AIM： To assess histochemical expression of KL-6 and its clinicopathological significance in carcinoma of the ampulla of Vater. METHODS： Ampullary carcinoma tissues were collected from 38 patients who underwent pancr...AIM： To assess histochemical expression of KL-6 and its clinicopathological significance in carcinoma of the ampulla of Vater. METHODS： Ampullary carcinoma tissues were collected from 38 patients who underwent pancreatoduodenectomy or local resection. Tissues were subjected to immunohistochemical analysis using KL-6 antibody. RESULTS： Positive staining of ampullary carcinoma cells was observed in 26 （68.4%） cases. Staining was not found in the surrounding non-cancer regions of the ampullary tissues. Remarkable KL-6 expression was observed in invasive carcinoma cells in pancreatic and duodenal tissues and in metastatic carcinoma cells in lymph nodes. Positive KL-6 expression was related to lymph node metastasis （P = 0.020）, pancreatic invasion （P = 0.016）, duodenal invasion （P = 0.034）, and advanced stage of TNM clinical classification （P = 0.010）. Survival analysis showed that positive expression of KL-6 was related to a poorer prognosis （P = 0.029）. CONCLUSION： The aberrant expression of KL-6 mucin is significantly related to unfavorable behaviors of cardnoma of the ampulla of Vater.展开更多
Small cell neuroendocrine carcinoma of the ampulla of Vater is extremely rare and different from the common ampullary adenocarcinoma. The ampullary adenoma is also a rare neoplasm and has the potential to develop an a...Small cell neuroendocrine carcinoma of the ampulla of Vater is extremely rare and different from the common ampullary adenocarcinoma. The ampullary adenoma is also a rare neoplasm and has the potential to develop an adenocarcinoma. Their coexistence has been rarely reported in the literature. We herein describe an unusual case of a small cell neuroendocrine carcinoma associated with a villous adenoma in the ampulla of Vater with emphasis on computed tomography (CT) and histopathological findings. We also discuss their clinical, histopathological and radiological features as well as possible histogenesis.展开更多
目的探讨晚期肝外胆管癌及壶腹癌采用^(125)I 粒子置入治疗的方法和价值。方法 12例经 B 超、CT、磁共振检查确诊或拟诊为肝外胆管癌及壶腹癌的患者,采用十二指肠镜行 ERCP 检查,并取活检行病理检查,确定恶性肿瘤的病变长度,行病变段胆...目的探讨晚期肝外胆管癌及壶腹癌采用^(125)I 粒子置入治疗的方法和价值。方法 12例经 B 超、CT、磁共振检查确诊或拟诊为肝外胆管癌及壶腹癌的患者,采用十二指肠镜行 ERCP 检查,并取活检行病理检查,确定恶性肿瘤的病变长度,行病变段胆管扩张后置入金属支架,引流胆汁。于支架置入7～14 d 后采用相应的自制粒子载体将^(125)I 粒子置入,行腔内持续近距离放射治疗。术后随访6～32个月,进行 B 超及内镜复查。结果 12例患者均顺利完成操作,无手术并发症。术后随访,超声及内镜结果与术前无明显变化,12例均存活,2例已存活32个月。结论内镜下肝外胆管癌及壶腹癌^(125)I 粒子腔内持续照射,是治疗晚期恶性肿瘤的安全有效的方法。展开更多
Objectives： To explore the prognostic relevance of the number and ratio of metastatic lymph nodes in resected Carcinoma of the ampulla of Vater （CAV）. Methods： The clinical data of 155 patients who underwent pancr...Objectives： To explore the prognostic relevance of the number and ratio of metastatic lymph nodes in resected Carcinoma of the ampulla of Vater （CAV）. Methods： The clinical data of 155 patients who underwent pancreaticoduodenectomy （PD） for cancer of the ampulla of Vater between January 1990 and December 2010 were retrospectively analyzed. Kaplan- Meier method was used in survival analysis and Log rank method in comparison. Multivariate analysis was performed using Cox proportional hazards model. Results： Among these 155 patients, the in-hospital mortality rate was 4.5%, lymph node positive disease was 21.3%, and the 5-year survival rate was 51.6%. Patients with a lymph node ratio （LNR） 〉20% were more likely to have tumor differentiation, depth of duodenal involvement, depth of pancreatic invasion, T-stage and TNM-Stage. The number of the metastatic lymph nodes is important prognostic factors of the CAV. Univariate analysis showed that the factors associated with the prognosis included tumor size （P=0.036）, tumor differentiation （P=0.019）, LNR （P=0.032）, mtmber of metastatic lymph nodes （P=0.024）, lymph node metastasis （P=0.03）, depth of pancreatic invasion （P=0.001）, T-stage （P=0.002）, TNM stage （P=0.001）, elevated CA 19-9 （P=0.000）, and jaundice （P=0.021）. Multivariate analysis showed that the factors associated with the prognosis were the number of metastatic lymph nodes （P=0.032; RR： 1.283; 95% CI： 1.022-1.611）, tumor size （P=0.043; RR： 1.736; 95% CI： 1.017-2.963）, and elevated CA 19-9 （P=0.003; RR： 3.247; 95% CI： 1.504-7.010）. Conclusions： LNR is a useful factor for predicting the prognosis of the radical treatment for CAV,, whereas the number of metastatic lymph nodes is the most important factor. Further research on the locations, number, and LNR will be clinically meaningful to improve survival in patients with CAV.展开更多
Signet-ring cell carcinoma(SRCC) of ampulla of Vater is extremely uncommon,and less than 15 cases have been reported so far in literature.It mainly occurs in elderly people(median age 57 years).We report a rare case o...Signet-ring cell carcinoma(SRCC) of ampulla of Vater is extremely uncommon,and less than 15 cases have been reported so far in literature.It mainly occurs in elderly people(median age 57 years).We report a rare case of SRCC of the ampulla of Vater in a 38-year-old woman who presented with a small tumor at the Vater,discovered by the contrast-enhanced ultrasound(CEUS).Histopathological examination showed prominent signet-ring features.We also describe the imaging features of SRCC of ampulla of Vater in CEUS.展开更多
Introduction: Signet ring cell carcinoma is a rare tumor that generally originates in the gastrointestinal tract. Signet-ring cell carcinoma of the ampulla of Vater is extremely uncommon and a very rare clinical entit...Introduction: Signet ring cell carcinoma is a rare tumor that generally originates in the gastrointestinal tract. Signet-ring cell carcinoma of the ampulla of Vater is extremely uncommon and a very rare clinical entity, which is infrequently reported in medical literature and only 31 cases have been mentioned. Most tumors affecting Vater’s Ampulla are adenocarcinomas and other histological variants are less frequent. It mainly occurs in elderly patients. Case Presentation: We report a case of signet ring cell carcinoma of Vater’s Ampulla. The tumour had infiltrated the duodenal, but local lymph nodes were clear (T3N0M0). Duodenopancreatectomy with pylorus preservation is the treatment of choice. Conclusions: Etiology and survival are not well-defined in the literature due to the extreme rarity of this disease.展开更多
Background Carcinomas of the ampulla of Vater （CAV） is a relatively rare malignant gastrointestinal tumor,and its postoperative prognostic factors have been well studied.However,as its first symptom,the impact of ja...Background Carcinomas of the ampulla of Vater （CAV） is a relatively rare malignant gastrointestinal tumor,and its postoperative prognostic factors have been well studied.However,as its first symptom,the impact of jaundice on the prognosis of CAV is not so clear.This study aims to explore the role of jaundice as a prognostic factor in patients undergoing radical treatment for CAV.Methods The clinical data of 195 patients with CAV who were treated in the Cancer Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,from January 1989 to January 2013 were retrospectively analyzed.Among them,170 patients with pathologically confirmed CAV entered the statistical analysis.Jaundice was defined as a total bilirubin serum concentration of ≥3 mg/dl.Result Of these 170 patients,99 （58.20％） had jaundice at presentation.Jaundice showed significant correlations with tumor differentiation （P=0.002）,lymph node metastasis （P=0.016）,pancreatic invasion （P=0.000）,elevated preoperative CA199 （P=0.000）,depth of invasion （P=0.000）,and tumor stage （P=0.000）.There were more patients with pancreatic invasion in the jaundice group than in the non-jaundice group.Also,lymph node metastasis was more common in the jaundice group （n=26） than in the non-jaundice group （n=8）.The non-jaundice group had significant better overall 5-year disease-free survival （72.6％） than the jaundice group （41.2％,P=0.013）.Jaundice was not significantly correlated with the postoperative bleeding （P=-0.050）.Conclusions Jaundice in patients with CAV often predicts more advanced stages and poorer prognoses.Pancreatic invasion and lymph node metastasis are more common in CAV patients with jaundice.Jaundice is not a risk factor for postoperative bleeding and preoperative biliary drainage cannot reduce the incidence of postoperative complications.展开更多
BACKGROUND Carcinoma of the ampulla of Vater is an uncommon ampullo-pancreatobiliary neoplasm,and the most common histological type is adenocarcinoma with a tubular growth pattern.Invasive micropapillary carcinoma(IMP...BACKGROUND Carcinoma of the ampulla of Vater is an uncommon ampullo-pancreatobiliary neoplasm,and the most common histological type is adenocarcinoma with a tubular growth pattern.Invasive micropapillary carcinoma(IMPC)is an aggressive variant of adenocarcinoma in several organs that is associated with lymph node metastasis and poor prognosis.IMPC was first described as a histological subtype of breast cancer;however,IMPC of the ampulla of Vater is extremely rare,with only three articles reported in the English literature.CASE SUMMARY We have reported a case of IMPC of the ampulla of Vater in an 80-year-old man.Microscopically,the surface area of the carcinoma was composed of tubulopapillary structures mimicking intra-ampullary papillary-tubular neoplasm,and the deep invasive front area exhibited a pattern of IMPC.The carcinoma showed lymphatic invasion and extensive lymph node metastasis.The immunohistochemical study revealed mixed intestinal and gastric/pancreatobiliary phenotypes.CONCLUSION This rare subtype tumor in the ampulla of Vater showed a histologically mixed phenotype and exhibited aggressive behavior.展开更多
BACKGROUND: Neuroendocrine tumors of the ampulla of Vater are extremely rare, and few cases of large cell neuroendocrine carcinoma (LCNEC) of the ampulla have been reported. METHODS: A 48-year-old male with obstructiv...BACKGROUND: Neuroendocrine tumors of the ampulla of Vater are extremely rare, and few cases of large cell neuroendocrine carcinoma (LCNEC) of the ampulla have been reported. METHODS: A 48-year-old male with obstructive jaundice was admitted to our hospital. On examination the patient was found to have a periampullary growth and subsequently underwent the Whipple's procedure. RESULTS: Histopathological examination and immunohistochemistry revealed features of LCNEC of the ampulla of Vater. The patient developed multiple liver metastases 6 months after Whipple's procedure. CONCLUSION: LCNEC of the ampulla of Vater is rare and highly aggressive, with a dismal prognosis.展开更多
目的:探讨壶腹癌P-gp、LRP的表达及其意义方法:用免疫组化染色方法检测39例壶腹癌和10例正常壶腹 P-gp、LRP表达的情况,并结合临床病理特征进行统计分析. 结果:P-gp和LRP在壶腹癌组织中的表达均高于正常壶腹组织(66．7％,59．0％ vs 20...目的:探讨壶腹癌P-gp、LRP的表达及其意义方法:用免疫组化染色方法检测39例壶腹癌和10例正常壶腹 P-gp、LRP表达的情况,并结合临床病理特征进行统计分析. 结果:P-gp和LRP在壶腹癌组织中的表达均高于正常壶腹组织(66．7％,59．0％ vs 20％,10％,P<0．05)．壶腹癌P-gp、LRP 表达与患者性别、年龄、肿瘤直径、临床分期无关;而有淋巴结转移的壶腹癌中P-gp表达率为80．0％,明显高于无淋巴结转移的壶腹癌中P-gp表达率42．9％(P<0．05);而LRP在高分化腺癌中表达率为77．8％,高于低分化腺癌42．9％(P<0．05)．结论:P-gp高表达与壶腹癌转移潜能有关,LRP与壶腹癌生物学特性有关．展开更多
基金Supported by Grants-in-aid From the Ministry of Education, Science, Sports, and Culture of Japan and a grant for Hi-Tech Research from Tokai University
文摘AIM： To assess histochemical expression of KL-6 and its clinicopathological significance in carcinoma of the ampulla of Vater. METHODS： Ampullary carcinoma tissues were collected from 38 patients who underwent pancreatoduodenectomy or local resection. Tissues were subjected to immunohistochemical analysis using KL-6 antibody. RESULTS： Positive staining of ampullary carcinoma cells was observed in 26 （68.4%） cases. Staining was not found in the surrounding non-cancer regions of the ampullary tissues. Remarkable KL-6 expression was observed in invasive carcinoma cells in pancreatic and duodenal tissues and in metastatic carcinoma cells in lymph nodes. Positive KL-6 expression was related to lymph node metastasis （P = 0.020）, pancreatic invasion （P = 0.016）, duodenal invasion （P = 0.034）, and advanced stage of TNM clinical classification （P = 0.010）. Survival analysis showed that positive expression of KL-6 was related to a poorer prognosis （P = 0.029）. CONCLUSION： The aberrant expression of KL-6 mucin is significantly related to unfavorable behaviors of cardnoma of the ampulla of Vater.
文摘Small cell neuroendocrine carcinoma of the ampulla of Vater is extremely rare and different from the common ampullary adenocarcinoma. The ampullary adenoma is also a rare neoplasm and has the potential to develop an adenocarcinoma. Their coexistence has been rarely reported in the literature. We herein describe an unusual case of a small cell neuroendocrine carcinoma associated with a villous adenoma in the ampulla of Vater with emphasis on computed tomography (CT) and histopathological findings. We also discuss their clinical, histopathological and radiological features as well as possible histogenesis.
文摘目的探讨晚期肝外胆管癌及壶腹癌采用^(125)I 粒子置入治疗的方法和价值。方法 12例经 B 超、CT、磁共振检查确诊或拟诊为肝外胆管癌及壶腹癌的患者,采用十二指肠镜行 ERCP 检查,并取活检行病理检查,确定恶性肿瘤的病变长度,行病变段胆管扩张后置入金属支架,引流胆汁。于支架置入7～14 d 后采用相应的自制粒子载体将^(125)I 粒子置入,行腔内持续近距离放射治疗。术后随访6～32个月,进行 B 超及内镜复查。结果 12例患者均顺利完成操作,无手术并发症。术后随访,超声及内镜结果与术前无明显变化,12例均存活,2例已存活32个月。结论内镜下肝外胆管癌及壶腹癌^(125)I 粒子腔内持续照射,是治疗晚期恶性肿瘤的安全有效的方法。
文摘Objectives： To explore the prognostic relevance of the number and ratio of metastatic lymph nodes in resected Carcinoma of the ampulla of Vater （CAV）. Methods： The clinical data of 155 patients who underwent pancreaticoduodenectomy （PD） for cancer of the ampulla of Vater between January 1990 and December 2010 were retrospectively analyzed. Kaplan- Meier method was used in survival analysis and Log rank method in comparison. Multivariate analysis was performed using Cox proportional hazards model. Results： Among these 155 patients, the in-hospital mortality rate was 4.5%, lymph node positive disease was 21.3%, and the 5-year survival rate was 51.6%. Patients with a lymph node ratio （LNR） 〉20% were more likely to have tumor differentiation, depth of duodenal involvement, depth of pancreatic invasion, T-stage and TNM-Stage. The number of the metastatic lymph nodes is important prognostic factors of the CAV. Univariate analysis showed that the factors associated with the prognosis included tumor size （P=0.036）, tumor differentiation （P=0.019）, LNR （P=0.032）, mtmber of metastatic lymph nodes （P=0.024）, lymph node metastasis （P=0.03）, depth of pancreatic invasion （P=0.001）, T-stage （P=0.002）, TNM stage （P=0.001）, elevated CA 19-9 （P=0.000）, and jaundice （P=0.021）. Multivariate analysis showed that the factors associated with the prognosis were the number of metastatic lymph nodes （P=0.032; RR： 1.283; 95% CI： 1.022-1.611）, tumor size （P=0.043; RR： 1.736; 95% CI： 1.017-2.963）, and elevated CA 19-9 （P=0.003; RR： 3.247; 95% CI： 1.504-7.010）. Conclusions： LNR is a useful factor for predicting the prognosis of the radical treatment for CAV,, whereas the number of metastatic lymph nodes is the most important factor. Further research on the locations, number, and LNR will be clinically meaningful to improve survival in patients with CAV.
基金Supported by The Educational Fund of Liaoning Province,No.2008795
文摘Signet-ring cell carcinoma(SRCC) of ampulla of Vater is extremely uncommon,and less than 15 cases have been reported so far in literature.It mainly occurs in elderly people(median age 57 years).We report a rare case of SRCC of the ampulla of Vater in a 38-year-old woman who presented with a small tumor at the Vater,discovered by the contrast-enhanced ultrasound(CEUS).Histopathological examination showed prominent signet-ring features.We also describe the imaging features of SRCC of ampulla of Vater in CEUS.
文摘Introduction: Signet ring cell carcinoma is a rare tumor that generally originates in the gastrointestinal tract. Signet-ring cell carcinoma of the ampulla of Vater is extremely uncommon and a very rare clinical entity, which is infrequently reported in medical literature and only 31 cases have been mentioned. Most tumors affecting Vater’s Ampulla are adenocarcinomas and other histological variants are less frequent. It mainly occurs in elderly patients. Case Presentation: We report a case of signet ring cell carcinoma of Vater’s Ampulla. The tumour had infiltrated the duodenal, but local lymph nodes were clear (T3N0M0). Duodenopancreatectomy with pylorus preservation is the treatment of choice. Conclusions: Etiology and survival are not well-defined in the literature due to the extreme rarity of this disease.
文摘Background Carcinomas of the ampulla of Vater （CAV） is a relatively rare malignant gastrointestinal tumor,and its postoperative prognostic factors have been well studied.However,as its first symptom,the impact of jaundice on the prognosis of CAV is not so clear.This study aims to explore the role of jaundice as a prognostic factor in patients undergoing radical treatment for CAV.Methods The clinical data of 195 patients with CAV who were treated in the Cancer Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,from January 1989 to January 2013 were retrospectively analyzed.Among them,170 patients with pathologically confirmed CAV entered the statistical analysis.Jaundice was defined as a total bilirubin serum concentration of ≥3 mg/dl.Result Of these 170 patients,99 （58.20％） had jaundice at presentation.Jaundice showed significant correlations with tumor differentiation （P=0.002）,lymph node metastasis （P=0.016）,pancreatic invasion （P=0.000）,elevated preoperative CA199 （P=0.000）,depth of invasion （P=0.000）,and tumor stage （P=0.000）.There were more patients with pancreatic invasion in the jaundice group than in the non-jaundice group.Also,lymph node metastasis was more common in the jaundice group （n=26） than in the non-jaundice group （n=8）.The non-jaundice group had significant better overall 5-year disease-free survival （72.6％） than the jaundice group （41.2％,P=0.013）.Jaundice was not significantly correlated with the postoperative bleeding （P=-0.050）.Conclusions Jaundice in patients with CAV often predicts more advanced stages and poorer prognoses.Pancreatic invasion and lymph node metastasis are more common in CAV patients with jaundice.Jaundice is not a risk factor for postoperative bleeding and preoperative biliary drainage cannot reduce the incidence of postoperative complications.
文摘BACKGROUND Carcinoma of the ampulla of Vater is an uncommon ampullo-pancreatobiliary neoplasm,and the most common histological type is adenocarcinoma with a tubular growth pattern.Invasive micropapillary carcinoma(IMPC)is an aggressive variant of adenocarcinoma in several organs that is associated with lymph node metastasis and poor prognosis.IMPC was first described as a histological subtype of breast cancer;however,IMPC of the ampulla of Vater is extremely rare,with only three articles reported in the English literature.CASE SUMMARY We have reported a case of IMPC of the ampulla of Vater in an 80-year-old man.Microscopically,the surface area of the carcinoma was composed of tubulopapillary structures mimicking intra-ampullary papillary-tubular neoplasm,and the deep invasive front area exhibited a pattern of IMPC.The carcinoma showed lymphatic invasion and extensive lymph node metastasis.The immunohistochemical study revealed mixed intestinal and gastric/pancreatobiliary phenotypes.CONCLUSION This rare subtype tumor in the ampulla of Vater showed a histologically mixed phenotype and exhibited aggressive behavior.
文摘BACKGROUND: Neuroendocrine tumors of the ampulla of Vater are extremely rare, and few cases of large cell neuroendocrine carcinoma (LCNEC) of the ampulla have been reported. METHODS: A 48-year-old male with obstructive jaundice was admitted to our hospital. On examination the patient was found to have a periampullary growth and subsequently underwent the Whipple's procedure. RESULTS: Histopathological examination and immunohistochemistry revealed features of LCNEC of the ampulla of Vater. The patient developed multiple liver metastases 6 months after Whipple's procedure. CONCLUSION: LCNEC of the ampulla of Vater is rare and highly aggressive, with a dismal prognosis.
