title: Clinicopathological characteristics of duodenal epithelial neoplasms: Focus on tumors with a gastric mucin phenotype (pyloric gland-type tumors).
abstract: OBJECTIVE
  Epithelial tumors less commonly occur in the duodenum than in the stomach or large intestine. The clinicopathological characteristics of duodenal epithelial tumors remain a matter of debate. We therefore studied resected specimens to investigate the clinicopathological characteristics of duodenal epithelial tumors.
  
  
  METHODS
  Among duodenal epithelial tumors resected endoscopically or surgically in our hospital, we studied the clinicopathological characteristics of 110 adenomas or intramucosal carcinomas. The grade of atypia of all tumors was classified into 3 groups according to the World Health Organization (WHO) 2010 classification. The tumors were immunohistochemically evaluated to determine the frequency of differentiation toward fundic glands.
  
  
  RESULTS
  As for patient characteristics, there were 76 men (75.2%) and 25 women (24.8%), with a median age of 65 years (range, 34 to 84). The tumors most commonly arose in the first to second part of the duodenum. Many lesions were flat, and the median tumor diameter was 8.0 mm. The lesions were classified into 2 types according to mucin phenotype: intestinal-type tumors (98 lesions, 89.1%) and gastric-type tumors (12 lesions, 10.9%). Intestinal-type tumors were subdivided into 2 groups: tubular-type tumors (91 lesions, 82.7%) and tubulovillous-type tumors (7 lesions, 6.4%). Gastric-type tumors were classified into 2 types: foveolar type (3 lesions, 2.7%) and pyloric gland-type (PG) tumors (9 lesions, 8.2%). The grade of atypia was significantly higher in gastric-type tumors (p<0.01). PG tumors were gastric-type tumors characterized by pyloric glands and findings suggesting differentiation toward fundic glands.
  
  
  CONCLUSIONS
  About 10% of the duodenal tumors had a gastric-type mucin phenotype. Gastric-type tumors showed high-grade atypia. In particular, PG tumors showed similarities to PG tumors of the stomach, such as differentiation toward fundic glands.
authors.affiliation: Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Mitsuishi
authors.affiliation: Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Hamatani
authors.affiliation: Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hirooka
authors.affiliation: Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Nei
authors.initials: N
authors.lastname: Fukasawa
authors.affiliation: Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Aizawa
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hara
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Dobashi
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Goda
authors.affiliation: Division of Neuropathology, Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Saruta
authors.affiliation: Division of Molecular Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Urashima
authors.affiliation: Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ikegami
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000378:metabolism / Q000473:pathology; D000236:Adenoma / Q000378:metabolism / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000378:metabolism / Q000473:pathology; D004379:Duodenal Neoplasms / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005752:Gastric Mucins / Q000378:metabolism; D005753:Gastric Mucosa / Q000378:metabolism / Q000473:pathology; D017506:H(+)-K(+)-Exchanging ATPase / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000378:metabolism; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology
chemical_list: D005752:Gastric Mucins; D020116:Pepsinogen A; D017506:H(+)-K(+)-Exchanging ATPase