Clinicopathological features of superficial non-ampurally duodenal epithelial tumor; gastric phenotype of histology correlates to higher malignant potency.
Superficial non-ampullary duodenal epithelial tumors (SNADETs) are relatively rare, but they are now being detected more frequently due to advances in endoscopic technology. Nevertheless, the pathological nature of SNADETs remains unclear and a management strategy for these tumors has not been established.



To elucidate the clinicopathological features, we conducted a retrospective analysis of 138 endoscopically resected SNADETs. Lesions were classified into two groups by histological grade according to the Vienna classification: category 3 (71 lesions, 51.4%) and category 4/5 (67 lesions, 48.6%).



Compared with category 3 lesions, category 4/5 lesions were significantly more common in elderly patients (p < 0.001) and had a significantly larger tumor diameter (p = 0.001). Immunohistochemical analysis showed that category 4/5 lesions expressed MUC5AC (p = 0.002), MUC6 (p < 0.001), and p53 (p = 0.003) significantly more frequently and expressed CD10 (p = 0.002) and CDX2 (p = 0.029) significantly less frequently. Multivariate regression analysis showed that advanced age (p < 0.001), MUC6 expression (p = 0.001), and p53 expression (p = 0.004) were independent risk factors for a classification of category 4/5. In addition, advanced age (p = 0.010) and MUC5AC expression (p = 0.011) were identified as risk factors for lesions classified as category 4.2 (noninvasive carcinoma) or higher. All category 5 lesions expressed MUC5AC.



The gastric phenotype of MUC5AC and MUC6 may be linked to the malignant potential of SNADETs.
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan. takahito-t@toranomon.gr.jp.|Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, 143-8541, Japan. takahito-t@toranomon.gr.jp.
Takahito
T
Toba
Department of Pathology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Naoko
N
Inoshita
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Mitsuru
M
Kaise
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Kosuke
K
Nomura
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Yasutaka
Y
Kuribayashi
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Masami
M
Tanaka
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Satoshi
S
Yamashita
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Tsukasa
T
Furuhata
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Daisuke
D
Kikuchi
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Akira
A
Matsui
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Toshifumi
T
Mitani
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Toshiro
T
Iizuka
Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Shu
S
Hoteya
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D004384:Duodenoscopy / Q000379:methods; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008297:Male; D008875:Middle Aged; D055271:Mucin 5AC / Q000235:genetics*; D055272:Mucin-6 / Q000235:genetics*; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000473:pathology*; D016159:Tumor Suppressor Protein p53 / Q000235:genetics
C524678:MUC5AC protein, human; C524734:MUC6 protein, human; D055271:Mucin 5AC; D055272:Mucin-6; D016159:Tumor Suppressor Protein p53
Endoscopic resection; MUC5AC MUC6; Superficial non-ampullary duodenal epithelial tumor (SNADET); p53