Factor; C491270:CDX2 protein, human; D018398:Homeodomain Proteins; C507499:KRT20 protein, human; D053554:Keratin-20
keywords: Ampulla of vater; Endoscopic papillectomy; Histology; Location; Non-invasive