title: Clinical, morphologic, and immunophenotypic characteristics of ampullary carcinomas with an emphasis on SMAD4 expression.
abstract: BACKGROUND
  The purpose of our study was to examine the relationship between clinicopathologic variables and morphologic subtypes in ampullary carcinoma, with an emphasis on the expression ofSMAD4tumor suppressor gene.
  
  
  METHODS
  Sixty-three cases of ampullary carcinomas resected between 2000-2011 were included in this study. Clinical characteristics and outcome data were recorded. Tumors were classified as pancreatobiliary or intestinal type based on morphology, and immunohistochemical (IHC) studies for cytokeratin 7 (CK7), cytokeratin 20 (CK20), cytokeratin 17 (CK17), and SMAD4 were performed.
  
  
  RESULTS
  Forty-nine percent of the ampullary tumors were pancreatobiliary, 29% were intestinal, and 22% were other variants. Tumors with pancreatobiliary morphology showed worse overall survival than those with intestinal morphology or other variants (P=0.03). A trend for higher stage, recurrence and less survival was seen in cases with negative SMAD4 expression. In multivariate analysis, age group (≤60vs. >60 years) and expression of CK17 were the most prognostic of survival.
  
  
  CONCLUSIONS
  Ampullary tumors with pancreatobiliary morphology have a worse overall survival, while negative SMAD4 expression is associated with a trend of less survival.
authors.affiliation: Department of Pathology, University of Florida College of Medicine, Jacksonville, FL 32204, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alkhasawneh
authors.affiliation: Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
authors.forename: Lizette Vila
authors.initials: LV
authors.lastname: Duckworth
authors.affiliation: Department of Medicine, University of Florida, College of Medicine, Gainesville, FL 32610, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: George
authors.affiliation: Department of Medicine, University of Florida, College of Medicine, Gainesville, FL 32610, USA.
authors.forename: Neelam V
authors.initials: NV
authors.lastname: Desai
authors.affiliation: Department of Medicine, University of Florida, College of Medicine, Gainesville, FL 32610, USA.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Sommerfeld
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL 32610, USA.
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
authors.forename: Tania Zuluaga
authors.initials: TZ
authors.lastname: Toro
keywords: SMAD4; ampulla of Vater (AOV); ampullary carcinoma