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Ampullary adenocarcinoma

Pat Gulhati, Kanwal Raghav, Rachna T Shroff, Gauri R Varadhachary, Scott Kopetz, Milind Javle, Wei Qiao, Huamin Wang, Jeffrey Morris, Robert A Wolff, Michael J Overman
BACKGROUND: Capecitabine with oxaliplatin (CAPOX) has previously demonstrated clinical activity in patients with small bowel adenocarcinoma (SBA) and ampullary adenocarcinoma (AAC). Herein, the authors conducted a phase 2 trial to evaluate the benefit of adding bevacizumab to CAPOX. METHODS: In this phase 2, single-arm, single-center, open-label study, patients aged ≥18 years with untreated, advanced SBA or AAC were recruited. Patients received capecitabine at a dose of 750 mg/m(2) orally twice daily on days 1 to 14, oxaliplatin at a dose of 130 mg/m(2) intravenously on day 1, and bevacizumab at a dose of 7...
November 14, 2016: Cancer
Dimitrios Moschovis, Giorgos Bamias, Ioanna Delladetsima
Tumors of the pancreas, the ampulla of Vater, and the extrahepatic and intrahepatic bile ducts have significant histological similarities due to the common embryonic origin of the pancreatobiliary system. This obviates the need for discovery of biomarkers with diagnostic and prognostic value for these tumors. Mucins, especially MUC-1, -2, -4 and -5AC, are important candidates for developing into such reliable biomarkers. Increased expression of MUC1 occurs in pancreatic ductal adenocarcinomas and is associated with increased degrees of dysplasia in pancreatic intraepithelial neoplasia (PanIN)...
October 15, 2016: World Journal of Gastrointestinal Oncology
Yue Xue, Alessandro Vanoli, Serdar Balci, Michelle M Reid, Burcu Saka, Pelin Bagci, Bahar Memis, Hyejeong Choi, Nobuyike Ohike, Takuma Tajiri, Takashi Muraki, Brian Quigley, Bassel F El-Rayes, Walid Shaib, David Kooby, Juan Sarmiento, Shishir K Maithel, Jessica H Knight, Michael Goodman, Alyssa M Krasinskas, Volkan Adsay
Literature on non-ampullary-duodenal carcinomas is limited. We analyzed 47 resected non-ampullary-duodenal carcinomas. Histologically, 78% were tubular-type adenocarcinomas mostly gastro-pancreatobiliary type and only 19% pure intestinal. Immunohistochemistry (n=38) revealed commonness of 'gastro-pancreatobiliary markers' (CK7 55, MUC1 50, MUC5AC 50, and MUC6 34%), whereas 'intestinal markers' were relatively less common (MUC2 36, CK20 42, and CDX2 44%). Squamous and mucinous differentiation were rare (in five each); previously, unrecognized adenocarcinoma patterns were noted (three microcystic/vacuolated, two cribriform, one of comedo-like, oncocytic papillary, and goblet-cell-carcinoid-like)...
October 14, 2016: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
Jennifer L Williams, Carmen K Chan, Paul A Toste, Irmina A Elliott, Charles R Vasquez, Dharma B Sunjaya, Eric A Swanson, Jamie Koo, O Joe Hines, Howard A Reber, David W Dawson, Timothy R Donahue
Importance: Patients with periampullary adenocarcinomas have widely variable survival. These cancers are traditionally categorized by their anatomic location of origin, namely, the duodenum, ampulla, distal common bile duct (CBD), or head of the pancreas. However, they can be alternatively subdivided histopathologically into intestinal or pancreaticobiliary (PB) types, which may more accurately estimate prognosis. Objectives: To identify factors associated with survival in patients with periampullary adenocarcinomas and to compare survival between those having intestinal-type or PB-type cancers originating from the duodenum, ampulla, or distal CBD with those having pancreatic ductal adenocarcinoma (PDAC)...
October 12, 2016: JAMA Surgery
Iraklis Perysinakis, Emilia Minaidou, Dimitrios Mantas, George C Sotiropoulos, Vasileia Leontara, Hercules Tsipras, George N Zografos, Ilias Margaris, Gregory Kouraklis
INTRODUCTION: Subclassification of ampullary adenocarcinomas into intestinal and pancreatobiliary type has prognostic and therapeutic implications. Immunohistochemical staining against specific biomarkers has been proven to be a useful adjunct in determining the exact histotype. Furthermore the immunohistochemical profile is suggestive of the molecular pathogenic mechanisms through which the tumor evolved. The aim of this study was to correlate p53, MDM2, CK7, CK20, MUC1, MUC2 and CDX2 expression in ampullary adenocarcinomas with the type of differentiation and patients' survival...
November 2016: Pathology, Research and Practice
Pallavi Rao, Sadiq S Sikora, Srikanth Narayanaswamy, Nandita Ghosal, Dinesh Kini
Caracinosarcomas are tumours with diverse epithelial and mesenchymal differentiation. They most commonly occur in the female reproductive organs and upper aero digestive tract. They are relatively rare in the gastrointestinal tract and affect the oesophagus most commonly. Ampullary carcinosarcomas are exceptionally rare. We report a case of ampullary carcinosarcoma in a 67-year-old male, with osteosarcomatous, small cell carcinoma and conventional adenocarcinoma components. To the best of our knowledge, this is the first reported case of its kind...
November 2016: Pathology, Research and Practice
Michelle D Reid, Serdar Balci, Nobuyuki Ohike, Yue Xue, Grace E Kim, Takuma Tajiri, Bahar Memis, Ipek Coban, Anil Dolgun, Alyssa M Krasinskas, Olca Basturk, David A Kooby, Juan M Sarmiento, Shishir K Maithel, Bassel F El-Rayes, Volkan Adsay
Histologic classification of ampullary carcinomas as intestinal versus pancreatobiliary is rapidly becoming a part of management algorithms, with immunohistochemical classification schemes also being devised using this classification scheme as their basis. However, data on the reproducibility and prognostic relevance of this classification system are limited. In this study, five observers independently evaluated 232 resected ampullary carcinomas with invasive component >3 mm. Overall interobserver agreement was 'fair' (κ 0...
September 2, 2016: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
Alejandro L Suarez, Gregory A Coté, B Joseph Elmunzer
Catheter-based radiofrequency ablation (RFA) delivered during endoscopic retrograde cholangiopancreatography (ERCP) may represent a viable treatment option for intraductal extension of ampullary neoplasms, however, clinical experience with this modality is limited. After ampullary resection, 4 patients with intraductal extension underwent adjunctive RFA of the distal bile duct. All patients received a temporary pancreatic stent to reduce the risk of pancreatitis, as well as a plastic biliary stent to prevent biliary obstruction...
July 2016: Endoscopy International Open
Michael J Overman, Harris S Soifer, Aaron Joel Schueneman, Joe Ensor, Volkan Adsay, Burcu Saka, Nastaran Neishaboori, Robert A Wolff, Huamin Wang, Catherine A Schnabel, Gauri Varadhachary
BACKGROUND: Ampullary adenocarcinoma is a rare gastrointestinal cancer associated with diverse outcomes due to clinical and pathological heterogeneity. Standardized methods to better prognosticate and inform therapeutic selection for ampullary adenocarcinoma are needed. This study explored the novel use and potential prognostic utility of a 92-gene cancer classifier in ampullary adenocarcinomas. METHODS: In this prospectively-defined, blinded study of ampullary adenocarcinoma [N =54; stage T3 or higher (57 %); Grade III (44 %); Node positive (55 %)], the performance of a 92-gene classifier was examined to predict the ampullary subtype that was derived from histomorphological examination of resected ampullary samples...
2016: BMC Cancer
Iraklis Perysinakis, Emilia Minaidou, Vasileia Leontara, Dimitrios Mantas, Georgios C Sotiropoulos, Hercules Tsipras, George N Zografos, Ilias Margaris, Gregory Kouraklis
INTRODUCTION: The purpose of this study was to associate immunohistochemical expression of β-catenin, EGFR, CK7, CK20, MUC1, MUC2, and CDX2 in ampullary adenocarcinomas with the type of differentiation and prognosis. METHODS: Forty-seven patients with ampullary adenocarcinoma who underwent pancreatoduodenectomy with curative intent from 1997 to 2014 were included in this study. Nine patients with perioperative death were included in the association analysis but excluded from survival analysis...
August 19, 2016: International Journal of Surgical Pathology
María-Victoria Alvarez-Sanchez, Inés Oria, Olivia B Luna, Jean Pialat, Rodica Gincul, Christine Lefort, Raphael Bourdariat, Fabien Fumex, Vincent Lepilliez, Jean Yves Scoazec, Angel Salgado-Barreira, Anne Isabelle Lemaistre, Bertrand Napoléon
BACKGROUND: The therapeutic role of endoscopic papillectomy (EP) for early ampullary cancer (AC) is still controversial. The aim of the present study was to evaluate the curative potential of EP for early AC and to identify predictors of lymph node metastases (LNMs). METHODS: We retrospectively reviewed 173 patients who were prospectively included in a database and who underwent EP between 1999 and 2013. Adenocarcinoma was present in 28 resected specimens. An additional surgery was proposed in cases of duodenal submucosal infiltration, duct ingrowth, R1 resection or lymphovascular invasion...
August 16, 2016: Surgical Endoscopy
Bum Jun Kim, Hyun Joo Jang, Jung Han Kim, Hyeong Su Kim, Jin Lee
Ampullary adenocarcinoma (A-AC) is a rare malignancy arising from the ampulla of Vater. KRAS mutation is detected in 30-40% of patients with A-AC, but its clinical implication and prognostic value are not well described. We conducted this meta-analysis to investigate the association between KRAS mutation and prognosis in patients with A-AC. We searched Pubmed, MEDLINE, EMBASE, and the Cochrane Library databases for articles including following terms in their titles, abstracts, or keywords: 'ampullary or periampullary or ampulla of vater', 'cancer or carcinoma', and 'KRAS'...
August 9, 2016: Oncotarget
Min-Chan Chen, Yi-Ling Chen, Tzu-Wen Wang, Hui-Ping Hsu, Ming-Derg Lai
Bile acids are potential carcinogens in gastrointestinal cancer, and interact with nuclear and membrane receptors to initiate downstream signaling. The effect of TGR5 [also known as G protein-coupled bile acid receptor 1 (GPBAR1)] on cancer progression is dependent on the tissue where it is activated. In this report, the function of TGR5 expression in cancer was studied using a bioinformatic approach. TGR5 expression in ampullary adenocarcinoma and normal duodenum was compared by western blotting, reverse transcription polymerase chain reaction, and immunohistochemistry (IHC)...
October 2016: Oncology Reports
Raul S Gonzalez, Pelin Bagci, Olca Basturk, Michelle D Reid, Serdar Balci, Jessica H Knight, So Yeon Kong, Bahar Memis, Kee-Taek Jang, Nobuyuki Ohike, Takuma Tajiri, Sudeshna Bandyopadhyay, Alyssa M Krasinskas, Grace E Kim, Jeanette D Cheng, N Volkan Adsay
Distal common bile duct carcinoma is a poorly characterized entity for reasons such as variable terminology and difficulty in determining site of origin of intrapancreatic lesions. We compared clinicopathologic features of pancreatobiliary-type adenocarcinomas within the pancreas, but arising from the distal common bile duct, with those of pancreatic and ampullary origin. Upon careful review of 1017 pancreatoduodenectomy specimens with primary adenocarcinoma, 52 (5%) qualified as intrapancreatic distal common bile duct carcinoma...
July 29, 2016: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
Nicole Max, Alexander Rothe, Cord Langner
Mixed adenoneuroendocrine carcinomas (MANECs) are rare biphasic tumour types, which are morphologically recognisable as both gland-forming and neuroendocrine neoplasms. Within the gastrointestinal tract, MANECs occur predominantly in the stomach or colorectum. The present study described a case of a MANEC originating from the ampullary region. The patient presented with widespread metastatic disease. Biopsy samples obtained from the ampullary primary tumour disclosed a complex lesion with adenocarcinoma and neuroendocrine small cell carcinoma components, positive for the intestinal transcription factor caudal type homeobox-2 and for neuroendocrine markers, including chromogranin A, synaptophysin, cluster of differentiation 56/neural cell adhesion molecule...
July 2016: Molecular and Clinical Oncology
Giedrius Barauskas, Kestutis Urbonas, Giedre Smailyte, Darius Pranys, Juozas Pundzius, Antanas Gulbinas
BACKGROUND/AIMS: Ampullary carcinoma is a rare tumour with a high resectability rate. There is an increasing body of evidence indicating not only tumour-related factors, but also jaundice influence survival following curative resection. Several modalities for preoperative biliary drainage are available; however, routine preoperative endoscopic biliary drainage (PEBD) is not recommended. There is no sufficient data regarding the impact of PEBD on long-term outcomes. The aim of our study was to identify predictive factors of survival with special regard to PEBD in patients undergoing curative resection for ampullary carcinoma...
2016: Digestive Surgery
Ferga C Gleeson, Sarah E Kerr, Benjamin R Kipp, Jesse S Voss, Douglas M Minot, Zheng Jin Tu, Michael R Henry, Rondell P Graham, George Vasmatzis, John C Cheville, Konstantinos N Lazaridis, Michael J Levy
BACKGROUND & AIMS: Less than 10% of registered drug intervention trials for pancreatic ductal adenocarcinoma (PDAC) include a biomarker stratification strategy. The ability to identify distinct mutation subsets via endoscopic ultrasound fine needle aspiration (EUS FNA) molecular cytology could greatly aid clinical trial patient stratification and offer predictive markers. We identified chemotherapy treatment naïve ampullary adenocarcinoma and PDAC patients who underwent EUS FNA to assess multigene mutational frequency and diversity with a surgical resection concordance assessment, where available...
May 18, 2016: Oncotarget
Lukasz Liszka, Slawomir Mrowiec, Katarzyna Kusnierz, Maciej Kajor
BACKGROUND: There is no universally accepted protocol for gross examination of pancreaticoduodenectomy specimens. Standardized protocol (SP), known as Leeds Pathology Protocol, was previously validated in pancreatic adenocarcinoma. In this study we aimed to assess usefulness of SP in a series of specimens with pancreatic, ampullary, and duodenal malignant neoplasms other than adenocarcinomas. MATERIALS AND METHODS: SP was based on multi-colour inking and serial slicing of the specimens in a plane perpendicular to the duodenal axis...
May 16, 2016: Histology and Histopathology
Matthew P Doepker, Zachary J Thompson, Barbara A Centeno, Richard D Kim, Joyce Wong, Pamela J Hodul
INTRODUCTION: Ampullary adenocarcinoma (AAC) is a rare neoplasm. We sought to determine the clinicopathologic factors contributing to the overall survival (OS) and recurrence-free (RFS) survival. METHODS: Patients (pts) with resected AAC were identified from 1996 to 2015 and reviewed for clinicopathologic factors and correlated with outcome. RESULTS: We identified and evaluated 106 pts diagnosed with AAC. The median age was 70.2 years (range 41-86) and 60 (56...
August 2016: Journal of Surgical Oncology
Eisuke Asano, Keiichi Okano, Minoru Oshima, Seiko Kagawa, Yoshio Kushida, Masaya Munekage, Kazuhiro Hanazaki, Jota Watanabe, Yasutsugu Takada, Tetsuya Ikemoto, Mitsuo Shimada, Yasuyuki Suzuki
BACKGROUND: Although various features of ampullary adenocarcinoma have been reported, the impact of genetic alterations and rare subtypes on clinical outcome remains unclear. METHODS: We determined the expression of proteins, including MUC1, MUC2, p53, p16, Smad/Dpc4, and β-catenin, and genetic mutations such as KRAS, BRAF, and GNAS mutations in 69 patients with ampullary adenocarcinoma to clarify their relationships with clinicopathological findings and subtypes...
July 2016: Journal of Surgical Oncology
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