Noninvasive and minimally invasive papillary carcinomas of the extrahepatic bile ducts

Albores‐Saavedra, Jorge; Murakata, Linda A.; Krueger, Jo Ellen; Henson, Donald E.

doi:10.1002/1097-0142(20000801)89:3<508::aid-cncr5>3.0.co;2-d

Cited by 107 publications

(89 citation statements)

References 17 publications

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“…Therefore, these two lesions should be included in a single group; that is, high‐grade dysplasia/carcinoma in situ. The dysplasia‐carcinoma sequence is the usual pathway for progression to invasive carcinoma from the extrahepatic bile ducts 47, 48, 49, 50, 51, 52. Non‐invasive papillary carcinomas do not metastasize, and complete excision may be curative, so extensive sampling is recommended to exclude invasion 47…”

Section: “Carcinoma In Situ”: Histopathological Terminologymentioning

confidence: 99%

“…In 2011, Wakai et al58 reported that after stratification based on pN and pM classification, the ductal resection margin status in patients with extrahepatic cholangiocarcinoma significantly influenced long‐term survival following resection in those with pN0pM0 disease but not in those with pN1 and/or pM1 disease. When the ductal resection margin status is shown to be carcinoma‐positive on examination of frozen sections, additional resection should be considered in patients with localized (pN0pM0) disease 28, 34, 36, 47, 58, 59, 60. In 2017, Tsukahara et al34 first reported that residual carcinoma in situ at the bile duct stumps increased the incidence of local recurrence and adversely affected postoperative survival in patients who underwent resection for early‐stage (pTis‐2N0M0) cholangiocarcinoma.…”

Section: Biological Behavior Of Residual Carcinoma In Situmentioning

confidence: 99%

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Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Wakai

Sakata

Katada

et al. 2018

Annals of Gastroent Surgery

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Recent advances in dimensional imaging, surgical technique, and perioperative patient care have resulted in increased rates of complete resection with histopathologically negative margins and improved surgical outcomes in patients with extrahepatic cholangiocarcinoma. However, achieving cancer‐free resection margins at ductal stumps in surgery for this disease remains challenging because of longitudinal extension, which is one of the hallmarks of extrahepatic cholangiocarcinoma. When the ductal resection margins are shown to be positive on examination of frozen sections, discrimination between carcinoma in situ and invasive carcinoma is clinically important because residual carcinoma in situ may lead to late local recurrence whereas residual invasive carcinoma is associated with early local recurrence. Residual invasive carcinoma at the ductal margins should be avoided whenever technically feasible. Residual “carcinoma in situ” at the ductal margins appears to be allowed in resection for the advanced disease because it has less effect on survival than other adverse prognostic factors (pN1 and/ or pM1). However, in surgery for early‐stage (pTis‐2N0M0) extrahepatic cholangiocarcinoma, residual carcinoma in situ at the ductal margins may have an adverse effect on long‐term survival, so should be avoided whenever possible. In this review, we focus on the histopathological term “carcinoma in situ,” the biological behavior of residual carcinoma in situ at ductal resection margins, intraoperative histological examination of the ductal resection margins, outcome of additional resection for positive ductal margins, and adjuvant therapy for patients with positive margins.

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Section: “Carcinoma In Situ”: Histopathological Terminologymentioning

confidence: 99%

Section: Biological Behavior Of Residual Carcinoma In Situmentioning

confidence: 99%

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Wakai

Sakata

Katada

et al. 2018

Annals of Gastroent Surgery

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“…There are different histological classifications of ampullary carcinomas (ACs) which [2,3,20] makes comparison of clinical, therapeutic, and prognostic studies of these tumors difficult. So far, two major histological types of these tumors have been recognized: an intestinal type, arising from intestinal mucosa of the papilla, and a biliopancreatic (BP) type, deriving from the BP ductal epithelium.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for ampullary adenocarcinomas: tumor stage, tumor histology, tumor location, immunohistochemistry and microsatellite instability

et al. 2007

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Prognostic factors for ampullary carcinomas (ACs) are poorly defined. Fifty three resected ACs were analyzed for CDX2, MUC1, MUC5AC, MUC6, MUC2, and for mismatch repair proteins (hMLH1, hMSH2, PMS2, hMSH6) using immunohistochemistry. Microsatellite instability (MSI) status was evaluated by fluorescently labeled PCR using an automated sequencer. Univariate and multivariate analysis was performed for clinicopathological, immunohistochemical and molecular parameters. CDX2 was found in 32 out of 53 (60%) ACs with a significantly higher frequency among intestinal ACs compared with biliopancreatic (BP) ACs. The MUC1, MUC5AC, MUC6, MUC2 apomucins were expressed in 75, 43, 39, and 28% of ACs, respectively, with a significantly higher coexpression of MUC1/MUC5AC in BP ACs. MSI and loss of expression of hMLH1/PMS2 or hMSH2/hMSH6 proteins were observed only in intestinal ACs. Factors significantly correlated with improved survival in the univariate analysis were: low stage, absence of lymph nodes metastases, negative surgical margins (R0 status), and presence of MSI. In the multivariate analysis, stage was the only independent prognostic factor of survival. We conclude that stage is the only independent prognostic factor of survival in the multivariate analysis, whereas histological criteria and the immunohistochemical expression of apomucins and CDX2 are helpful in the classification and understanding of the histogenesis of ACs.

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“…Conflicting data have been reported about the frequency of these two histological types due to the absence of reliable and consistent histomorphological criteria for differential diagnosis. [6][7][8][9] MicroRNAs are 19-25-nucleotide-long non-coding RNAs which after cleavage of a precursor into their mature form bind to the RNA-inducedsilencing-complex (RISC) and regulate gene expression posttranscriptionally by a binding of specific mRNA. MicroRNAs regulate many genes known to play important roles in oncogenesis, angiogenesis and tissue differentiation.…”

mentioning

confidence: 99%

MicroRNA expression profiles associated with pancreatic adenocarcinoma and ampullary adenocarcinoma

Schultz

Werner

Willenbrock³

et al. 2012

Modern Pathology

135

106

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MicroRNAs have potential as diagnostic cancer biomarkers. The aim of this study was (1) to define microRNA expression patterns in formalin-fixed parafin-embedded tissue from pancreatic ductal adenocarcinoma, ampullary adenocarcinoma, normal pancreas and chronic pancreatitis without using micro-dissection and (2) to discover new diagnostic microRNAs and combinations of microRNAs in cancer tissue. The expression of 664 microRNAs in tissue from 170 pancreatic adenocarcinomas and 107 ampullary adenocarcinomas were analyzed using a commercial microRNA assay. Results were compared with chronic pancreatitis, normal pancreas and duodenal adenocarcinoma. In all, 43 microRNAs had higher and 41 microRNAs reduced expression in pancreatic cancer compared with normal pancreas. In all, 32 microRNAs were differently expressed in pancreatic adenocarcinoma compared with chronic pancreatitis (17 higher; 15 reduced). Several of these microRNAs have not before been related to diagnosis of pancreatic cancer (eg, miR-492, miR-614, miR-622). MiR-614, miR-492, miR-622, miR-135b* and miR-196 were most differently expressed. MicroRNA profiles of pancreatic and ampullary adenocarcinomas were correlated (0.990). MicroRNA expression profiles for pancreatic cancer described in the literature were consistent with our findings, and the microRNA profile for pancreatic adenocarcinoma (miR-196b-miR-217) was validated. We identified a more significant expression profile, the difference between miR-411 and miR-198 (P ¼ 2.06 Â 10 À 54 ) and a diagnostic LASSO classifier using 19 microRNAs (sensitivity 98.5%; positive predictive value 97.8%; accuracy 97.0%). We also identified microRNA profiles to subclassify ampullary adenocarcinomas into pancreatobiliary or intestinal type. In conclusion, we found that combinations of two microRNAs could roughly separate neoplastic from nonneoplastic samples. A diagnostic 19 microRNA classifier was constructed which without micro-dissection could discriminate pancreatic and ampullary adenocarcinomas from chronic pancreatitis and normal pancreas with high sensitivity and accuracy. Ongoing prospective studies will evaluate if these microRNA profiles are useful on fine-needle biopsies for early diagnosis of pancreatic cancer. Modern Pathology (2012Pathology ( ) 25, 1609Pathology ( -1622 doi:10.1038/modpathol.2012; published online 10 August 2012Keywords: ampullary adenocarcinoma; chronic pancreatitis; microRNA; normal pancreas; pancreatic adenocarcinoma; pancreatic cancer Pancreatic cancer is the fourth most common cause of cancer death in United States and Europe. 1,2 Less than 20% of the patients can be operated with curative intent and the 5-year survival after surgery is below 20%. 3 Early diagnosis is difficult and the clinical and histological similarities between pancreatic cancer and chronic pancreatitis further complicate the differentiation between inflammation and cancer.

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Noninvasive and minimally invasive papillary carcinomas of the extrahepatic bile ducts

Cited by 107 publications

References 17 publications

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Prognostic factors for ampullary adenocarcinomas: tumor stage, tumor histology, tumor location, immunohistochemistry and microsatellite instability

MicroRNA expression profiles associated with pancreatic adenocarcinoma and ampullary adenocarcinoma

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