Depressed adenoma of the duodenum in patients with familial adenomatous polyposis

Matsumoto, Takayuki; Iida, Mitsuo; Nakamura, Shotaro; Hizawa, Kazuoki; Mizuno, Mitsuru; Yao, Takashi; Tsuneyoshi, Masazumi; Fujishima, Masatoshi

doi:10.1002/(sici)1097-0142(19991015)86:8<1414::aid-cncr5>3.0.co;2-#

Cited by 10 publications

(6 citation statements)

References 34 publications

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“…corresponding to red color area in this study), nodular surface, or depressed portions that are suspected to harbor the most dysplastic portion of the tumor that had been previously reported. [25][26][27] This strict biopsy protocol would provide higher diagnostic yields of preoperative biopsy in their study than those in the present case series. Moreover, the worse diagnostic performance of preoperative biopsy in the present case series compared to the previous study is concerned with non-standardized histological criteria for adenoma and adenocarcinoma between different pathologists in each hospital.…”

Section: Discussionmentioning

confidence: 63%

“…In the previous study, preoperative biopsies were all taken from the lesions’ erythematous area (i.e. corresponding to red color area in this study), nodular surface, or depressed portions that are suspected to harbor the most dysplastic portion of the tumor that had been previously reported . This strict biopsy protocol would provide higher diagnostic yields of preoperative biopsy in their study than those in the present case series.…”

Section: Discussionmentioning

confidence: 85%

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Endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors in Japan: Multicenter case series

Goda

Kikuchi

Yamamoto

et al. 2014

Digestive Endoscopy

174

230

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Background and Aim:To verify the current status in Japan on endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADET) by a multicenter case series through a questionnaire survey.Methods: Nine endoscopists and a surgeon responded to a questionnaire on endoscopic diagnosis of SNADET. The subjects of this survey were histologically confirmed SNADET that were endoscopically or surgically resected from 2007 to 2012. This survey collected data of 364 patients with 396 SNADET.Results: Of the 396 SNADET, 121 were histologically diagnosed as low-grade dysplasia (LGD), 112 as high-grade dysplasia (HGD), and 163 as superficial adenocarcinoma (SAC) including 153 mucosal carcinomas and 10 submucosal carcinomas. Total number of SNADET increased from 125 in the first half to 271 in the second half of the survey period. Compared to LGD, a significantly greater number of HGD or SAC was found in the tumors having a diameter >5 mm as well as solitary or predominantly red color. Preoperative endoscopic diagnosis indicated significantly higher sensitivity and accuracy and significantly lower specificity for HGD or SAC of final histology than preoperative biopsy. Ten submucosal carcinomas had 0-I or 0-IIa+IIc macroscopic-type tumors with red color.Conclusions: This multicenter case series study suggested that the number of resected SNADET is dramatically increasing in Japan. Tumor diameter >5 mm and red color seemed to be signs for tumors of HGD or SAC. Preoperative endoscopy may provide a more reliable diagnosis of final histology of HGD or SAC than preoperative biopsy. Further studies are warranted for establishing endoscopic features of submucosal carcinoma.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 85%

Endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors in Japan: Multicenter case series

Goda

Kikuchi

Yamamoto

et al. 2014

Digestive Endoscopy

174

230

View full text Add to dashboard Cite

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“…Toyooka et al [22] detected somatic APC mutations in 50% of ampullary cancers, 67% of ampullary adenomas and 46% of duodenal adenomas; but other groups have reported lower detection rates ranging from 6 to18% [65,66]. Additional genetic mutations, including K-ras and p53 mutation [65,[67][68][69], are also well described in the published literature. Genotype/phenotype correlations for colonic disease in FAP are well recognised to the extent that mutation analysis may contribute to decisions, including the timing of primary surgery or the procedure performed [70][71][72].…”

Section: Geneticsmentioning

confidence: 99%

Surveillance and management of upper gastrointestinal disease in Familial Adenomatous Polyposis

2006

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Almost all patients affected by Familial Adenomatous polyposis (FAP) will develop foregut as well as hindgut polyps, and following prophylactic colectomy duodenal cancer constitutes one of the leading causes of death in screened populations. Without prophylactic colectomy, FAP patients predictably develop colorectal cancer, but the lifetime risk of upper gastrointestinal cancer is lower, estimated at approximately 5%. Management of the upper gastrointestinal cancer risk is one of the greatest challenges facing clinicians involved in the care of Polyposis families, and with improved survival following prophylactic colectomy, the burden of foregut disease (particularly duodenal adenomatosis) will increase. Until recently, the value of upper gastrointestinal surveillance in FAP populations has been contentious, but with improved understanding of the natural history coupled with developments in surgery, interventional endoscopy and medical therapy, treatment algorithms for duodenal adenomatosis in FAP are becoming clearer.

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“…Their father is also under continuous surveillance for his duodenal polyps. Interestingly, FA has been identified [18] in the nonperiampullary area of the duodenum in 10 patients with FAP Based on the endoscopic, histologic, and genetic features, FA has usually been regarded as different from the classical polypoid adenomas of FAP. However, Lanspa et al [19] investigated the epidemiologic characteristics of the FA in a prospective examination of an adult cohort referred for colonoscopy and noted coexistence of FA and florid polyposis in 2 cases of FAP from 2 different families.…”

Section: Discussionmentioning

confidence: 99%

Colonic and Duodenal Flat Adenomas in Children with Classical Familial Adenomatous Polyposis

Cohen

Thomson²,

Taylor

et al. 2006

Int J Surg Pathol

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Flat adenomas of the colon and duodenum have been described as associating with familial adenomatous polyposis (FAP), its attenuated variant, and the so-called hereditary nonpolyposis colorectal cancer. There seem to be no report on the occurrence of flat adenomas in pediatric patients with family history of FAP. We are reporting 4 children from 2 cancer-prone families in whom colonic and duodenal moderately dysplastic flat adenomas were found. Gastrointestinal endoscopy and biopsies were performed in 3 female siblings (7, 9, and 11 years old) and 1 male (9 years old) when referred for screening owing to familial history of bowel cancer (family 1) or evidence of bilateral congenital hypertrophy of the retinal pigment epithelium (CHRPE), which is known to be associated with FAP (family 2). Endoscopic visualization of the mucosa was improved by use of 0.2% indigo carmine solution spray. Biopsies were routinely processed for H&E and immunohistochemistry staining. Present patients were asymptomatic, with the exception of 2 weeks rectal bleeding in 1 of them. The colonic videoendoscopy showed in 2/3 siblings hundreds of flat or slightly raised plaques less than 1 cm in diameter as well as some classic polyps throughout the colon. The other sibling showed 40 flat-topped lesions with minimal elevation and central umbilication in the cecum. Upper endoscopy demonstrated a few flat lesions in the nonperiampullary area of the duodenum in 2/4 patients. The colonic videoendoscopy performed on the 9-year-old boy revealed multiple small sessile polyps. Microscopic study demonstrated tubular adenomas with a few neoplastic crypts, slight disarray of the overall architecture, and moderate (low-grade) dysplasia of the epithelium. These features were more obvious at the center and superficial areas of the adenomas. The 4 children had multiple flat adenomas of the colon and duodenum (2/4) matching with those described in adult patients. Flat adenomas in the context of FAP probably represent early stages of the adenoma development. Careful endoscopic-histologic correlation may result in increasing recognition of these lesions at the pediatric age.

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Depressed adenoma of the duodenum in patients with familial adenomatous polyposis

Cited by 10 publications

References 34 publications

Endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors in Japan: Multicenter case series

Endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors in Japan: Multicenter case series

Surveillance and management of upper gastrointestinal disease in Familial Adenomatous Polyposis

Colonic and Duodenal Flat Adenomas in Children with Classical Familial Adenomatous Polyposis

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