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首页> 外文期刊>Modern Pathology >Carcinoma of the Ampulla of Vater Associated With or Without Adenoma: A Clinicopathologic Analysis of 198 Cases With Reference to p53 and Ki-67 Immunohistochemical Expressions
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Carcinoma of the Ampulla of Vater Associated With or Without Adenoma: A Clinicopathologic Analysis of 198 Cases With Reference to p53 and Ki-67 Immunohistochemical Expressions

机译：伴或不伴腺瘤的壶腹壶腹癌：198例p53和Ki-67免疫组织化学表达的临床病理分析。

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Adenomatous areas are found frequently within or in the vicinity of carcinoma of the ampulla of Vater. This makes definite diagnosis difficult in the preoperative examination. The adenoma–carcinoma development hypothesis is generally accepted for colorectal tumors. Recently, a genetic alteration model during colorectal tumor development has attracted much attention, leading to various studies. We studied clinicopathologic features, prognostic factors, and the alteration of the p53 tumor suppressor gene using p53 immunohistochemical staining in pure adenomas, pure carcinomas, and carcinomas with adenomatous areas. A proliferative activity of the tumors using Ki-67 was also evaluated. Nine cases of pure adenoma and 198 cases of carcinoma of the ampulla of Vater were selected for this study. Among the 198 cases of the carcinoma, 83 cases (42%) had adenomatous areas. Positivity of p53 immunohistochemical staining was 0% in pure adenomas, 36% in the adenomatous areas of carcinomas with adenomatous areas and 62% in the carcinomatous areas of carcinomas with adenomatous areas, and 56% in pure carcinoma. Accumulation of p53 protein and the Ki-67 labeling index revealed no significant difference in prognosis. The clinicopathological factors examined were as follows: degree of invasion of the surrounding tissue, such as duodenal wall; pancreatic parenchyma; the presence or absence of lymphatic permeation; venous invasion; perineural invasion; the presence of regional lymph node metastasis; and TNM stage. Each of the clinicopathological factors showed a significant difference. Multivariate analysis revealed strong predictors for a worse prognosis: presence of lymphatic permeation, invasion of the pancreas, and perineural invasion. In conclusion, our results are consistent with the adenoma–carcinoma development hypothesis. It would seem that the molecular events leading to p53 accumulation in neoplasms of the ampulla of Vater occur relatively late during the oncogenetic process. Moreover, we think it may be useful to refer to the p53 overexpression in the diagnosis of ampullary tumors.
机译：经常在瓦特壶腹的癌内或癌旁发现腺瘤区。这使得在术前检查中难以明确诊断。大肠肿瘤普遍接受腺瘤-癌发展假说。近来，在大肠肿瘤发展过程中的遗传改变模型引起了广泛的关注，导致了各种研究。我们研究了p53免疫组织化学染色在纯腺瘤，纯癌和具有腺瘤区的癌中的临床病理特征，预后因素以及p53抑癌基因的变化。还评估了使用Ki-67对肿瘤的增殖活性。本研究选择了9例纯腺瘤和198例Vater壶腹癌。在198例癌中，有83例（42％）具有腺瘤区域。 p53免疫组织化学染色的阳性率在纯腺瘤中为0％，在有腺瘤区域的癌的腺瘤区域中为36％，在有腺瘤区域的癌的癌性区域中为62％，在纯癌中为56％。 p53蛋白的积累和Ki-67标记指数显示预后无明显差异。检查的临床病理因素如下：周围组织如十二指肠壁的浸润程度;胰腺实质是否存在淋巴渗透;静脉侵袭神经周围浸润是否存在区域淋巴结转移;和TNM阶段。每个临床病理因素均显示出显着差异。多变量分析显示了预后较差的强有力的预测指标：淋巴渗透，胰腺侵犯和神经周围浸润的存在。总之，我们的结果与腺瘤-癌发展假说相符。在致癌过程中，导致p53在Vater壶腹肿瘤中积累的分子事件似乎发生得相对较晚。此外，我们认为在壶腹肿瘤的诊断中参考p53过表达可能是有用的。

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