Copyright
©The Author(s) 2018.
World J Gastrointest Oncol. Nov 15, 2018; 10(11): 370-380
Published online Nov 15, 2018. doi: 10.4251/wjgo.v10.i11.370
Published online Nov 15, 2018. doi: 10.4251/wjgo.v10.i11.370
Table 1 Proposed immunohistochemical markers for ampulla of Vater carcinoma histological classification (adapted from Mafficini et al[16])
| Immunohistochemical marker criteria present | Intestinal type | Pancreatobiliary type positive | Mixed/Ambiguous type | Note |
| Ang et al[12] (MUC1, MUC2, CDX2, CK20) | Positive CK20 or CDX2 or MUC2, and negative MUC1 Positive CK20 and CDX2, and MUC2 and any MUC1 | Positive MUC1 and negative CDX2, and negative MUC2 and any CK20 | All other combinations | |
| Chang et al[13] (MUC1, CDX2) | Positive CDX2 or negative MUC1 | Negative CDX2 and positive MUC1 | Not applicable | CDX2 positivity based on H score (percentage of positive cells × intensity of staining) > 35 MUC1 positivity based on any staining |
| Gingras et al[17] (MUC1, CDX2) | Ratio of the CDX2/MUC1 H score ≥ 2 | Ratio of the CDX2/MUC1 H score < 0.5 | Ratio of CDX2/MUC1 H score ≥ 0.5 and < 2 | Use only MUC1 and CDX2 as per Chang et al[13], with H scores for both CDX2 and MUC1 |
| Mafficini et al[16] (MUC1, MUC2, CDX2, CK20) | Positive CK20 or CDX2 or MUC2, and negative MUC1 | Positive MUC1 and negative CDX2, and negative MUC2 and any CK20 | All other combinations |
Table 2 Frequency of significantly mutated ampulla of Vater carcinoma genes in different histotypes and compared to colorectal and pancreatic adenocarcinoma (adapted from Yachida et al[14])
| Yachida et al[14] | Gingras et al[17] | Biankin et al[36] Pancreatic carcinoma, % | Colorectal Carcinoma (TCGA), %[35] | |||
| Intestinal type, % | Pancreato-biliary type, % | Mixed type, % | Pancreato-biliary type, % | Intestinal type, % | ||
| APC (50) | KRAS (68) | KRAS (50) | TP53 (72) | TP53 (65) | KRAS (99) | APC (81) |
| TP53 (39) | TP53 (67) | APC (50) | KRAS (65) | KRAS (46) | TP53 (33) | TP53 (60) |
| KRAS (39) | SMAD4 (20) | TP53 (41) | SMAD4 (18) | APC (41) | SMAD4 (16) | KRAS (43) |
| CTNNB1 (26) | CTNNB1 (15) | SMARCA4 (27) | CDKN2A (16) | PIK3CA (26) | MLL3 (7) | TTN (31) |
| ARID2 (18) | ERBB3 (14) | PIK3CA (23) | PIK3CA (13) | SMAD4 (20) | ATM (5) | PIK3CA (18) |
| ERBB2 (14) | GNAS (12) | SMAD 4 (23) | ARID1A (13) | TGFBR2 (17) | NALCN (5) | FBXW7 (14) |
| ACVR2A (13) | CDH10 (12) | SOX 9 (23) | APC (11) | ARID2 (17) | ARID1A (4) | SMAD4 (10) |
| SMAD4 (13) | ELF3 (11) | CDKN2A (23) | ATM (10) | ELF3 (7) | SF3B1 (4) | NRAS (9) |
| GNAS (13) | CDKN2A (9) | ARID1A (18) | TGFBR2 (10) | CTNNB1 (17) | TGFBR2 (4) | TCF7L2 (9) |
| SOX9 (13) | TGFBR2 (14) | FBXW7 (8) | NF1 (15) | ARID2 (3) | FAM123B (7) | |
Table 3 Ampulla of Vater cancer staging AJCC 2017[21]
| Primary tumor (T) | |
| T category | T criteria |
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ |
| T1 | Tumor limited to ampulla of Vater or sphincter of Oddi, or tumor invades beyond the sphincter of Oddi (perisphincteric invasion) and/or into the duodenal submucosa |
| T1a | Tumor limited to ampulla of Vater or sphincter of Oddi |
| T1b | Tumor invades beyond the sphincter of Oddi (perisphincteric invasion) and/or into the duodenal submucosa |
| T2 | Tumor invades into the muscularis propria of the duodenum |
| T3 | Tumor directly invades the pancreas (up to 0.5 cm) or tumor extends more than 0.5 cm into the pancreas, or extends into peripancreatic or periduodenal tissue or duodenal serosa without involvement of the celiac axis or superior mesenteric artery |
| T3a | Tumor directly invades pancreas, up to 0.5 cm |
| T3b | Tumor extends more than 0.5 cm into the pancreas, or extends into peripancreatic tissue or duodenal serosa without involvement of the celiac axis or superior mesenteric artery |
| T4 | Tumor involves the celiac axis, superior mesenteric artery, and/or common hepatic artery, irrespective of size |
| Regional lymph nodes (N) | |
| N category | N criteria |
| NX | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis to 1 to 3 regional lymph nodes |
| N2 | Metastasis in > 3 regional lymph nodes |
- Citation: Pea A, Riva G, Bernasconi R, Sereni E, Lawlor RT, Scarpa A, Luchini C. Ampulla of Vater carcinoma: Molecular landscape and clinical implications. World J Gastrointest Oncol 2018; 10(11): 370-380
- URL: https://www.wjgnet.com/1948-5204/full/v10/i11/370.htm
- DOI: https://dx.doi.org/10.4251/wjgo.v10.i11.370