Extra-ampullary duodenal adenocarcinoma

Am J Surg Pathol. 2014 Nov;38(11):1484-93. doi: 10.1097/PAS.0000000000000278.

Abstract

Extra-ampullary duodenal adenocarcinomas are rare, and when studied, frequently have been grouped with jejunoileal adenocarcinomas. Nevertheless, anecdotal experiences suggest that these neoplasms may present 2 or more distinct phenotypes. To better characterize these neoplasms, we performed a retrospective review of 38 cases with a special focus on the morphologic and immunophenotypic characteristics and their clinicopathologic significance. Our cohort of extra-ampullary duodenal adenocarcinomas was classified on the basis of the morphologic features into gastric type (n=19, 50%), intestinal type (n=14, 37%), pancreaticobiliary type (n=2, 5%), and others (n=3, 8%). Most gastric-type adenocarcinomas (n=18, 95%) developed in the proximal duodenum, whereas the other types were located equally in the proximal and distal duodenum. Intestinal-type dysplasia was present at the periphery of 8 (57%) intestinal-type adenocarcinomas, and 8 (42%) gastric-type adenocarcinoma were associated with gastric-type dysplasia. Gastric foveolar metaplasia (n=12) and Brunner gland hyperplasia (n=10) were exclusively recognized adjacent to gastric-type adenocarcinomas. Notably, intestinal-type histology and the absence of lymph node metastasis were significantly associated with favorable disease-free survival in univariate and multivariate analyses. In summary, this study demonstrated that 2 major subsets of extra-ampullary duodenal adenocarcinoma, intestinal type and gastric type, are associated with distinct histopathologic features and clinical behavior.

MeSH terms

  • Adenocarcinoma / immunology
  • Adenocarcinoma / mortality
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / analysis
  • Biopsy
  • Disease-Free Survival
  • Duodenal Neoplasms / immunology
  • Duodenal Neoplasms / mortality
  • Duodenal Neoplasms / pathology*
  • Duodenal Neoplasms / surgery
  • Duodenum / immunology
  • Duodenum / pathology*
  • Female
  • Humans
  • Immunohistochemistry
  • Immunophenotyping
  • Kaplan-Meier Estimate
  • Male
  • Metaplasia
  • Middle Aged
  • Multivariate Analysis
  • Phenotype
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Time Factors

Substances

  • Biomarkers, Tumor