Treatment of ampullary villous adenomas that may harbor carcinoma
Treatment of ampullary villous adenomas that may harbor carcinoma
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DOI：
10.1016/s1091-255x(02)00040-9
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发表时间：
2002-09-01
影响因子：
3.2
通讯作者：
Kinner, BM
中科院分区：
文献类型：
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作者：
Jordan, PH;Ayala, G;Kinner, BM
壶腹绒毛状腺瘤是一种罕见的肿瘤。它是一种欺骗性肿瘤，因为它是一种癌前病变，25%至56%的患者的病变活检呈假阴性。本报告的主要焦点是30例接受维普莱手术的乏特壶腹绒毛状腺瘤中的23例。22名患者的石蜡块可用。在8例患者中，可获得活检组织块和相应的切除标本。使用p53和Ki-67抗体进行免疫组织化学研究，以确定这些抗体在活检标本中的积累是否会识别假阴性活检。有1例手术死亡。维普莱手术后存活的22例患者的2年、5年和10年生存率分别为74%、57%和35%。三个病人死于癌症。平均p53表达指数在腺瘤中增加到88（P=0.001），在癌中增加到114（P=0.01），而与肿瘤相邻的正常壶腹上皮为12.6。Ki-67增殖指数在正常相邻上皮（13%）、腺瘤（34%，P=0.0002）和癌（53%，P=0.034）之间以及腺瘤上皮和癌之间（34% vs. 53%，P= 0.012）存在显著差异。65%的绒毛状腺瘤患者存在绒毛状壶腹腺癌（如果包括切除标本中的原位癌患者，则为87%）。由于壶腹活检的高假阴性率，以及不能准确地对这些病变进行分期，我们建议大多数患者行胰十二指肠切除术。p53和Ki-67标记物的研究表明，它们可能有助于识别常规活检未发现的壶腹绒毛状癌。
Villous adenoma of the ampulla of Vater is a rare tumor. It Is a deceptive tumor because it is a premalignant lesion and biopsies of the lesion are false negative in 25% to 56% of patients. The primary focus of this report is 23 of 30 patients with villous adenoma of the ampulla of Vater who underwent Whipple operations. Paraffin blocks from 22 patients were available. In eight patients, blocks of the biopsies and the corresponding resected specimens were available. Immunohistochemical studies using antibodies to p53 and Ki-67 were performed to determine whether accumulation of these antibodies in the biopsy specimens would identify false negative biopsies. There was one operative death. The 2-, 5-, and 10-year survival rates for the 22 patients surviving a Whipple operation were 74%, 57%, and 35%, respectively. Three patients died of cancer. The mean p53 expression index was increased in adenomas to 88 (P=0.001) and in carcinomas to 114 (P=0.01), compared with 12.6 for normal ampullary epithelium adjacent to tumor. Significant differences in the Ki-67 proliferation index were noted between normal adjacent epithelium (13%), adenoma (34%, P=0.0002), and carcinoma (53%, P=0.034), as well as between adenomatous epithelium and carcinoma (34% vs. 53%, P=.012). Villous ampullary adenocarcinoma was present in 65% of patients with villous adenoma (87% if patients with carcinoma in situ in resected specimens are included). Because of the high false negative rate of ampullary biopsies, and the inability to accurately stage these lesions, we recommend pancreaticoduodenectomy in most patients. Studies with p53 and Ki-67 markers suggest that they may be helpful in the recognition of ampullary villous cancer not identified on routine biopsies.