Journal of Gastrointestinal Surgery

, Volume 14, Issue 4, pp 719–728

Lymph Node Involvement and Not the Histophatologic Subtype Is Correlated with Outcome After Resection of Adenocarcinoma of the Ampulla of Vater

  • Luciana Bertocco de Paiva Haddad
  • Rosely Antunes Patzina
  • Sônia Penteado
  • André Luiz Montagnini
  • José Eduardo Monteiro da Cunha
  • Marcel Cerqueira César Machado
  • José Jukemura
Original Article

DOI: 10.1007/s11605-010-1156-4

Cite this article as:
de Paiva Haddad, L.B., Patzina, R.A., Penteado, S. et al. J Gastrointest Surg (2010) 14: 719. doi:10.1007/s11605-010-1156-4

Abstract

Background

Intestinal and pancreaticobiliary types of Vater’s ampulla adenocarcinoma have been considered as having different biologic behavior and prognosis. The aim of the present study was to determine the best immunohistochemical panel for tumor classification and to analyze the survival of patients having these histological types of adenocarcinoma.

Method

Ninety-seven resected ampullary adenocarcinomas were histologically classified, and the prognosis factors were analyzed. The expression of MUC1, MUC2, MUC5AC, MUC6, CK7, CK17, CK20, CD10, and CDX2 was evaluated by using immunohistochemistry.

Results

Forty-three Vater’s ampulla carcinomas were histologically classified as intestinal type, 47 as pancreaticobiliary, and seven as other types. The intestinal type had a significantly higher expression of MUC2 (74.4% vs. 23.4%), CK20 (76.7% vs. 29.8%), CDX2 (86% vs. 21.3%), and CD10 (81.4% vs. 51.1%), while MUC1 (53.5% vs. 82.9%) and CK7 (79.1% vs. 95.7%) were higher in pancreatobiliary adenocarcinomas. The most accurate markers for immunohistochemical classification were CDX2, MUC1, and MUC2. Survival was significantly affected by pancreaticobiliary type (p = 0.021), but only lymph node metastasis, lymphatic invasion, and stage were independent risk factors for survival in a multivariate analysis.

Conclusion

The immunohistochemical expression of CDX2, MUC1, and MUC2 allows a reproducible classification of ampullary carcinomas. Although carcinomas of the intestinal type showed better survival in the univariate analysis, neither histological classification nor immunohistochemistry were independent predictors of poor prognosis.

Keywords

Ampulla of vater Adenocarcinoma Immunohistochemistry Mucins Prognostic factor 

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Luciana Bertocco de Paiva Haddad
    • 1
  • Rosely Antunes Patzina
    • 2
  • Sônia Penteado
    • 1
  • André Luiz Montagnini
    • 1
  • José Eduardo Monteiro da Cunha
    • 1
  • Marcel Cerqueira César Machado
    • 1
  • José Jukemura
    • 1
  1. 1.Digestive Surgery Division, Department of GastroenterologyUniversity of São Paulo School of MedicineHigienopolisBrazil
  2. 2.Pathology DepartmentUniversity of São Paulo School of MedicineHigienopolisBrazil

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