Clinical efficacy of endoscopic resection of duodenal papilla tumor (with video) / 中华消化内镜杂志

Objective To evaluate therapeutic effect of endoscopy on duodenal papilla tumor. Methods Clinical data of patients who underwent the endoscopic duodenal papilla tumor resection in Zhongshan Hospital were retrospectively studied from April 2007 to May 2014. Results A total of 21 patients underwent 28 procedures. Postoperative biliary stent were retained in 6 cases (6/28) , with no perforation or postoperative pancreatitis. Delayed bleeding occurred in 7 cases (7/28) and controlled by endoscopic hemostasis, and no death occurred. Mean follow-up was 31. 5 months. There were 6 recurrent cases, and mean recurrence time was 14. 1 months. All these recurrent cases are treated by endoscopy treatments or surgery. Conclusion Endoscopic treatment of duodenal papilla tumor is safe, effective and minimally invasive, but the occurrence of delayed bleeding is worth concern.

Adenoma da papila de Vater associado a tumor carcinoide em papila duodenal menor / Adenoma of the papilla of Vater associatedwith carcinoid tumor in the minor duodenal papilla

As neoplasias benignas da ampola de Vater são raras. Essas lesões têm propensão à degeneração maligna de 35 a 55%1 e podem ter tamanho relativamente grande (>5 cm) em diâmetro, em geral sendo notadas por sintomas de hemorragia digestiva, obstrução intestinal ou icterícia obstrutiva. Os tumores carcinoides da papila menor também são extremamente raros e são, a maioria, assintomáticos, porém podem apresentar comportamento agressivo na forma de metástases. Este trabalho apresenta um caso raro de um paciente portador de adenoma viloso em ampola de Vater associado ao carcinoide de papila menor.

Benign neoplasias are rare in the ampulla of Vater, and the likelihood of their degenerating to malign tumor is 35 to 55 %1. Benign neoplasias can have a relatively large size (> 5 cm diameter) and are usually noticed upon such symptoms as gastrointestinal bleeding, intestinal obstruction or obstructive jaundice. Carcinoid tumors in the minor duodenal papilla are also extremely rare and usually asymptomatic, but they can be severe in the metastasis form. This paper reports on a rare case of a patient with villous adenoma in the ampulla of Vater associated with carcinoid tumor in the minor duodenal papilla.

Expressão de marcadores imunoistoquímicos de origem tecidual e de carcinogênese nos adenocarcinomas tipo intestinal e pancreatobiliar da ampola de Vater / Immunohistochemistry expression of tissue origin and carcinogenesis markers in adenocarcinomas of intestinal and pancreaticobiliary types of Vaters ampolla

INTRODUÇÃO: Os adenocarcinomas da ampola de Vater (AAV) são classificados conforme a diferenciação histológica em tipos pancreatobliliar e intestinal, com comportamento biológico e prognóstico diferentes. O objetivo deste estudo foi determinar um painel imuno-histoquímico para a diferenciação do tipo histológico dos AAVs e analisar os fatores relacionados com a sobrevivência desses tumores em uma série de pacientes submetidos à ressecção do tumor com intenção curativa. MÉTODO: Variáveis clínicas e histopatológicas foram analisadas para os tipos intestinal e pancreatobiliar em 97 doentes submetidos à ressecção pancreática por AAV. A expressão de mucinas (MUC1, MUC2, MUC5AC, MUC6), citoqueratinas (CK7, CK17, CK20), CD10, CDX2, p53, p16, Ki67, CEA, CA19-9, hMLH1, hMLH2 e hMSH6 foi avaliada usando técnica de imunoistoquímica. RESULTADOS: Quarenta e três casos foram histologicamente classificados como tipo intestinal, 47 como tipo pancreatobiliar e 7 em outros tipos, de acordo com a classificação de Albores-Saavedra. O tipo intestinal apresentou expressão significativamente maior de MUC2 (74,4% vs 23,4%; p<0,001), CK20 (76,7% vs 29,8%; p <0,001), CDX2 (86% vs 21,3%; p<0,001) e CD10 (81,4% vs 51,1%; p=0,002); enquanto MUC1 (53,5% vs 82,9%; p=0,001) e CK7 (79,1% vs 95,7%; p=0,041) foram mais expressos nos adenocarcinomas pancreatobiliares. Os marcadores imunoistoquímicos com maior acurácia para determinação do tipo histológico foram CDX2, MUC2 e CK20 (82,2%, 75,5% e 73,3% respectivamente). A positividade para p53, p16, Ki67, CEA e CA19-9 foram 36,1%, 30,9%, 37,1%, 79,4% e 88,6%, respectivamente, sem qualquer diferença significativa entre os tipos intestinal e pancreatobiliar. A perda de expressão de pelo menos uma das proteínas hMLH1, hMLH2 e hMSH6 ocorreu em 13,4%, sem diferença entre os tipos histológicos. Em análise univarida, a sobrevivência foi significativamente menor para o tipo histológico pancreaticobiliar (p = 0,021), estadiamentos TNM mais avançados...

The intestinal and pancreatobliliary types of histological Vaters ampulla adenocarcinoma present different biologic behavior and prognosis. The aim of the present study was to determine the best immunohistochemical panel for tumor classification and analyze the survival of these histological types in a series of patients. Clinical and histopathologal variables were analyzed for each pancreatobiliary and intestinal type differentiation in 97 resected ampullary adenocarcinomas. The expression of mucins (MUC1, MUC2, MUC5AC, MUC6), cytokeratins (CK7, CK17, CK20), CD10, CDX2, p53, p16, Ki67, CEA, CA19-9, hMLH1, hMLH2 and hMSH6 was evaluated by using immunohistochemistry. Forty three Vaters ampulla carcinomas were histologically classified into intestinal type, 47 into pancreatobiliary type and 7 into other types, according to Albores-Saavedra classification. The intestinal type had a significantly higher expression of MUC2 (74.4%vs23.4%. p<0.001), CK20 (76.7%vs29.8% p<0.001), CDX2 (86%vs21. 3%. p<0.001) and CD10 (81.4%vs51.1%. p=0.002); while MUC1 (53.5%vs82.9%. p=0.001) and CK7 (79.1%vs95.7%. p=0.041) were higher in pancreatobiliary adenocarcinomas. The most accurate markers for the immunohistochemical classification were CDX2, MUC2 and CK20 (82.2%. 75.5% and 73.3% respectively). The positivity of p53, p16, Ki67, CEA and CA19-9 were 36.1%, 30.6%, 37.1%, 79% and 88%, respectively without any significant difference between intestinal and pancreatobiliary types. Loss of hMLH1, hMLH2 and hMSH6 proteins expression occurred in 13.4% of Vaters adenocarcinoma, without difference between intestinal and pancreaticobiliary types. Survival was significantly affected by pancreaticobiliary type (p=0.021), tumor grade (p<0.001), nodal status (p<0.001) and lymphatic invasion (p=0.004). Only regional lymph node involvement (p<0.001) and lymphatic invasion (p=0.013) was independent risk factors for survival in a multivariate analysis. In conclusion, the immunohistochemical ...