Clinicopathological characteristics of non‐ampullary duodenal tumors and their phenotypic classification

Yoshida, Masao; Shimoda, Tadakazu; Abe, Masato; Kakushima, Naomi; Kawata, Noboru; Takizawa, Kohei; Ono, Hiroyuki; Sugino, Takashi

doi:10.1111/pin.12829

Cited by 39 publications

(45 citation statements)

References 21 publications

(69 reference statements)

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“…Moreover, the incidence of SM invasion was higher among gastric‐type compared with intestinal‐type (28% vs 13%). All of the gastric type with SM invasion were located on the oral‐Vater and manifested as small lesions . These results including the present study lend support to the credence that NADCs may have several carcinogenesis pathways of different malignant potential depending on the location.…”

Section: Discussionsupporting

confidence: 86%

“…Unfortunately, immunohistochemical staining was not possible among all the cases included in this study because of the long study period (2005 to 2018). However, we have recently published another study in which immunohistochemical staining was performed among consecutive superficial non‐ampullary duodenal epithelial tumors during January 2010 to December 2016 . According to location analysis, the mucin phenotype was significantly different (oral‐Vater, gastric‐type 35%, intestinal‐type 65%; anal‐Vater, gastric‐type 13%, intestinal type 87%; P < 0.01).…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic features of submucosal invasive non‐ampullary duodenal carcinomas

Takinami

Kakushima

Yoshida

et al. 2019

J of Gastro and Hepatol

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Background and Aim: It is imperative to distinguish superficial non-ampullary duodenal carcinomas (NADCs) between intramucosal and submucosal invasive carcinoma for treatment selection. The aim of this study was to evaluate the clinicopathological differences of intramucosal and submucosal carcinoma. Methods: This was a retrospective, single-center study comprising 134 patients with 137 superficial NADCs during May 2005 and March 2018. Clinicopathological characteristics and treatment outcomes data were used to perform a comparative analysis of endoscopic findings, preoperative diagnoses of depth of cancer, and treatment outcomes of histologically diagnosed intramucosal and submucosal carcinoma. Results: Of the 137 NADCs, 125 (91%) were intramucosal, and 12 (9%) were submucosal. The proportion of submucosal carcinoma was significantly higher on the oral side of the papilla than on the anal side (16% vs 1%, P = 0.002). Submucosal tumor-like appearance was more frequent in submucosal than in intramucosal carcinoma (58% vs 13%, P = 0.001). There was no significant difference in tumor diameter between the groups, but 33% of submucosal carcinomas were ≤ 10 mm. Correct preoperative diagnosis of depth was achieved in 33% of submucosal carcinoma. Submucosal carcinoma was frequently underestimated when tumor diameters were ≤ 10 mm. Conversely, intramucosal carcinoma was frequently overestimated when the tumor was ≥ 30 mm and had thickness or giant nodules. Lymph node metastasis was found in one submucosal carcinoma patient. Conclusions:The possibility of submucosal invasion should be considered when NADCs are located on the oral side of the papilla or have submucosal tumor-like appearance even if tumor diameters are ≤ 10 mm.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Endoscopic features of submucosal invasive non‐ampullary duodenal carcinomas

Takinami

Kakushima

Yoshida

et al. 2019

J of Gastro and Hepatol

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“…In general, histological diagnosis of mucosal duodenal cancer is made on the basis of features such as irregular nuclear size and shape, an increased nuclear:cytoplasmic (N/C) ratio, loss of polarity in nuclear arrangement, and structural abnormality [14]. In our present series, all cases of NAMDC showed a villous structure, disappearance of goblet cells, and loss of polarity.…”

Section: Discussionmentioning

confidence: 61%

Endocytoscopic Observation of Non-Ampullary Mucosal Duodenal Cancer

Kumagai

Higashi

Muramatsu

et al. 2020

Case Rep Gastroenterol

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KeywordsEndocytoscopy system · Non-ampullary duodenal epithelial tumor · Duodenal cancer · Mucin phenotype Abstract Our previous study of duodenal adenoma using an endocytoscopy system (ECS) demonstrated that disappearance of goblet cells and spindle-shaped nuclei with loss of polarity were characteristic features. In addition, round duct openings and finger-like projections were observed in tubular adenoma and villous adenoma, respectively. Here, we retrospectively investigated six cases of histologically proven sporadic non-ampullary mucosal duodenal cancer (NAMDC) using ECS. Immunohistochemistry for CD10, MUC2, MUC5AC, and MUC6 was employed to determine the mucin phenotype in addition to conventional HE histology. Immunohistochemistry revealed one case involving the duodenal bulb that was considered to be the mixed type. The other five cases, located in the second or third portion, were considered to be the intestinal type. Vital staining of the mixed-type case was considered insufficient for ECS observation because of surface mucus. However, all five cases of intestinal-type duodenal cancer Kumagai et al.: Endocytoscopic Observation of Non-Ampullary Mucosal Duodenal Cancer 157 demonstrated a villous structure, disappearance of goblet cells and enlarged nuclei with loss of polarity. Tubular structures were admixed in four of those cases. Four cases demonstrated oval-shaped nuclei, and one case had spindle-shaped nuclei. Cases showing spindle-shaped nuclei in most of the lesion were diagnosed histologically as cancer in adenoma where the adenomatous component of the tumor was dominant. Oval-shaped nuclei and nuclear enlargement are the characteristic features of NAMDC revealed by ECS and are included among the histological criteria used for diagnosis. ECS offers the potential to perform real-time histological diagnosis of NAMDC in vivo.

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“…It was reported recently that there is a close association between mucin phenotypes and clinicopathological features of NADETs. We and other investigators have shown correlations of the mucin phenotype of NADETs with tumor location, morphology, endoscopic findings and malignant potential,18,25,26 suggesting that the distinction of these two mucin phenotypes is clinically important. Furthermore, we are able to show in the present investigation that ME‐CV had higher diagnostic value than the WLE scoring system for NADETs of both gastric and intestinal phenotypes.…”

Section: Discussionmentioning

confidence: 69%

Diagnostic algorithm of magnifying endoscopy with crystal violet staining for non‐ampullary duodenal epithelial tumors

Toya

Endo

Oizumi

et al. 2020

Digestive Endoscopy

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Objectives Little is known about the usefulness of magnifying endoscopy with crystal violet staining (ME‐CV) for the diagnosis of duodenal tumors. We assessed the ability of ME‐CV to distinguish Vienna classification (VCL) category 4/5 (C4/5) from category 3 (C3) non‐ampullary duodenal epithelial tumors (NADETs). Methods A total of 76 NADETs were studied. We retrospectively analyzed the diagnostic values of the white light endoscopy (WLE) scoring system and the ME‐CV algorithm with receiver operating characteristic (ROC) curves, and three endoscopists calculated the sensitivity, specificity, accuracy, and the area under the curve (AUC) of each. The diagnostic values were tested among NADETs overall and among subgroups of tumors with gastric, gastrointestinal or intestinal mucin phenotypes. Inter‐observer agreement of the diagnostic results was also calculated. Results According to the VCL, 54 lesions (71.1%) were regarded as C3 and 22 lesions (28.9%) as C4/5. The sensitivity, specificity, accuracy and AUC of ME‐CV were higher than those of the WLE scoring system (63.6 vs 54.5, 85.2 vs 75.9, 78.9 vs 69.7, 0.744 vs 0.652, respectively). Inter‐observer agreements of the WLE scoring system and ME‐CV were both moderate (kappa 0.45 and 0.41). ME‐CV had higher sensitivity, specificity, accuracy and AUC than those of the WLE scoring system among the gastric and intestinal phenotypes of NADETs. Conclusions ME‐CV is appropriate for the diagnosis of C4/5 and C3 NADETs.

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Clinicopathological characteristics of non‐ampullary duodenal tumors and their phenotypic classification

Cited by 39 publications

References 21 publications

Endoscopic features of submucosal invasive non‐ampullary duodenal carcinomas

Endoscopic features of submucosal invasive non‐ampullary duodenal carcinomas

Endocytoscopic Observation of Non-Ampullary Mucosal Duodenal Cancer

Diagnostic algorithm of magnifying endoscopy with crystal violet staining for non‐ampullary duodenal epithelial tumors

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