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Zhao Z, Jiao Y, Yang S, Zhou A, Zhao G, Guo S, Li P, Zhang S. Endoscopic diagnosis and treatment of superficial non-ampullary duodenal epithelial tumors: A review. J Transl Int Med 2023; 11:206-215. [PMID: 37662895 PMCID: PMC10474890 DOI: 10.2478/jtim-2023-0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
The surface of the small bowel mucosa is covered more than any other section of the digestive canal; however, the overall prevalence of small bowel tumors of the whole gastrointestinal tract is evidently low. Owing to the improvement in endoscopic techniques, the prevalence of small bowel tumors has increased across multiple countries, which is mainly due to an increase in duodenal tumors. Superficial non-ampullary duodenal epithelial tumors (SNADETs) are defined as tumors originating from the non-ampullary region in the duodenum that share similarities and discrepancies with their gastric and colorectal counterparts in the pathogenesis and clinicopathologic characteristics. To date, white light endoscopy (WLE) remains the cornerstone of endoscopic diagnosis for SNADETs. Besides, narrow-band imaging (NBI) techniques and magnifying endoscopy (ME) have been widely used in the clinic and endorsed by multiple guidelines and consensuses for SNADETs' evaluation. Confocal laser endomicroscopy (CLE), endocytoscopy (ECS), and artificial intelligence (AI) are also up-and-coming methods, showing an exceptional value in the diagnosis of SNADETs. Similar to the endoscopic treatment for colorectal polyps, the choices for SNADETs mainly include cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and laparoscopic endoscopic cooperative surgery (LECS). However, owing to the narrow lumen, rich vascularity, weak muscle layer, abundant Brunner's gland, and the hardship of endoscope control, the duodenum ranks as one of the most dangerous operating areas in the digestive tract. Therefore, endoscopists must anticipate the difficulties in endoscopic maneuverability, remain aware of the increased risk of complications, and then select the appropriate treatment according to the advantages and disadvantages of each method.
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Affiliation(s)
- Zheng Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Yue Jiao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Shuyue Yang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Anni Zhou
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Guiping Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Shuilong Guo
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
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Yamasaki Y, Kato M, Takeuchi Y, Hoteya S, Oyama T, Nonaka S, Yoshimizu S, Yoshida M, Ohata K, Miura Y, Hara Y, Tsuji S, Dohi O, Ueyama H, Kurahara K, Tashima T, Abe N, Mitsuhashi T, Nakayama A, Oda I, Yahagi N. Characteristics of synchronous and metachronous duodenal tumors and association with colorectal cancer: a supplementary analysis. J Gastroenterol 2023; 58:459-469. [PMID: 36847918 DOI: 10.1007/s00535-023-01964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND We previously reported outcomes of endoscopic resection for duodenal tumors in a large cohort. This study investigated the frequency and characteristics of synchronous and metachronous lesions, and their association with colorectal advanced adenoma (CAA) and colorectal cancer (CRC). METHODS Patients underwent duodenal endoscopic resection during January 2008 to December 2018. Background and characteristics, incidence of synchronous and metachronous lesions, and incidence of CAA and CRC were investigated. Patients without synchronous lesions were classified as the single group, and those with synchronous lesions as the synchronous group. Patients were also classified as the metachronous and non-metachronous groups. The characteristics among the groups were compared. RESULTS We included 2658 patients with 2881 duodenal tumors: 2472 (93.0%) patients had single, 186 (7.0%) had synchronous, and 54 (2.0%) had metachronous lesions. The 5-year cumulative incidence of metachronous lesions was 4.1%. In total, 208 (7.8%) had CAA and 127 (4.8%) patients had CRC, and colonoscopy was performed in 936 (35.2%) patients. The incidence of CAA in the synchronous groups tended to be higher compared with that in the single groups (11.8% vs 7.5%, adjusted risk ratio 1.56), and the incidence of CRC in the metachronous groups tended to be higher compared with that in the non-metachronous groups (13.0% vs 4.6%, adjusted risk ratio 2.75), but there was no difference after adjusting for colonoscopy. CONCLUSIONS This study showed the incidence of synchronous and metachronous duodenal lesions. There was no significant difference in incidence of CAA and CRC among each group, but further studies are warranted.
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Affiliation(s)
- Yasushi Yamasaki
- Department of Gastroenterology, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology and Department of Genetic Oncology, Division of Hereditary Tumors, Osaka International Cancer Institute, Osaka, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ken Ohata
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yoshimasa Miura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yuko Hara
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Shigetsugu Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Koichi Kurahara
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Tomoaki Tashima
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Nobutsugu Abe
- Department of Gastroenterological and General Surgery, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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Kawasaki A, Tsuji K, Uedo N, Kanesaka T, Miyamoto H, Gushima R, Minoda Y, Ihara E, Amano R, Yao K, Naito Y, Aoyagi H, Iwasaki T, Uchita K, Arima H, Doyama H. Non-atrophic gastric mucosa is an independently associated factor for superficial non-ampullary duodenal epithelial tumors: a multicenter, matched, case-control study. Clin Endosc 2023; 56:75-82. [PMID: 36600655 PMCID: PMC9902693 DOI: 10.5946/ce.2022.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/27/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studies have reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastric mucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopic gastric mucosal atrophy. METHODS This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopic or surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophy and the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies at two of the seven participating institutions. RESULTS For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected (p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%) control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent risk factor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44-8.40; p<0.001). CONCLUSION Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.
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Affiliation(s)
- Azusa Kawasaki
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Kunihiro Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hideaki Miyamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryosuke Gushima
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryosuke Amano
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoshihide Naito
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiroyuki Aoyagi
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
| | - Takehiro Iwasaki
- Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
| | - Kunihisa Uchita
- Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan,Correspondence: Hisashi Doyama Department of Gastroenterology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa 920-8530, Japan E-mail:
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High frequency of colorectal neoplasia in patients with sporadic adenomas or adenocarcinomas of the papilla of Vater: The same adenoma-carcinoma sequence? Dig Liver Dis 2022; 55:679-684. [PMID: 36411191 DOI: 10.1016/j.dld.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/30/2022] [Accepted: 10/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data on the frequency of colorectal neoplasia in sporadic ampullary tumors remains scarce. METHODS We retrospectively reviewed 135 patients undergoing endoscopic ampullectomy from January 2018 to July 2021, and identified 95 patients with sporadic ampullary adenoma who underwent total colonoscopy. Colonoscopy findings were compared with 380 asymptomatic controls using the chi-squared test. Whole-exome sequencing (WES) was performed on one patient with synchronous adenomas of the ampulla of Vater and ascending colon. RESULTS Colorectal polyps were present in 60% of Cases vs. 34.7% of Controls (P = 0.001), advanced adenoma in 20% vs. 5.5%, and adenocarcinoma in 4.2% vs. 0.8%. Cases tended to have larger polyps than Controls (P<0.001), while there was no difference in polyp location and histology between the two groups. The odds ratio of all the colorectal lesions, advanced colorectal adenoma and adenocarcinoma in Cases was 1.7, 4.2, and 4, respectively. WES in one patient revealed that both of ampullary adenoma and colonic adenoma shared somatic ABCB1 mutation. CONCLUSIONS The frequency of colorectal polyps or neoplasia was significantly higher in Cases than Controls. We proposed that ampullary neoplasia is analogous to colon lesions and warrants total colonoscopy screening in patients diagnosed with ampullary tumors.
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Kanzaki H, Matsueda K, Nakagawa M, Inaba T, Takatani M, Takenaka R, Yoshioka M, Imagawa A, Inoue M, Suzuki S, Tomoda J, Iwamuro M, Kawano S, Kawahara Y, Tanaka T, Okada H. Clinical characteristics and course of sporadic non-ampullary duodenal adenomas: A multicenter retrospective study. Medicine (Baltimore) 2021; 100:e27382. [PMID: 34596158 PMCID: PMC8483853 DOI: 10.1097/md.0000000000027382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/15/2021] [Accepted: 09/11/2021] [Indexed: 01/05/2023] Open
Abstract
Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA.We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into "no-resection" and "resection" groups based on the initial treatment approach. We investigated the long-term outcome of the "no-resection" group and treatment results of the "resection" group, with particular interest in endoscopic resection.Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31-88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2-60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 ± 2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate.With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could be considered especially for the older adults, poor-prognosis patients, or small lesions.
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Affiliation(s)
- Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masahiro Nakagawa
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Masahiro Takatani
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo, Japan
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama, Okayama, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Okayama, Japan
| | - Atsushi Imagawa
- Department of Gastroenterology, Mitoyo General Hospital, Kanonji, Kagawa, Japan
| | - Masafumi Inoue
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, Okayama, Japan
| | - Seiyuu Suzuki
- Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama, Ehime, Japan
| | - Jun Tomoda
- Department of Internal Medicine, Akaiwa Medical Association Hospital, Akaiwa, Okayama, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Yoshiro Kawahara
- Department of Practical Gastrointestinal Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
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Awadie H, Klein A, Tate D, Jideh B, Bar-Yishai I, Goodrick K, Ahlenstiel G, Bourke MJ. The prevalence of small-bowel polyps on video capsule endoscopy in patients with sporadic duodenal or ampullary adenomas. Gastrointest Endosc 2021; 93:630-636. [PMID: 32717365 DOI: 10.1016/j.gie.2020.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Although sporadic duodenal and/or ampullary adenomas (DAs) are uncommon, they are increasingly diagnosed during upper endoscopy. These patients have a 3- to 7-fold increased risk of colonic neoplasia compared with the normal population. It is unknown, however, whether they also have an increased risk of additional small-bowel (SB) polyps. Our aim was to establish the prevalence of SB polyps in patients with DA. METHODS In a single-center, prospective study, we used video capsule endoscopy (VCE) to investigate the prevalence of SB polyps in patients with a DA compared with patients undergoing VCE for obscure GI bleeding or iron deficiency anemia. RESULTS Over 25 months, 201 patients were enrolled in the study; the mean age was 65 years and 47% were male. There were 101 control patients and 100 cases of DA cases (mean size, 30 mm (range, 10-80 mm)). We did not identify any SB polyps in either group. Colonic polyps were found more frequently in the DA group compared with controls (61% versus 37%, respectively (P =.002)). Advanced colonic adenoma (high-grade dysplasia, >10 mm, villous histology) were found in 18% of the DA group and 5% of the control group (P =.018). CONCLUSION Our data suggest that patients with a DA are not at risk for additional SB polyps and hence do not support screening with VCE. However, colonoscopy is mandatory due to the significantly higher risk of colonic polyps including advanced adenomas. (Clinical trial registration number: NCT02470416.).
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Affiliation(s)
- Halim Awadie
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Amir Klein
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Tate
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Bilel Jideh
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Iddo Bar-Yishai
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Kathleen Goodrick
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Golo Ahlenstiel
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia; Blacktown Clinical School, Western Sydney University, Blacktown, New South Wales, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
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Takinami M, Kakushima N, Yoshida M, Sasaki K, Takizawa K, Yabuuchi Y, Kawata N, Kishida Y, Ito S, Imai K, Hotta K, Ishiwatari H, Matsubayashi H, Ono H. Endoscopic features of submucosal invasive non-ampullary duodenal carcinomas. J Gastroenterol Hepatol 2020; 35:821-826. [PMID: 31617601 DOI: 10.1111/jgh.14870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/14/2022]
Abstract
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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Affiliation(s)
- Masaki Takinami
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yohei Yabuuchi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Chou CL, Chen TJ, Lin CY, Lee SW, Wang SC, Chu SS, Yang CC. PCSK1 Overexpression in Rectal Cancer Correlates with Poor Response to Preoperative Chemoradiotherapy and Prognosis. Onco Targets Ther 2020; 13:3141-3150. [PMID: 32346297 PMCID: PMC7167277 DOI: 10.2147/ott.s243750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 03/30/2020] [Indexed: 12/28/2022] Open
Abstract
Background In a data mining search for potential therapeutic targets to improve the outcome of rectal cancer, we identified PCSK1 as the cell-cell signaling gene most significantly associated with poor response to concurrent chemoradiotherapy (CCRT). This study aims to investigate the prognostic value of PCSK1 expression in rectal cancer patients who underwent neoadjuvant CCRT. Methods Endoscopic biopsy specimens from 172 rectal cancer patients receiving neoadjuvant CCRT followed by curative surgery were assessed immunohistochemically for PCSK1 expression, and H-scores were determined. Expression levels of PCSK1 were further analyzed for correlations with clinicopathologic features, tumor regression grade, metastasis-free survival, disease-specific survival, and recurrence-free survival. Results PCKS1 overexpression was significantly associated with pretreatment tumor status (T3-4; p = 0.009), pretreatment nodal status (N1-2; p < 0.001), posttreatment tumor status (T3-4; p < 0.001), posttreatment nodal status (N1-2; p < 0.001), vascular invasion (p = 0.003), and perineurial invasion (p = 0.023). PCKS1 overexpression was also found to be significantly associated with a lower degree of tumor regression (p < 0.001). In the univariate analysis, PCSK1 overexpression was significantly associated with lower disease-specific survival, metastasis-free survival, and recurrence-free survival (p < 0.005). PCSK1 overexpression remained an independent prognostic factor of lower disease-specific survival (p = 0.003; hazard ratio, 5.478) in the multivariate analysis. Conclusion Determination of PCSK1 overexpression may be useful for identifying rectal cancer patients at risk for a poor response and worse survival after CCRT.
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Affiliation(s)
- Chia-Lin Chou
- Division of Colon and Rectal Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Tzu-Ju Chen
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Cheng-Yi Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Sung-Wei Lee
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Shih-Chang Wang
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - Shou-Sheng Chu
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ching-Chieh Yang
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
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Matsueda K, Kanzaki H, Matsueda K, Nasu J, Yoshioka M, Nakagawa M, Inoue M, Inaba T, Imagawa A, Takatani M, Takenaka R, Suzuki S, Tomoda J, Yagi T, Fujiwara T, Tanaka T, Okada H. The clinicopathological differences of sporadic non-ampullary duodenal epithelial neoplasm depending on tumor location. J Gastroenterol Hepatol 2019; 34:1540-1544. [PMID: 30812050 DOI: 10.1111/jgh.14640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/24/2019] [Accepted: 02/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Although sporadic non-ampullary duodenal adenoma is speculated to be precancerous lesion, the relationship between adenoma and carcinoma remains unclear due to their rarity. Previous studies on sporadic non-ampullary duodenal epithelial neoplasm (SNADEN) have mainly targeted superficial tumors, like adenoma and early carcinoma. The clinicopathological features, including those of advanced carcinoma, remain poorly investigated. We assessed the clinicopathological features of SNADEN, including advanced carcinoma, focusing on tumor location. METHODS We retrospectively collected the data of 410 patients who had been clinically and pathologically diagnosed with SNADEN at 11 institutions in Japan between June 2002 and March 2014. RESULTS The SNADEN was mucosal neoplasia and invasive carcinoma in 321 (78.3%) and 89 (21.7%) patients, respectively. The proportion of invasive carcinomas in SNADEN was significantly higher on the oral side of the papilla of Vater (oral-Vater) than on the anal side (anal-Vater) (27.9% vs 14.4%, P < 0.001). Undifferentiated-type carcinoma was significantly more frequent with oral-Vater than anal-Vater (38.7% vs 14.8%, P = 0.026). The recurrence rate of surgically R0 resected locally advanced carcinomas was significantly higher with oral-Vater than anal-Vater (46.4% vs 8.3%, P = 0.021). Furthermore, the relapse-free survival with oral-Vater was significantly shorter than with anal-Vater (hazard ratio: 2.35; 95% confidence interval: 1.09-5.50; P = 0.028). CONCLUSIONS The clinicopathological features of SNADEN on oral-Vater were different from those on anal-Vater. SNADEN on oral-Vater was more likely to be invasive carcinomas and might behave more aggressively due to biologically higher malignancy than that on anal-Vater.
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Affiliation(s)
- Katsunori Matsueda
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Masahiro Nakagawa
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masafumi Inoue
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Atsushi Imagawa
- Department of Gastroenterology, Mitoyo General Hospital, Kanonji, Japan
| | - Masahiro Takatani
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama, Japan
| | - Seiyu Suzuki
- Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama, Japan
| | - Jun Tomoda
- Department of Internal Medicine, Akaiwa Medical Association Hospital, Okayama, Japan
| | - Takahito Yagi
- Department of Hepato-Biliary-Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Kountouras J, Doulberis M, Papaefthymiou A, Polyzos SA, Touloumtzi M, Elisabeth V, Kapetanakis N, Liatsos C, Gavalas E, Katsinelos P. Helicobacter pylori infection and gastrointestinal tract cancer biology: considering a double-edged sword reflection. Cell Mol Life Sci 2019; 76:2487-2488. [PMID: 31006036 PMCID: PMC11105426 DOI: 10.1007/s00018-019-03106-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Jannis Kountouras
- Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece.
| | - Michael Doulberis
- Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece
- Department of Gastroenterology and Hepatology, University of Zurich, 8091, Zurich, Switzerland
| | - Apostolis Papaefthymiou
- Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece
| | - Stergios A Polyzos
- First Department of Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, 54642, Thessaloniki, Macedonia, Greece
| | - Maria Touloumtzi
- Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece
| | - Vardaka Elisabeth
- Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece
| | - Nikolaos Kapetanakis
- Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece
| | - Christos Liatsos
- Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece
| | - Emmanouel Gavalas
- Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece
| | - Panagiotis Katsinelos
- Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 8 Fanariou St, Byzantio, 551 33, Thessaloniki, Macedonia, Greece
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11
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Matsuzaki J, Suzuki H, Shimoda M, Mori H, Fukuhara S, Miyoshi S, Masaoka T, Iwao Y, Kanai Y, Kanai T. Clinical and endoscopic findings to assist the early detection of duodenal adenoma and adenocarcinoma. United European Gastroenterol J 2019; 7:250-260. [PMID: 31080610 PMCID: PMC6498797 DOI: 10.1177/2050640618817689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sporadic nonampullary duodenal adenocarcinoma is a rare malignant neoplasm in which poor prognosis is often associated with delayed diagnosis. OBJECTIVE A case-control study was designed to evaluate the clinical and endoscopic characteristics of patients with nonampullary duodenal epithelial tumours (NADETs). METHODS Patients with NADETs were chronologically divided into a discovery and a validation sets. Two age- and sex-matched control individuals for each case in the discovery set were randomly selected from individuals without NADET. A prediction model for the presence of NADET, constructed in the discovery set, was evaluated in the validation set. RESULTS In total, 368 adenomas, 81 adenocarcinomas, and 314 controls were analysed. Current smoking, Barrett oesophagus, fundic gland polyps, history of malignant disease, and absence of dyslipidaemia were independently associated with the presence of NADET. The combination of these five factors enabled significant discrimination for NADET in the bulb with a sensitivity of 0.81 in the validation set. We also showed that duodenal adenocarcinomas in the bulb had greater invasive potential than adenocarcinomas in the second portion. CONCLUSION The presence of a duodenal tumour in the bulb could be predicted by clinical and endoscopic findings, which helps improve the prognosis and quality of life of patients.
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Affiliation(s)
- Juntaro Matsuzaki
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine, Keio University School of Medicine,
Tokyo, Japan
- Center for Preventive Medicine, Keio
University Hospital, Tokyo, Japan
- Division of Molecular and Cellular
Medicine, National Cancer Center Research Institute, Tokyo, Japan
| | - Hidekazu Suzuki
- Fellowship Training Center, Medical
Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Shimoda
- Department of Pathology, Keio University
School of Medicine, Tokyo, Japan
| | - Hideki Mori
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine, Keio University School of Medicine,
Tokyo, Japan
| | - Seiichiro Fukuhara
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine, Keio University School of Medicine,
Tokyo, Japan
| | - Sawako Miyoshi
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine, Keio University School of Medicine,
Tokyo, Japan
| | - Tatsuhiro Masaoka
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine, Keio University School of Medicine,
Tokyo, Japan
| | - Yasushi Iwao
- Center for Preventive Medicine, Keio
University Hospital, Tokyo, Japan
| | - Yae Kanai
- Department of Pathology, Keio University
School of Medicine, Tokyo, Japan
- Division of Molecular Pathology,
National Cancer Center Research Institute, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine, Keio University School of Medicine,
Tokyo, Japan
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12
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Minatsuki C, Yamamichi N, Inada KI, Takahashi Y, Sakurai K, Shimamoto T, Tsuji Y, Shiogama K, Kodashima S, Sakaguchi Y, Niimi K, Ono S, Niwa T, Ohata K, Matsuhashi N, Ichinose M, Fujishiro M, Tsutsumi Y, Koike K. Expression of Gastric Markers Is Associated with Malignant Potential of Nonampullary Duodenal Adenocarcinoma. Dig Dis Sci 2018; 63:2617-2625. [PMID: 29956011 DOI: 10.1007/s10620-018-5179-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/22/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sporadic nonampullary duodenal epithelial tumors (NADETs) are uncommon, and thus their clinicopathological features have not been fully assessed. AIMS In this study, we have analyzed a series of early sporadic NADETs, focusing on various immunohistological features. METHODS We conducted a multicenter retrospective analysis of 68 patients with endoscopically resected sporadic NADETs. Associations between immunohistological features and clinicopathological features were statistically analyzed. RESULTS The 68 patients consisted of 46 men (68%) and 22 women (32%) with a mean age of 60.7 ± 12.2 years (range 37-85 years). The 68 tumors were composed of 39 adenomas (57%) and 29 early-stage adenocarcinomas (43%). Duodenal adenocarcinomas were larger in size than adenomas and had papillary architecture in their pathological diagnosis with statistical significance. Duodenal adenocarcinomas also demonstrated a significantly higher expression of gastric markers (MUC5AC and MUC6) and a higher MIB-1 index. Duodenal adenomas were contrastively apt to express intestinal markers (MUC2, CDX1 and CDX2). Of the 68 cases analyzed, there were only 3 tumors positive for p53 staining, all of which were adenocarcinoma. When 7 submucosal invasive cancers and 21 intramucosal cancers were compared, submucosal invasion was positively associated with expression of MUC5AC. Also, submucosal invasion showed strong association with double-positivity of MUC5AC and MUC6. CONCLUSIONS Our results indicate that immunohistochemical evaluation is useful for predicting malignant potential of NADETs, especially focusing on the expression of gastrointestinal markers.
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Affiliation(s)
- Chihiro Minatsuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan
| | - Nobutake Yamamichi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan.
| | - Ken-Ichi Inada
- Department of Diagnostic Pathology II, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-Ku, Nagoya City, Aichi, 454-8509, Japan
| | - Yu Takahashi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan
| | - Kouhei Sakurai
- Department of Diagnostic Pathology II, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-Ku, Nagoya City, Aichi, 454-8509, Japan
| | - Takeshi Shimamoto
- Kameda Medical Center Makuhari, CD-2, 1-3, Nakase, Mihama-ku, Chiba-shi, Chiba, 261-0023, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan
| | - Kazuya Shiogama
- Department of Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Shinya Kodashima
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan
| | - Yoshiki Sakaguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan
| | - Keiko Niimi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan
| | - Satoshi Ono
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan
| | - Toru Niwa
- Wakayama Medical University Hospital, 811-1, Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Ken Ohata
- NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Nobuyuki Matsuhashi
- NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Masao Ichinose
- Wakayama Medical University Hospital, 811-1, Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan
| | - Yutaka Tsutsumi
- Department of Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Hongo, Tokyo, 113-8655, Japan
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13
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Esaki M, Suzuki S, Ikehara H, Kusano C, Gotoda T. Endoscopic diagnosis and treatment of superficial non-ampullary duodenal tumors. World J Gastrointest Endosc 2018; 10:156-164. [PMID: 30283598 PMCID: PMC6162251 DOI: 10.4253/wjge.v10.i9.156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/17/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
The diagnostic and treatment guidelines of superficial non-ampullary duodenal tumors have not been standardized due to their low prevalence. Previous reports suggested that a superficial adenocarcinoma (SAC) should be treated via local resection because of its low risk of lymph node metastasis, whereas a high-grade adenoma (HGA) should be resected because of its high risk of progression to adenocarcinoma. Therefore, pretreatment diagnosis of SAC or HGA is important to determine the appropriate treatment strategy. There are certain endoscopic features known to be associated with SAC or HGA, and current practice prioritizes the endoscopic and biopsy diagnosis of these conditions. Surgical treatment of these duodenal lesions is often related to high risk of morbidity, and therefore endoscopic resection has become increasingly common in recent years. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the commonly performed endoscopic resection methods. EMR is preferred due to its lower risk of adverse events; however, it has a higher risk of recurrence than ESD. Recently, a new and safer endoscopic procedure that reduces adverse events from EMR or ESD has been reported.
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Affiliation(s)
- Mitsuru Esaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1018309, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1018309, Japan
| | - Hisatomo Ikehara
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1018309, Japan
| | - Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1018309, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1018309, Japan
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14
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Niwa A, Kuwano S, Tomita H, Kimura K, Orihara Y, Kanayama T, Noguchi K, Hisamatsu K, Nakashima T, Hatano Y, Hirata A, Miyazaki T, Kaneko K, Tanaka T, Hara A. The different pathogeneses of sporadic adenoma and adenocarcinoma in non-ampullary lesions of the proximal and distal duodenum. Oncotarget 2018; 8:41078-41090. [PMID: 28467793 PMCID: PMC5522249 DOI: 10.18632/oncotarget.17051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/27/2017] [Indexed: 12/11/2022] Open
Abstract
Non-ampullary duodenal adenoma with activation of Wnt/β-catenin signalling is common in familial adenomatous polyposis (FAP) patients, whereas sporadic non-ampullary adenoma is uncommon. The adenoma-carcinoma sequence similar to colon cancer is associated with duodenal tumors in FAP, but not always in sporadic tumors. We obtained 37 non-ampullary duodenal tumors, including 25 adenomas and 12 adenocarcinomas, were obtained from biopsies and endoscopic resections. We performed immunohistochemistry for β-catenin, the hallmark of Wnt activation, and aldehyde dehydrogenase 1 (ALDH1), a putative cancer stem cell marker. In non-ampullary lesions, abnormal nuclear localization of β-catenin was observed in 21 (84.0%) of 25 adenomas and 4 (33.3%) of 12 adenocarcinomas. In the proximal duodenum, nuclear β-catenin was less frequent in both adenomas and adenocarcinomas. Gastric duodenal metaplasia (GDM) was observed only in the proximal duodenum. All adenomas with GDM were the gastric foveolar and pyloric gland types, and showed only membranous β-catenin. The intestinal-type adenomas had nuclear β-catenin in the proximal and distal duodenum. ALDH1-positive cells were more frequent in adenocarcinomas than adenomas. Nuclear β-catenin accumulation frequently occurred in ALDH1-positive cells in adenoma, but not in adenocarcinoma. In the non-ampullary proximal duodenum, Wnt/β-catenin pathway activation was more closely associated with adenomas than adenocarcinomas, and while it might cooperate with ALDH1 in adenoma, it does not in adenocarcinoma. The pathogenesis thus may differ between sporadic adenoma and adenocarcinoma of non-ampullary duodenal lesions, especially in the proximal and distal duodenum.
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Affiliation(s)
- Ayumi Niwa
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Seiya Kuwano
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Keita Kimura
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yukiya Orihara
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tomohiro Kanayama
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kei Noguchi
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kenji Hisamatsu
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takayuki Nakashima
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuichiro Hatano
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akihiro Hirata
- Division of Animal Experiment, Life Science Research Center, Gifu University, Gifu, Japan
| | | | - Kazuhiro Kaneko
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuji Tanaka
- Department of Diagnostic Pathology (DDP) and Research Center of Diagnostic Pathology (RC-DiP), Gifu Municipal Hospital, Gifu, Japan
| | - Akira Hara
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan
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15
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Kakushima N, Ono H, Yoshida M, Takizawa K, Tanaka M, Kawata N, Ito S, Imai K, Hotta K, Ishiwatari H, Matsubayashi H. Characteristics and risk factors for sporadic non-ampullary duodenal adenocarcinoma. Scand J Gastroenterol 2017; 52:1253-1257. [PMID: 28830268 DOI: 10.1080/00365521.2017.1369563] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Despite the gradual increase in the incidence of non-ampullary duodenal adenocarcinoma (NADAC), the associated characteristics and risk factors remain poorly understood. The aim of this study was to clarify the clinical characteristics and risk factors of sporadic NADAC. MATERIALS AND METHODS In this retrospective case-control study, we enrolled 156 Japanese NADAC patients with 160 lesions from our hospital's cancer registry over 13 years. The patient demographics and clinical findings were compared to 468 age- and sex-matched controls selected from our medical health checkup recipients. RESULTS The ratio of men to women among the NADAC patients was 2:1, the median age was 64 years (range 31 to 90 years), the majority of the lesions were located in the second portion of the duodenum, and well-differentiated adenocarcinoma was the dominant histology. A univariate analysis revealed that smoking was a common risk factor for both men and women, whereas Helicobacter pylori (HP) infection and a history of colorectal cancer (CRC) were risk factors for the men. The multivariate analysis revealed that smoking, a history of CRC, and HP positivity were also individual risk factors for NADAC. CONCLUSIONS Smoking, a history of CRC, and HP positivity were identified as risk factors for NADAC.
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Affiliation(s)
- Naomi Kakushima
- a Division of Endoscopy , Shizuoka Cancer Center , Shizuoka , Japan
| | - Hiroyuki Ono
- a Division of Endoscopy , Shizuoka Cancer Center , Shizuoka , Japan
| | - Masao Yoshida
- a Division of Endoscopy , Shizuoka Cancer Center , Shizuoka , Japan
| | - Kohei Takizawa
- a Division of Endoscopy , Shizuoka Cancer Center , Shizuoka , Japan
| | - Masaki Tanaka
- a Division of Endoscopy , Shizuoka Cancer Center , Shizuoka , Japan
| | - Noboru Kawata
- a Division of Endoscopy , Shizuoka Cancer Center , Shizuoka , Japan
| | - Sayo Ito
- a Division of Endoscopy , Shizuoka Cancer Center , Shizuoka , Japan
| | - Kenichiro Imai
- a Division of Endoscopy , Shizuoka Cancer Center , Shizuoka , Japan
| | - Kinichi Hotta
- a Division of Endoscopy , Shizuoka Cancer Center , Shizuoka , Japan
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16
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Hijikata K, Nemoto T, Igarashi Y, Shibuya K. Extra-ampullary duodenal adenoma: a clinicopathological study. Histopathology 2017; 71:200-207. [PMID: 28211946 DOI: 10.1111/his.13192] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/15/2017] [Indexed: 11/29/2022]
Abstract
AIMS Extra-ampullary duodenal adenoma (EADA) is a rare condition with poorly described clinicopathological details. In this study, we aimed to characterize EADA clinicopathologically. METHODS AND RESULTS We performed a retrospective review of 44 serial cases of EADA. Each EADA was categorized as either gastric-type (n = 5) or intestinal-type (n = 39). All gastric-type adenomas were located in the first portion of the duodenum and exhibited a pedunculated shape. Gastric-type adenomas were classified into two subtypes: pyloric gland and foveolar. The former consisted of mucin 6 (MUC6)-positive glands covered with MUC5AC-positive cells, whereas nearly all the latter consisted of MUC5AC-positive cells. When EADAs were categorized into high and low grades, approximately 40% (16 of 44) were high-grade. The high-grade adenomas were significantly larger than the low-grade adenomas (19.4 ± 8.6 mm versus 11.8 ± 5.1 mm, P = 0.021), and all adenomas greater than 20 mm in largest diameter were categorized as high-grade adenomas. Among 16 individuals who underwent total colonoscopy before or after duodenal mucosal resection, nine had a colorectal neoplasm, and all nine duodenal lesions were of the intestinal phenotype. CONCLUSIONS We clarified the clinicopathological characteristics of gastric- and intestinal-type EADAs. EADAs greater than 20 mm at the largest diameter were consistently high-grade, and are thought to have the potential to progress to adenocarcinoma. These findings should be helpful for the clinical management of EADA.
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Affiliation(s)
- Kazunori Hijikata
- Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan
| | - Tetsuo Nemoto
- Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo, Japan
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