Article ; Online: Tissue microarray-chip featuring computerized immunophenotypical characterization more accurately subtypes ampullary adenocarcinoma than routine histology.
World journal of gastroenterology
2020 Volume 26, Issue 43, Page(s) 6822–6836
Abstract: Background: Ampullary adenocarcinomas (AACs) are heterogeneous tumors currently classified into three important sub-classes (SC): Intestinal (INT), Pancreato-Biliary (PB) and Mixed-Type (MT). The different subgroups have similar clinical presentation ... ...
| Abstract | Background: Ampullary adenocarcinomas (AACs) are heterogeneous tumors currently classified into three important sub-classes (SC): Intestinal (INT), Pancreato-Biliary (PB) and Mixed-Type (MT). The different subgroups have similar clinical presentation and are treated by pancreatoduodenectomy with curative intent. However, they respond differently to chemotherapy and have different prognostic outcomes. The SC are often difficult to identify with conventional histology alone. The clinical outcome of all three remains unclear, particularly for MT. Aim: To identify two main subtypes of AACs, using an immunohistochemical (IHC) score based on CDX2, CK7 and CK20. Methods: Tissue samples from 21 patients who had undergone resection of AAC were classified by HE histology and IHC expression of CDX2, CK7 and CK 20. An IHC score was obtained for each marker by counting the number of positive cells (0 = no stained cells; 1 < 25%; 2 < 50% and 3 > 50%) and their intensity (1 = weak; 2 = moderate and 3 = strong). A global score (GS) was then obtained by summation of the IHC scores of each marker. The MT tumors were grouped either with the INT or PB group based on the predominant immuno-molecular phenotype, obtaining only two AACs subtypes. The overall survival in INT and PB patients was obtained by Kaplan-Meier methods. Results: Histological parameters defined the AACs subtypes as follows: 15% INT, 45% PB and 40% MT. Using IHC expression and the GS, 75% and 25% of MT samples were assigned to either the INT or the PB group. The mean value of the GS was 9.5 (range 4-16). All INT samples had a GS above the average, distinct from the PB samples which had a GS score significantly below the average ( Conclusion: The combination of histopathological and molecular criteria enables the classification of AACs into two clinically relevant histo-molecular phenotypes, which appear to represent distinct disorders with potentially significant changes to the current therapeutic strategies. |
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| MeSH term(s) | Adenocarcinoma/surgery ; Biomarkers, Tumor/genetics ; CDX2 Transcription Factor ; Common Bile Duct Neoplasms/surgery ; Humans ; Immunohistochemistry ; Keratin-7 |
| Chemical Substances | Biomarkers, Tumor ; CDX2 Transcription Factor ; Keratin-7 |
| Language | English |
| Publishing date | 2020-12-02 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 2185929-2 |
| ISSN | 2219-2840 ; 1007-9327 |
| ISSN (online) | 2219-2840 |
| ISSN | 1007-9327 |
| DOI | 10.3748/wjg.v26.i43.6822 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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