Neoplasms of the Ampulla of Vater with Concurrent Pancreatic Intraductal Neoplasia: A Histological and Molecular Study

Abstract

Adenoma and adenocarcinoma of the ampulla of Vater are uncommon neoplasms of the gastrointestinal tract that are found with increased frequency in familial adenomatous polyposis syndrome (1-3). Ampullary adenoma represents the precursor lesion to adenocarcinoma, and a coexistent adenoma can be identified frequently in patients with ampullary adenocarcinoma (1, 2). Because of their premalignant nature, ampullary adenomas are often resected either by polypectomy or, in the case of larger lesions, by pancreaticoduodenectomy (1,4,5). An association between adenomas of the ampullary region and pancreatic intraductal neoplasia has not been documented previously. Adenocarcinoma of the pancreas is often associated with pancreatic intraductal neoplasia (PanIN), which is thought to represent the precursor lesion for this cancer (6 -12). Several case reports documenting progression of high-grade (HG) PanIN to invasive pancreatic adenocarcinoma over time (17 mo to 29 y) support the role of PanIN as a precursor of carcinoma (10,13,14).The relationship between ampullary adenoma and PanIN has not been investigated previously, and only one analysis of the relationship between

Cyclooxygenase-2 expression associated with severity of PanIN lesions: A possible link between chronic pancreatitis and pancreatic cancer

“…Furthermore, a gradual increase in COX-2 expression was seen with increasing severity of intraepithelial neoplastic changes (PanIN-3 1 PanIN-2 1 PanIN-1). To date, only four publications commented on COX-2 in PanIN, and in three of these [23,32,38] fi ndings were incidental, diffi cult to interpret and confl icting. Maitra et al [35] who performed a more systematical study on COX-2 expression in PanIN, reported overexpression in 65% of PanIN lesions, and similar to our fi ndings they observed that COX-2 expression increased from normal ducts to low-grade to high-grade PanIN lesions [35] .…”

Precursors to Pancreatic Cancer

“…To date, at least five genetic syndromes are known to increase the risk of pancreatic cancer (Table 3) (77)(78)(79)(80)(81)(82)(83)(84). For example, germ line (inherited) mutations in the second breast cancer gene (BRCA2), are associated with a three-to 10-fold increased risk of pancreatic cancer (78;85-88).…”

Carcinoma of Ampulla of Vater: Carcinogenesis and Immunophenotypic Evaluation

“…Other found high-grade PanIN in seven of seventeen patients [19]. Lastly, others authors reported that the incidence of PanIN was similar between pancreatic adenocarcinomas and ampullary adenocarcinomas [20].…”