Morphogenesis and possible precursor lesions of invasive carcinoma of the papilla of vater: Epithelial dysplasia and adenoma

Baczako, K.; Büchler, Markus W.; Beger, H. G.; Kirkpatrick, Charles James; Haferkamp, O

doi:10.1016/s0046-8177(85)80018-6

Cited by 111 publications

(62 citation statements)

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“…10,[14][15][16] Ampullary adenoma is well known as a premalignant lesion because of adenoma-carcinoma sequence, similar to colonic cancer. 17,18 However, the coexistence of carcinoma within the adenoma cannot be LGD low-grade dysplasia, HGD high-grade dysplasia, CI confidential interval excluded by preprocedural biopsy. 9,10 Moreover, the falsenegative rate of endoscopic biopsy for cancer has been reported to be high, ranging from 11.7% to 60%.…”

Section: Discussionmentioning

confidence: 99%

Is Endoscopic Papillectomy Safe for Ampullary Adenomas with High-Grade Dysplasia?

Kim

Han

et al. 2009

Ann Surg Oncol

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Objectives. This study was designed to provide safe management guidelines for ampullary adenoma by analysis of clinicopathological features. Background. The treatment of ampullary cancer has been established; however, the indications for treatment of ampullary adenoma remain controversial. Methods. Between July 1997 and July 2008, a total of 33 patients were diagnosed with ampullary adenoma prior to procedures: 20 endoscopic papillectomies (ESP), 5 transduodenal resections (TDR), and 8 pancreatoduodenectomies (PD). Results. The false-negative rate of biopsy for cancer was 27.5% (8/29). Coexistence of cancer in patients with prehigh-grade dysplasia (HGD) was 50.0% (5/10), whereas it was 15.7% in pre-low-grade dysplasia (LGD). In addition, the rate of recurrence was 80% (8/10) in patients with pre-HGD. The size of tumor by final pathology was 1.27 ± 0.89 cm in LGD, 1.81 ± 0.99 cm in HGD, and 1.98 ± 1.08 cm in cancer group. There was a significant correlation between size of tumor and final pathology (P = 0.036). According to receiver operating characteristic (ROC) curve, criterion to predict HGD/cancer was tumor size larger than 1.5 cm; sensitivity and specificity were 55.6% and 80.0%, respectively, and likelihood ratio was 2.778. However, size of tumor was not associated with preprocedural pathology. Conclusions. Ampullary adenoma with preprocedural HGD was highly associated with coexistence of cancer and recurrence. Moreover, most of large tumors were treated by surgical procedures and proved to be cancer. Therefore, we suggest that ampullary adenoma with preprocedural HGD or more than 1.5 cm should not be managed with endoscopic papillectomy due to high associated rates of recurrence.Since 1935, pancreatoduodenectomy (PD) has been used as the treatment of choice for periampullary tumors.1,2 For the treatment of ampullary cancer, Beger et al. reported that oncological resection of ampullary cancer by means of PD is the surgical procedure of choice; the 3-and 5-year survival rates were 72% and 52%, respectively.3 Moreover, Yoon et al. reported that PD should preferably be performed even in early ampullary cancer. 4 The management criteria for ampullary cancer have already been established.As a noninvasive treatment, transduodenal resection (TDR) is usually indicated in patients with high operative risk.3 However, most surgeons have no great desire to try local resection of ampullary tumors, because of high recurrence rate and lack of established management criteria. Recently, endoscopic papillectomy (ESP) has been accepted as an alternative therapy to surgery in ampullary adenoma. According to some studies, the tumor size criterion for endoscopic papillectomy is up to 4-4.5 cm. [5][6][7] Nevertheless, ampullary adenoma is considered as a precancerous lesion, and the rate of development of carcinoma has been shown to be 30%. 8 Moreover, the coexistence of carcinoma within adenoma cannot be excluded by preprocedural biopsy. 9,10 As described above, the management strategies for ampulla adenoma are expanding...

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Section: Discussionmentioning

confidence: 99%

Is Endoscopic Papillectomy Safe for Ampullary Adenomas with High-Grade Dysplasia?

Kim

Han

et al. 2009

Ann Surg Oncol

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“…Microscopically, the tumors were classified by the system in the World Health Organization (WHO) monograph (24) as papillary adenocarcinoma, adenocarcinoma (including well differentiated, moderately differentiated and poorly differentiated), mucinous adenocarcinoma, signet-ring cell carcinoma, clear cell adenocarcinoma, adenosquamous carcinoma, squamous carcinoma, small cell carcinoma, and undifferentiated carcinoma. We classified the degree of dysplasia of the lesions adjacent to the carcinoma of the ampulla of Vater using the criteria of Baczako et al (6). We were able to classify three degrees of dysplasia: mild, moderate, or severe.…”

Section: Methodsmentioning

confidence: 99%

Carcinoma of the Ampulla of Vater Associated With or Without Adenoma: A Clinicopathologic Analysis of 198 Cases With Reference to p53 and Ki-67 Immunohistochemical Expressions

et al. 2000

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Adenomatous areas are found frequently within or in the vicinity of carcinoma of the ampulla of Vater. This makes definite diagnosis difficult in the preoperative examination. The adenoma-carcinoma development hypothesis is generally accepted for colorectal tumors. Recently, a genetic alteration model during colorectal tumor development has attracted much attention, leading to various studies. We studied clinicopathologic features, prognostic factors, and the alteration of the p53 tumor suppressor gene using p53 immunohistochemical staining in pure adenomas, pure carcinomas, and carcinomas with adenomatous areas. A proliferative activity of the tumors using Ki-67 was also evaluated. Nine cases of pure adenoma and 198 cases of carcinoma of the ampulla of Vater were selected for this study. Among the 198 cases of the carcinoma, 83 cases (42%) had adenomatous areas. Positivity of p53 immunohistochemical staining was 0% in pure adenomas, 36% in the adenomatous areas of carcinomas with adenomatous areas and 62% in the carcinomatous areas of carcinomas with adenomatous areas, and 56% in pure carcinoma. Accumulation of p53 protein and the Ki-67 labeling index revealed no significant difference in prognosis. The clinicopathological factors examined were as follows: degree of invasion of the surrounding tissue, such as duodenal wall; pancreatic parenchyma; the presence or absence of lymphatic permeation; venous invasion; perineural invasion; the presence of regional lymph node metastasis; and TNM stage. Each of the clinicopathological factors showed a significant difference. Multivariate analysis revealed strong predictors for a worse prognosis: presence of lymphatic permeation, invasion of the pancreas, and perineural invasion. In conclusion, our results are consistent with the adenoma-carcinoma development hypothesis. It would seem that the molecular events leading to p53 accumulation in neoplasms of the ampulla of Vater occur relatively late during the oncogenetic process. Moreover, we think it may be useful to refer to the p53 overexpression in the diagnosis of ampullary tumors.

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“…Adenoma lesion is often seen around carcinoma lesion [242][243][244] and the abnormal findings of oncogene and tumor suppressor gene in adenoma are also reported [244,245].…”

Section: Radiation Therapymentioning

confidence: 99%

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Miyazaki

Yoshitomi

Miyakawa³

et al. 2015

J Hepato Biliary Pancreat

237

165

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Background The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations. Methods Clinical questions (CQs) were proposed in seven topics. Recommendation, grade of recommendation and statement for each CQ were discussed and finalized by evidencebased approach. Recommendation was graded to grade 1 (strong) and 2 (weak) according to the concept of GRADE system. Results The 29 CQs covered seven topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, (6) radiation therapy, and (7) pathology. In 27 CQs, 19 recommendations were rated strong and 11 recommendations weak. Each CQ included the statement of how the recommendation was graded. Conclusions This guideline provides recommendation for important clinical aspects based on evidence. Future collaboration with cancer registry will be a key for assessment of the guidelines and establishment of new evidence. Free full-text articles and a mobile application of this guideline are available via

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Morphogenesis and possible precursor lesions of invasive carcinoma of the papilla of vater: Epithelial dysplasia and adenoma

Cited by 111 publications

References 4 publications

Is Endoscopic Papillectomy Safe for Ampullary Adenomas with High-Grade Dysplasia?

Is Endoscopic Papillectomy Safe for Ampullary Adenomas with High-Grade Dysplasia?

Carcinoma of the Ampulla of Vater Associated With or Without Adenoma: A Clinicopathologic Analysis of 198 Cases With Reference to p53 and Ki-67 Immunohistochemical Expressions

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

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Morphogenesis and possible precursor lesions of invasive carcinoma of the papilla of vater: Epithelial dysplasia and adenoma

Cited by 111 publications

References 4 publications

Is Endoscopic Papillectomy Safe for Ampullary Adenomas with High-Grade Dysplasia?

Is Endoscopic Papillectomy Safe for Ampullary Adenomas with High-Grade Dysplasia?

Carcinoma of the Ampulla of Vater Associated With or Without Adenoma: A Clinicopathologic Analysis of 198 Cases With Reference to p53 and Ki-67 Immunohistochemical Expressions

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

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Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition