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Extra-ampullary duodenal adenocarcinoma
Tetsuo Ushiku1, Thomas Arnason, Masashi Fukayama
1*Department of Pathology, Massachusetts General Hospital Boston, MA †Department of Pathology, University of Tokyo, Tokyo, Japan ‡Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
The American Journal of Surgical Pathology
|October 14, 2014
Summary
Extra-ampullary duodenal adenocarcinomas present distinct gastric and intestinal types. Intestinal-type histology is linked to better survival, highlighting differences in these rare cancers.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Extra-ampullary duodenal adenocarcinomas are rare and often studied with other small bowel cancers.
- Anecdotal evidence suggests these tumors may have distinct phenotypes.
Purpose of the Study:
- To characterize extra-ampullary duodenal adenocarcinomas.
- To investigate the morphologic, immunophenotypic, and clinicopathologic features of these neoplasms.
Main Methods:
- Retrospective review of 38 cases of extra-ampullary duodenal adenocarcinoma.
- Classification based on morphologic features: gastric, intestinal, and pancreaticobiliary types.
- Analysis of histopathologic characteristics and association with dysplasia and metaplasia.
Main Results:
- Classified adenocarcinomas into gastric (50%), intestinal (37%), and pancreaticobiliary (5%) types.
- Gastric-type tumors predominantly in the proximal duodenum; others equally distributed.
- Gastric foveolar metaplasia and Brunner gland hyperplasia associated with gastric-type adenocarcinomas.
- Intestinal-type histology and absence of lymph node metastasis correlated with favorable disease-free survival.
Conclusions:
- Extra-ampullary duodenal adenocarcinomas comprise at least two major subsets: intestinal and gastric types.
- These subsets exhibit distinct histopathologic features and clinical behaviors.
- Intestinal-type histology is a significant predictor of favorable prognosis.
