Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kim RD, Kundhal PS, McGilvray ID, et al. Predictors of failure after pancreaticoduodenectomy for ampullary carcinoma. J Am Coll Surg 2006;202:112–119.

    Article  PubMed  Google Scholar 

  2. Fischer HP, Zhou H. Pathogenesis of carcinoma of the papilla of Vater. J Hepatobiliary Pancreat Surg 2004;11:301–309.

    Article  PubMed  Google Scholar 

  3. Howe JR, Klimstra DS, Moccia RD, et al. Factors predictive of survival in ampullary carcinoma. Ann Surg 1998;228:87–94.

    Article  CAS  PubMed  Google Scholar 

  4. Yeo CJ, Sohn TA, Cameron JL, et al. Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 1998;227:821–831.

    Article  CAS  PubMed  Google Scholar 

  5. Warren KW, Choe DS, Plaza J, et al. Results of radical resection for periampullary cancer. Ann Surg 1975;181:534–540.

    CAS  PubMed  Google Scholar 

  6. Talamini MA, Moesinger RC, Pitt HA, et al. Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg 1997;225:590–599; discussion 599–600.

    Article  CAS  PubMed  Google Scholar 

  7. Carter JT, Grenert JP, Rubenstein L, et al. Tumors of the ampulla of vater: histopathologic classification and predictors of survival. J Am Coll Surg 2008;207:210–218.

    Article  PubMed  Google Scholar 

  8. Bouvet M, Gamagami RA, Gilpin EA, et al. Factors influencing survival after resection for periampullary neoplasms. Am J Surg 2000;180:13–17.

    Article  CAS  PubMed  Google Scholar 

  9. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248–257; discussion 257–60.

    Article  CAS  PubMed  Google Scholar 

  10. Kimura W, Futakawa N, Yamagata S, et al. Different clinicopathologic findings in two histologic types of carcinoma of papilla of Vater. Jpn J Cancer Res 1994;85:161–156.

    CAS  PubMed  Google Scholar 

  11. Albores-Saavedra J. Tumors of the gallbladder, extrahepatic bile ducts, and ampulla of Vater. In: Albores-Saavedra J, editor. Atlas of Tumor Pathology. Washington, D.C.: Armed Forces Institute of Pathology; 2000. p. 259:316.

    Google Scholar 

  12. Matsubayashi H, Watanabe H, Yamaguchi T, et al. Differences in mucus and K-ras mutation in relation to phenotypes of tumors of the papilla of vater. Cancer 1999;86:596–607.

    Article  CAS  PubMed  Google Scholar 

  13. Zhou H, Schaefer N, Wolff M, et al. Carcinoma of the ampulla of Vater: comparative histologic/immunohistochemical classification and follow-up. Am J Surg Pathol 2004;28:875–882.

    Article  PubMed  Google Scholar 

  14. Chu PG, Schwarz RE, Lau SK, et al. Immunohistochemical staining in the diagnosis of pancreatobiliary and ampulla of Vater adenocarcinoma: application of CDX2, CK17, MUC1, and MUC2. Am J Surg Pathol 2005;29:359–367.

    Article  PubMed  Google Scholar 

  15. Westgaard A, Tafjord S, Farstad IN, et al. Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer 2008;8:170.

    Article  PubMed  Google Scholar 

  16. Sessa F, Furlan D, Zampatti C, et al. Prognostic factors for ampullary adenocarcinomas: tumor stage, tumor histology, tumor location, immunohistochemistry and microsatellite instability. Virchows Arch 2007;451:649–657.

    Article  CAS  PubMed  Google Scholar 

  17. Roh YH, Kim YH, Lee HW, et al. The clinicopathologic and immunohistochemical characteristics of ampulla of Vater carcinoma: the intestinal type is associated with a better prognosis. Hepatogastroenterology 2007;54:1641–1644.

    PubMed  Google Scholar 

  18. Ruemmele P, Dietmaier W, Terracciano L, et al. Histopathologic features and microsatellite instability of cancers of the papilla of vater and their precursor lesions. Am J Surg Pathol 2009;33:691–704.

    Article  PubMed  Google Scholar 

  19. (UICC) IUAC. Ampulla of Vater. In: Wittekind LHSaC, editor. TNM Classification of Malignant Tumors. 6th ed. ed. New York: Jonh Wiley & Sons, Hoboken; 2002. p. 90–92.

    Google Scholar 

  20. Nelder JA, Wedderburn RWM. Generalized linear models. J Royal Stat Soc A 1972;135:370–384.

    Article  Google Scholar 

  21. Hansel DE, Maitra A, Lin JW, et al. Expression of the caudal-type homeodomain transcription factors CDX 1/2 and outcome in carcinomas of the ampulla of Vater. J Clin Oncol 2005;23:1811–1818.

    Article  CAS  PubMed  Google Scholar 

  22. Mallo GV, Soubeyran P, Lissitzky JC, et al. Expression of the Cdx1 and Cdx2 homeotic genes leads to reduced malignancy in colon cancer-derived cells. J Biol Chem 1998;273:14030–14036.

    Article  CAS  PubMed  Google Scholar 

  23. Bai YQ, Yamamoto H, Akiyama Y, et al. Ectopic expression of homeodomain protein CDX2 in intestinal metaplasia and carcinomas of the stomach. Cancer Lett 2002;176:47–55.

    Article  CAS  PubMed  Google Scholar 

  24. Mizoshita T, Tsukamoto T, Nakanishi H, et al. Expression of Cdx2 and the phenotype of advanced gastric cancers: relationship with prognosis. J Cancer Res Clin Oncol 2003;129:727–734.

    Article  CAS  PubMed  Google Scholar 

  25. Handra-Luca A, Flejou JF, Rufat P, et al. Human pancreatic mucinous cystadenoma is characterized by distinct mucin, cytokeratin and CD10 expression compared with intraductal papillary-mucinous adenoma. Histopathology 2006;48:813–821.

    Article  CAS  PubMed  Google Scholar 

  26. Notohara K, Hamazaki S, Tsukayama C, et al. Solid-pseudopapillary tumor of the pancreas: immunohistochemical localization of neuroendocrine markers and CD10. Am J Surg Pathol 2000;24:1361–1371.

    Article  CAS  PubMed  Google Scholar 

  27. Ho SB, Niehans GA, Lyftogt C, et al. Heterogeneity of mucin gene expression in normal and neoplastic tissues. Cancer Res 1993;53:641–651.

    CAS  PubMed  Google Scholar 

  28. Vogelstein B, Fearon ER, Hamilton SR, et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988;319:525–532.

    Article  CAS  PubMed  Google Scholar 

  29. Perzin KH, Bridge MF. Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma. Cancer 1981;48:799–819.

    Article  CAS  PubMed  Google Scholar 

  30. Tasaka K. Carcinoma in the region of the duodenal papilla. A histopathologic study (author’s transl). Fukuoka Igaku Zasshi 1977;68:20–44.

    CAS  PubMed  Google Scholar 

  31. Baczako K, Buchler M, Beger HG, et al. Morphogenesis and possible precursor lesions of invasive carcinoma of the papilla of Vater: epithelial dysplasia and adenoma. Hum Pathol 1985;16:305–310.

    Article  CAS  PubMed  Google Scholar 

  32. Agoff SN, Crispin DA, Bronner MP, et al. Neoplasms of the ampulla of vater with concurrent pancreatic intraductal neoplasia: a histological and molecular study. Mod Pathol 2001;14:139–146.

    Article  CAS  PubMed  Google Scholar 

  33. Klempnauer J, Ridder GJ, Pichlmayr R. Prognostic factors after resection of ampullary carcinoma: multivariate survival analysis in comparison with ductal cancer of the pancreatic head. Br J Surg 1995;82:1686–691.

    Article  CAS  PubMed  Google Scholar 

  34. Talbot IC, Neoptolemos JP, Shaw DE, et al. The histopathology and staging of carcinoma of the ampulla of Vater. Histopathology 1988;12:155–165.

    Article  CAS  PubMed  Google Scholar 

  35. Monson JR, Donohue JH, McEntee GP, et al. Radical resection for carcinoma of the ampulla of Vater. Arch Surg 1991;126:353–357.

    CAS  PubMed  Google Scholar 

  36. Beger HG, Treitschke F, Gansauge F, et al. Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg 1999;134:526–532.

    Article  CAS  PubMed  Google Scholar 

  37. Kitamura H, Yonezawa S, Tanaka S, et al. Expression of mucin carbohydrates and core proteins in carcinomas of the ampulla of Vater: their relationship to prognosis. Jpn J Cancer Res 1996;87:631–640.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, R. Aracaju, 42, ap 41, Higienopolis, São Paulo, 0501240030, Brazil

    Luciana Bertocco de Paiva Haddad, Sônia Penteado, André Luiz Montagnini, José Eduardo Monteiro da Cunha, Marcel Cerqueira César Machado & José Jukemura

  2. Pathology Department, University of São Paulo School of Medicine, R. Aracaju, 42, ap 41, Higienopolis, São Paulo, 0501240030, Brazil

    Rosely Antunes Patzina

Authors
  1. Luciana Bertocco de Paiva Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosely Antunes Patzina
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sônia Penteado
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. André Luiz Montagnini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. José Eduardo Monteiro da Cunha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcel Cerqueira César Machado
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. José Jukemura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luciana Bertocco de Paiva Haddad.

Additional information

Support: FAPESP, Fundação de Amparo à Pesquisa do Estado de São Paulo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Paiva Haddad, L.B., Patzina, R.A., Penteado, S. et al. Lymph Node Involvement and Not the Histophatologic Subtype Is Correlated with Outcome After Resection of Adenocarcinoma of the Ampulla of Vater. J Gastrointest Surg 14, 719–728 (2010). https://doi.org/10.1007/s11605-010-1156-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-010-1156-4

Keywords

Search

Navigation