Rare Cancer News & Clinical Trials

Ampulla Of Vater (24 unread)

Trial - Ampullary Carcinoma

EUS-Guided ERCP Multicenter Registry

Posted: January 26th, 2012, 8:00am MST

Conditions: Cholangiocarcinoma; Pancreatic Cancer; Bile Duct Cancer; Biliary Stricture; Biliary Obstruction; Stent Obstruction; Proximal Duct Stricture; Distal Duct Stricture; Ampullary Cancer; Biliary Sphincter Stenosis; Impacted Stones; Chronic Pancreatitis; Peri-ampullary Diverticula; Altered Anatomy
Intervention: Procedure: Endoscopic Ultrasound (EUS) guided Endoscopic retrograde cholangiopancreatography (ERCP)
Sponsor: Weill Medical College of Cornell University
Recruiting - verified January 2012

PubMed - Ampullary Cancer

Confirmation of a potential biomarker for early-stage pancreatic cancer.

Fetched: February 4th, 2012, 10:00pm MST

Confirmation of a potential biomarker for early-stage pancreatic cancer.

Cancer Biomark. 2011 Jan 1;10(1):27-33

Authors: Topilow AA, Davis JM, Vernick JJ, Tang D, Corbett S, Veltman T, Wagner SJ, Gilvarg C

Abstract
Introduction: Pancreatic cancer has a dismal prognosis because it is often diagnosed at an advanced stage. Therefore, serological biomarkers are eagerly sought for early detection. The digestive enzyme pro-carboxypeptidase A (PCPA) may be able to fill this role. The purpose of this study was to validate and extend previous research done at New York University (NYU), demonstrating that measurement of serum PCPA is a sensitive biomarker for early stage pancreatic cancer. Materials and methods: Samples were collected from 10 early and 16 late stage patients at Jersey Shore University Medical Center (JSUMC) and Robert Wood Johnson Hospital (RWJ) with adenocarcinoma of the head of the pancreas. Results: The percentages of early and late stage cancer patients with PCPA values above the upper limit (2.35u/L) were 90.0% and 56.0%, respectively. Mean PCPA values for early and late stage cancer were determined to be 22.95u/L and 3.55u/L, respectively. In one case, the prospective patient was detected by our assay one month before diagnosis. Additionally, data from an ampullary cancer patient supports the proposed mechanism behind this test. Conclusions: Combining the JSUMC and NYU results show 94% sensitivity, demonstrating that determining serum PCPA has the requisite sensitivity to detect early stage pancreatic cancer.

PMID: 22297549 [PubMed - in process]
Chemotherapy outcomes for the treatment of unresectable intrahepatic and hilar cholangiocarcinoma: a retrospective analysis.

Fetched: February 3rd, 2012, 10:00pm MST

Chemotherapy outcomes for the treatment of unresectable intrahepatic and hilar cholangiocarcinoma: a retrospective analysis.

Gastrointest Cancer Res. 2011 Sep;4(5-6):155-60

Authors: Eckmann KR, Patel DK, Landgraf A, Slade JH, Lin E, Kaur H, Loyer E, Weatherly JM, Javle M

Abstract
BACKGROUND: Recent clinical trials for "biliary cancers" include a heterogenous group of patients with cholangiocarcinoma, gallbladder, and ampullary cancers. Limited data exist regarding the relative effectiveness of known chemotherapeutic regimens specifically in intrahepatic or hilar cholangiocarcinoma.
METHODS: Records of M D Anderson Cancer Center patients with unresectable intrahepatic and hilar cholangiocarcinoma who received first-line chemotherapy from January 1, 2005, to October 31, 2009, were retrospectively reviewed. The primary objective of this research was to determine overall tumor control rates with chemotherapeutic regimens used for first-line treatment of unresectable intrahepatic and hilar cholangiocarcinoma. Secondary objectives included duration of response, overall survival, and prognostic factors.
RESULTS: Eighty-five patients met inclusion criteria and were eligible for analysis. The most commonly used regimen was gemcitabine/cisplatin (62%), followed by oxaliplatin and capecitabine (16%). There was no significant difference between tumor control rates with gemcitabine/cisplatin (72% PR + SD) and other regimens (69% PR + SD). There was no significant difference between overall survival with the use of gemcitabine/cisplatin (15.2 months) or alternative regimens (13.9 months). A decrease in overall survival was seen with elevated baseline CA 19-9 (p < .0001), an initial diagnosis of unknown primary tumor (p = .0001), and prior treatment with chemoradiation (p = .0018).
CONCLUSION: In this retrospective review, both gemcitabine/cisplatin and alternative doublets (including capecitabine/oxaliplatin, gemcitabine/capecitabine, and gemcitabine/oxaliplatin) were effective regimens in maintaining disease control in intrahepatic and hilar cholangiocarcinoma.

PMID: 22295126 [PubMed - in process]
Efficacy of intraductal ultrasonography in the diagnosis of non-opaque choledocholith.

Fetched: February 3rd, 2012, 10:00pm MST

Efficacy of intraductal ultrasonography in the diagnosis of non-opaque choledocholith.

World J Gastroenterol. 2012 Jan 21;18(3):275-8

Authors: Lu J, Guo CY, Xu XF, Wang XP, Wan R

Abstract
AIM: To evaluate the efficacy of intraductal ultrasonography (IDUS) in the diagnosis of non-opaque, common bile duct stones.
METHODS: A total of 183 patients (102 males, mean age 73 years; 81 females, mean age 70 years) with suspected common bile duct stones diagnosed through abdominal computed tomography (CT), magnetic resonance imaging (MRI), and abdominal Type-B ultrasound were included in the study. The diagnosis was confirmed through endoscopic retrograde cholangiopancreatography (ERCP) followed by IDUS.
RESULTS: A total of 183 patients with suspected common bile duct (CBD) stones were included in the study as follows: 36 patients with high-density CBD stones, 68 patients with sand-like stones, 44 patients with low-density stones, 21 patients with ampullary cancer, and 14 patients with pancreatic cancer. Conventional imaging revealed 124 cases of choledochectasia, and only 36 cases of suspected CBD stones; ERCP revealed 145 cases of CBD stones with three missed diagnoses. IDUS revealed 148 cases of CBD stones, 21 cases of ampullary tumors, and 14 cases of pancreatic cancer.
CONCLUSION: IDUS was more effective in the diagnosis of bile duct stones than ERCP, upper abdominal CT or upper abdominal MRI.

PMID: 22294831 [PubMed - in process]
[Tumors of Vater's ampulla.]

Fetched: February 3rd, 2012, 10:00pm MST

[Tumors of Vater's ampulla.]

Pathologe. 2012 Feb;33(1):17-23

Authors: Gaßler N, Knüchel R

Abstract
Tumors of Vater's ampulla are generally uncommon. In this location intestinal type adenomas are frequently found, followed by noninvasive papillary neoplasms of the pancreaticobiliary type and neuroendocrine tumors (carcinoids). Carcinomas of Vater's ampulla represent about 0.5% of all gastrointestinal malignancies. Intestinal type adenocarcinoma is the most common malignant epithelial tumor followed by the pancreaticobiliary type adenocarcinoma. Highly malignant neuroendocrine carcinomas of Vater's ampulla are very uncommon. Carcinomas of the ampullary region can be sporadic or a component of several disease syndromes. Designation of large carcinomas as tumors with an ampullary or extra-ampullary origin can be difficult but is of relevance for a TNM conform classification. Helpful in the decision are the relationship between the tumor centre and Vater's ampulla, the existence of premalignant lesions in the ampullary epithelium as well as histology and immunostaining of the tumor.

PMID: 22293786 [PubMed - as supplied by publisher]
[A case of a neuroendocrine carcinoma in the minor papilla].

Fetched: January 26th, 2012, 10:00pm MST

[A case of a neuroendocrine carcinoma in the minor papilla].

Korean J Gastroenterol. 2011 Sep 25;58(3):144-8

Authors: Ha DW, Kim GH, Kim DU, Bae MJ, Kim BW, Jeon HK, Park do Y, Seo HI

Abstract
Neuroendocrine tumors are usually found in the ileum, appendix, rectum, colon and stomach. Ampullary neuroendocrine tumor is extremely rare and only a few cases of neuroendocrine carcinoma of the minor papilla have been reported. The preoperative diagnosis is very challenging because either asymptomatic or manifests as nonspecific abdominal pain. The tumor is relatively small and located at the deep mucosa and submucosa. Endoscopy with deep biopsy, endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography are good diagnostic tools. The best therapeutic choice is surgery. We report an unusual case of a 55-year-old woman who underwent endoscopy as part of a regular health checkup and was diagnosed a neuroendocrine carcinoma in the minor papilla, which was successfully resected by pancreaticoduodenectomy. (Korean J Gastroenterol 2011;58:144-148).

PMID: 21960102 [PubMed - indexed for MEDLINE]
Surgical management for advanced duodenal adenomatosis and duodenal cancer in Dutch patients with familial adenomatous polyposis: A nationwide retrospective cohort study.

Fetched: January 25th, 2012, 10:00pm MST

Surgical management for advanced duodenal adenomatosis and duodenal cancer in Dutch patients with familial adenomatous polyposis: A nationwide retrospective cohort study.

Surgery. 2012 Jan 20;

Authors: van Heumen BW, Nieuwenhuis MH, van Goor H, Mathus-Vliegen LE, Dekker E, Gouma DJ, Dees J, van Eijck CH, Vasen HF, Nagengast FM

Abstract
BACKGROUND: Duodenal cancer is a major cause of mortality in patients with familial adenomatous polyposis (FAP). The clinical challenge is to perform duodenectomy before cancer develops; however, procedures are associated with complications. Our aim was to gain insight into the pros and cons of prophylactic duodenectomy. METHODS: Patients with FAP from the nationwide Dutch polyposis registry who underwent prophylactic duodenectomy or were diagnosed with duodenal cancer were identified and classified as having benign disease or cancer at preoperative endoscopy. Surveillance, clinical presentation, surgical management, outcome, survival, and recurrence were compared. RESULTS: Of 1,066 patients with FAP in the registry, 52 (5%; 25 males) were included: 36 with benign adenomatosis (median: 48 years old; including two (6%) cancer cases diagnosed after operation), and 16 with cancer (median: 53 years old). Cancer cases had been diagnosed with colorectal cancer more often (6% vs 44%; P < .01). Forty-three patients underwent duodenectomy (35 benign/eight cancer): 30-day mortality was 4.7% (n = 2), and in-hospital morbidity occurred in 21 patients (49%), without differences between patients with benign adenomatosis and cancer. Adenomas recurred in reconstructed proximal small bowel in 14 of 28 patients (50%, median time to recurrence: 75 months), and one patient developed cancer. Median survival of all 18 cancer cases in the registry (1.7%; 12 ampullary/six duodenal) was 11 months. CONCLUSION: Prognosis of duodenal cancer in patients with FAP is poor, which justifies an aggressive approach to advanced benign adenomatosis. Strict adherence to recommended surveillance intervals is essential for a well-timed intervention. Given the substantial morbidity and mortality of duodenectomy, patients' individual characteristics are to be critically evaluated preoperatively. As adenomas recur, postoperative endoscopic surveillance is mandatory.

PMID: 22265391 [PubMed - as supplied by publisher]
Mucins differently expressed in various ampullary adenocarcinomas.

Fetched: January 25th, 2012, 10:00pm MST

Mucins differently expressed in various ampullary adenocarcinomas.

Diagn Pathol. 2011;6:102

Authors: Wang T, Liang YM, Hu P, Cheng YF

Abstract
BACKGROUND: We investigated the occurrence and clinical significance of mucin expression in ampullary adenocarcinoma.
METHODS: We retrospectively analyzed clinical, pathological, and survival data from 74 ampullary adenocarcinoma patients who received radical operation from January 2004 to November 2006.
RESULTS: The tumors were located in the lower end of the common bile duct (46%), papillary duodenum (42%), and ampullary duodenum (12%), and expressed MUC1 (72%), MUC2 (20%), MUC5AC (43%), and MUC6 (27%). Expression of MUC1 was associated with tumor differentiation (OR: 4.71, 95% CI: 1.26, 17.66, P = 0.021). Expression of MUC5AC was associated with age (OR: 1.07, 95% CI: 1.11, 1.14, P = 0.026) and less vessel invasion(OR: 0.14, 95% CI: 0.03, 0.72, P = 0.019). The survival rates were not significantly different when patients had or had no expression of MUC1, MUC2, MUC5AC, or MUC6 in tumor. Patients with tumors positive for MUC5AC in the papillary duodenum had worse survival than those with tumors negative for MUC5AC (P = 0.044).
CONCLUSIONS: Expression of MUC1 was high (72%) in ampullary adenocarcinoma, while expressions of MUC2, MUC5AC, and MUC6 were lower. Mucins are useful markers to diagnose and identify ampullary adenocarcinoma, particularly in determining the degree of malignancy of ampullary adenocarcinoma.

PMID: 22027009 [PubMed - indexed for MEDLINE]
Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study.

Fetched: January 25th, 2012, 10:00pm MST

Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study.

Radiat Oncol. 2011;6:126

Authors: Narang AK, Miller RC, Hsu CC, Bhatia S, Pawlik TM, Laheru D, Hruban RH, Zhou J, Winter JM, Haddock MG, Donohue JH, Schulick RD, Wolfgang CL, Cameron JL, Herman JM

Abstract
BACKGROUND: The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. We combined the experience of two institutions to better delineate which patients may benefit from adjuvant chemoradiation.
METHODS: Patients who underwent curative surgery for ampullary carcinoma at the Johns Hopkins Hospital (n=290; 1992-2007) and at the Mayo Clinic (n=130; 1977-2005) were reviewed. Patients with <60 days of follow-up, metastatic disease at surgery, or insufficient pathologic data were excluded. The final combined study consisted of 186 patients (n=104 Johns Hopkins, n=82 Mayo). Most patients received 5-FU based chemoradiation with conformal radiation. Cox proportional hazards models were used for survival analysis.
RESULTS: Median overall-survival was 39.9 months with 2- and 5-year survival rates of 62.4% and 39.1%. On univariate analysis, adverse prognostic factors for overall survival included T3/T4 stage disease (RR=1.86, p=0.002), node positive status (RR=3.18, p<0.001), and poor histological grade (RR=1.69, p=0.011). Patients who received adjuvant chemoradiation (n=66) vs. surgery alone (n=120) showed a higher rate of T3/T4 stage disease (57.6% vs. 30.8%, P<0.001), lymph node involvement (72.7% vs. 30.0%, P<0.001), and close or positive margins (4.6% vs. 0.0%, P=0.019). Five year survival rates among node negative and node positive patients were 58.7% and 18.4% respectively. When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5 yr OS: 27.5% vs. 5.9%; RR=0.47, P=0.004). After adjusting for adverse prognostic factors on multivariate analysis, patients treated with adjuvant chemoradiation demonstrated a significant survival benefit (RR=0.40, P<0.001). Disease relapse occurred in 37.1% of all patients, most commonly metastatic disease in the liver or peritoneum.
CONCLUSIONS: Node-positive patients with resected ampullary adenocarcinoma may benefit from 5-FU based adjuvant chemoradiation. Since a significant proportion of patients develop metastatic disease, there is a need for more effective systemic treatment.

PMID: 21951377 [PubMed - indexed for MEDLINE]
Hybrid resection of duodenal tumors.

Fetched: January 12th, 2012, 10:00pm MST

Hybrid resection of duodenal tumors.

J Laparoendosc Adv Surg Tech A. 2011 Sep;21(7):603-8

Authors: Poultsides GA, Pappou EP, Bloom GP, Orlando R

Abstract
INTRODUCTION: The aim of this study was to review our experience with the hand-assisted laparoscopic management of duodenal tumors with no or low malignant potential and to compare this approach with published case reports of purely laparoscopic local duodenal resection.
PATIENTS AND METHODS: Eight cases of hand-assisted laparoscopic local duodenal resection performed from 2000 to 2008 were retrospectively reviewed. Hand-assistance was utilized for complete duodenal mobilization, and local duodenal resection was accomplished extracorporeally through the hand-access incision. Patient and tumor characteristics, operative time, length of stay, and complications were compared with 18 cases of totally laparoscopic local excision of duodenal tumors published since 1997. Patients with ampullary tumors were excluded.
RESULTS: Compared with the purely laparoscopic approach, the hand-assisted technique was associated with shorter operative time (179 versus 131 minutes, P=.03) and was more commonly used for lesions located in the third portion of the duodenum (0% versus 37.5%, P=.02). Tumor size (2.9 cm versus 3.2 cm, P=.61) and length of hospital stay (5.9 versus 5.9 days, P=.96) were similar between the two groups. The rate of complications was also comparable (0% versus 12.5%, P=.31); 1 of 8 patients in the hand-assisted group developed an incisional hernia at the hand-access site.
CONCLUSION: Hand-assisted laparoscopic local duodenal resection is a feasible, safe, and effective alternative to the totally laparoscopic approach. In addition to being associated with comparable length of hospital stay, hand-assistance can shorten operative time by facilitating duodenal mobilization as well as extracorporeal duodenal resection and closure.

PMID: 21774700 [PubMed - indexed for MEDLINE]
[Results of pancreaticoduodenectomy in the treatment of periampullary tumors].

Fetched: January 6th, 2012, 10:00pm MST

[Results of pancreaticoduodenectomy in the treatment of periampullary tumors].

Rev Med Chil. 2011 Aug;139(8):1015-24

Authors: Norero E, Viñuela E, Báez S, Martínez C, Reyes J, Kusanovic R, Sanhueza M, Aguayo G, Calvo A, Mege RM, Caracci M, Díaz A

Abstract
Background: The diagnosis and treatment of periampullary tumors represents a challenge for current medicine. Aim: To review the results of pancreaticoduodenectomy (PDD) in the treatment of periampullary tumors and to identify risk factors that impact the long-term survival. Patients and Methods: We performed a retrospective study of patients who underwent a PDD for periampullary tumors between 1993 and 2009. We reviewed perioperative results and long term survival. We performed a multivariate analysis for long-term survival. Results: A PDD was performed in 181 patients aged 58 ± 12 years (98 females). Piloric preservation was done in 53% and a pancreatogastric anastomosis was used in 94% of cases. Morbidity was 62% and postoperative mortality was 5.5%. Pancreatic cancer was the most frequent pathological finding in 41%, followed by ampullary cancer in 28% and distal bile duct cancer in 16%. Median survival was 17 months, with a five years survival of 24%. Survival for ampullary tumors was 28 months with a five years survival of 32%. The median and five years survival were 14 months and 16% for bile duct cancer and 11 months and 14% for pancreatic cancer. Multivariate analysis identified tumor type (pancreas /bile duct) and lymph node dissemination as independent predictors of mortality. Conclusions: One quarter of patients experienced long term survival. Mortality predictors were tumor type and lymph node dissemination.

PMID: 22215331 [PubMed - in process]
CA 19-9 in pancreatic cancer: retrospective evaluation of patients with suspicion of pancreatic cancer.

Fetched: January 2nd, 2012, 10:00pm MST

CA 19-9 in pancreatic cancer: retrospective evaluation of patients with suspicion of pancreatic cancer.

Tumour Biol. 2011 Dec 29;

Authors: Molina V, Visa L, Conill C, Navarro S, Escudero JM, Auge JM, Filella X, Lopez-Boado MA, Ferrer J, Fernandez-Cruz L, Molina R

Abstract
CA 19.9 serum levels were prospectively determined in 573 patients admitted to hospital for suspicion of pancreatic cancer. The final diagnosis was 77 patients with no malignancy, 389 patients with pancreatic cancer, 37 neuroendocrine pancreatic cancer, 28 cholangiocarcinomas, 4 gallbladder cancer, 27 ampullary carcinomas, and 11 periampullary carcinomas. CA 19.9 was determined using a commercial assay from Roche Diagnostics, and 37 U/ml was considered as the upper limit of normality. Abnormal CA 19.9 serum levels were found in 27%, 81.5%, 85.7%, 59.3%, 63.6%, and 18.9% of patients with benign diseases, pancreatic cancer, cholangiocarcinomas, and ampullary, periampullary, or neuroendocrine tumors. Significantly higher concentrations of CA 19.9 were found in patients with than in those without malignancy or with neuroendocrine tumors. CA 19.9 serum levels were higher in pancreatic cancer or cholangiocarcinoma than in other malignancies (p < 0.0001). CA 19.9 serum levels were also correlated with tumor stage, treatment (significantly lower concentrations in resectable tumors), and tumor location (the highest in those located in the body, the lowest in those in the tail or uncinate) and site of metastases (highest in liver metastases). A trend to higher CA 19.9 serum concentrations was found in patients with jaundice, but only with statistical significance in the early stages. Using 50 or 100 U/ml in patients with jaundice, CA 19.9 was useful as an aid in the diagnosis of pancreatic cancer (sensitivity 77.9%, specificity 95.9%) as well as tumor resectability in pancreatic cancer with different cutoffs according to tumor location and bilirubin serum levels with specificities ranging from 90% to 100%. CA 19.9 is the tumor marker of choice in pancreatic adenocarcinomas, with a clear relationship with tumor location, stage, and resectability.

PMID: 22203495 [PubMed - as supplied by publisher]
Assessment of the nodal status in ampullary carcinoma: the number of positive lymph nodes versus the lymph node ratio.

Fetched: December 25th, 2011, 10:00pm MST

Assessment of the nodal status in ampullary carcinoma: the number of positive lymph nodes versus the lymph node ratio.

World J Surg. 2011 Sep;35(9):2118-24

Authors: Sakata J, Shirai Y, Wakai T, Ajioka Y, Akazawa K, Hatakeyama K

Abstract
BACKGROUND: This study was intended to compare the prognostic power of the number of positive lymph nodes with that of the lymph node ratio in patients with ampullary carcinoma.
METHODS: A retrospective analysis was conducted of the medical records of 71 consecutive patients with ampullary carcinoma who underwent pancreaticoduodenectomy with regional lymph node dissection. A total of 2151 lymph nodes were dissected (median: 28 nodes per patient) and examined histologically. Cutoff points were determined for both the number of positive nodes and the lymph node ratio using χ(2) scores calculated with the Cox proportional hazards regression model.
RESULTS: Lymph node metastasis was found in 34 patients. The best cutoff point for the number of positive nodes was identified as three nodes, and that for the lymph node ratio was identified as 10%. Univariate analysis revealed both the number of positive nodes (0, 1-3, or ≥ 4; P < 0.0001) and the lymph node ratio (0%, 0-10%, or >10%; P < 0.0001) as significant prognostic factors. Multivariate analysis identified the number of positive nodes as an independent prognostic factor (P < 0.001), whereas the lymph node ratio failed to remain as an independent variable. The cumulative 5-year survival rates were 85% for patients with 0 positive nodes, 63% for patients with 1-3 positive nodes, and 0% for patients with ≥ 4 positive nodes (P < 0.0001).
CONCLUSIONS: The number of positive lymph nodes better predicts the outcome after resection than the lymph node ratio in patients with ampullary carcinoma.

PMID: 21717240 [PubMed - indexed for MEDLINE]
Tumour growth is more dispersed in pancreatic head cancers than in rectal cancer: implications for resection margin assessment*.

Fetched: December 21st, 2011, 10:00pm MST

Tumour growth is more dispersed in pancreatic head cancers than in rectal cancer: implications for resection margin assessment*.

Histopathology. 2011 Dec;59(6):1111-21

Authors: Verbeke CS, Knapp J, Gladhaug IP

Abstract
Verbeke C S, Knapp J & Gladhaug I P (2011) Histopathology 59, 1111-1121 Tumour growth is more dispersed in pancreatic head cancers than in rectal cancer: implications for resection margin assessment Aims: The UK definition of microscopic resection margin involvement (R1) in pancreatic head cancer, based on tumour lying <1 mm from the margin, has been adopted from rectal cancer, but has never been validated. The aim of this study was to assess the adequacy of the R1 definition for pancreatic head cancers by comparing the growth patterns of rectal (RC), pancreatic (PC), ampullary (AC) and distal bile duct (DBC) adenocarcinomas. Methods and results: Distances between tumour cells and tumour cell density in the tumour centre and periphery were quantified by Minimum Spanning Tree (MST) analysis in 10 cases of the four cancer groups. In RC, the MST distance was similar throughout the entire width of the tumour, whereas in PC, DBC and AC it was significantly larger at the periphery than at the tumour centre (P ≤ 0.003). While results were similar for PC and DBC, however, distances at the centre and periphery of both cancers were larger compared to AC (P ≤ 0.046). Tumour cell density dropped at the periphery of PC to 31% of that at the centre, compared to 83% in RC (P < 0.0002). Conclusions: Tumour growth in pancreatic head cancers is more dispersed than in RC, particularly in the tumour periphery. Revision of the R1 definition for pancreatic head cancer may therefore need to be considered.

PMID: 22175891 [PubMed - in process]
Pancreatoduodenectomy for bile duct and ampullary cancer.

Fetched: December 20th, 2011, 10:00pm MST

Pancreatoduodenectomy for bile duct and ampullary cancer.

J Hepatobiliary Pancreat Sci. 2011 Dec 15;

Authors: Yamaguchi K

Abstract
Pylorus-preserving pancreatoduodenectomy has become a standard operation for distal and middle bile duct cancers. Bile duct cancer typically extends longitudinally and invades vertically. It frequently metastasizes to the lymph nodes and infiltrates the perineural spaces. The presence of residual cancer in the bile duct stump and lymph node metastases are significant prognostic factors. Negative surgical margins and D2 lymph node dissection are necessary for curative resection. The clinical course after portal vein resection for bile duct cancer with portal vein invasion is better than that of non-resectable bile duct cancer. Portal vein resection can therefore be useful. The efficacy of prophylactic portal vein resection is unclear. We describe here our methods for performing pylorus-preserving pancreatoduodenectomy for bile duct cancer.

PMID: 22170385 [PubMed - as supplied by publisher]
Giant Brunner's gland adenoma of the duodenal bulb presenting with ampullary and duodenal obstruction mimicking pancreatic malignancy.

Fetched: December 20th, 2011, 10:00pm MST

Giant Brunner's gland adenoma of the duodenal bulb presenting with ampullary and duodenal obstruction mimicking pancreatic malignancy.

JOP. 2011 Jul;12(4):413-9

Authors: Gupta V, Gupta P, Jain A

Abstract
CONTEXT: Brunner's gland adenoma is a rare benign duodenal neoplasm. It usually presents with luminal obstruction or gastrointestinal bleeding. In rare cases, it may mimic a pancreatic malignancy and may present with obstructive jaundice.
CASE REPORT: A 65-year-old female presented with a two-month history of abdominal pain, early satiety and retrosternal burning pain. Liver function tests showed elevated enzymes with normal bilirubin. Imaging studies revealed a large mass in relation to the uncinate process of the pancreas and the distal duodenum along with the dilated common bile duct and the main pancreatic duct. Initial endoscopic evaluation failed to make a correct diagnosis. Repeat endoscopic evaluation combined with endoscopic sonography, however, revealed a large polypoid mass arising from the duodenal bulb. The patient underwent a transduodenal polypectomy. A diagnosis of Brunner's gland adenoma was made on histopathological examination.
CONCLUSION: Giant Brunner's adenoma may have unusual presentations. It may present with the features of ampullary obstruction mimicking periampullary or pancreatic malignancies. Extensive preoperative evaluation is required to reach a correct diagnosis in order to avoid more extensive surgery.

PMID: 21737907 [PubMed - indexed for MEDLINE]
An unusual cause of obstructive jaundice.

Fetched: December 15th, 2011, 10:00pm MST

An unusual cause of obstructive jaundice.

Hong Kong Med J. 2011 Aug;17(4):332-4

Authors: Law ST, Lee WK, Li MK, Lok KH

Abstract
Small-cell carcinomas of lung origin have been well characterised for their clinico-histopathological features. However, extrapulmonary small-cell carcinomas are rare, and in particular, they are extremely rare at the ampullary region. We report herein a case of small-cell carcinoma of ampulla of Vater and review its clinical, histological, and immunohistochemical features.

PMID: 21813905 [PubMed - indexed for MEDLINE]
Management of duodenal adenomatosis in FAP: single centre experience.

Fetched: December 4th, 2011, 10:00pm MST

Management of duodenal adenomatosis in FAP: single centre experience.

Fam Cancer. 2011 Dec 1;

Authors: Drini M, Speer A, Dow C, Collier N, Bhathal P, Macrae FA

Abstract
Duodenal and ampullary carcinoma in familial adenomatosis (FAP) is the third leading cause of FAP related deaths. Management of this condition is a challenging. The aim of this study was to evaluate the role of multiple targeted endoscopic biopsies and macroscopic appearance as the major determinants for surgical intervention. A secondary aim was to assess histological heterogeneity through comparing endoscopic biopsies and describe the clinical outcomes of our cohort after intervention. We reviewed our FAP surveillance database of 67 patients, between January 1999-June 2011 undergoing upper GI surveillance and where indicated, subsequent surgical intervention. Among 67 patients, 11 underwent surgical resection. Pancreas-preserving duodenectomy was performed in four patients (five procedures), and Whipple's operation in seven patients. The average size of polyps was 43 mm (range 17-65 mm), and the average number of targeted endoscopic biopsies per lesion was 7.5 (range 5-10). Two cases of high-grade (severe) dysplasia were diagnosed on endoscopic biopsies each understaged compared with the subsequent surgical specimen. All carcinomas identified have been resectable with no evidence of local spread or distant metastasis. There was one postoperative death, but no cancer related deaths. We identified both cancers at an early stage and there were no missed or late diagnoses. There have been no recurrences of carcinoma in a more than 7 years follow-up. Due to the heterogeneous nature of these lesions, comprehensive macroscopic assessment should be complemented with multiple targeted biopsies to improve the chance of early detection of advanced lesions.

PMID: 22131053 [PubMed - as supplied by publisher]
Effect of EpCAM, CD44, CD133 and CD166 expression on patient survival in tumours of the ampulla of Vater.

Fetched: December 4th, 2011, 10:00pm MST

Effect of EpCAM, CD44, CD133 and CD166 expression on patient survival in tumours of the ampulla of Vater.

J Clin Pathol. 2011 Nov 30;

Authors: Piscuoglio S, Lehmann FS, Zlobec I, Tornillo L, Dietmaier W, Hartmann A, Wünsch PH, Sessa F, Rümmele P, Baumhoer D, Terracciano LM

Abstract
BackgroundCarcinomas of the Vaterian system are rare and presumably arise from pre-existing adenomas. According to the cancer stem cell (CSC) hypothesis, only a small subset of tumor cells has the ability to initiate and develop tumor growth. In colorectal cancer, CD44, CD133, CD166 and EpCAM have been proposed to represent CSC marker proteins and their expression has been shown to correlate with patient survival.AimsTo evaluate a potential role of these CSC proteins in tumors of the ampulla of Vater, we investigated their expression in 175 carcinoma, 111 adenoma and 152 normal mucosa specimens arranged in a Tissue Microarray format.Materials and methodsMembranous immunoreactivity for each protein marker was scored semi-quantitatively by evaluating the number of positive tumor cells over the total number of tumor cells. Median protein expression levels were used as cut-off scores to define protein marker positivity. Clinical data including survival time were obtained by retrospective analysis of medical records, tumor registries or direct contact.ResultsThe expression of all evaluated marker proteins differed significantly between normal mucosa, adenoma and carcinoma samples. In all markers, we found a tendency towards more constant expression from normal to neoplastic tissue. EpCAM expression was significantly correlated with better patient survival. The increased expression of CD44s, CD166 and CD133 from normal mucosa samples to adenoma and carcinoma was linked to tumor progression. However, there was no statistically significant correlation with survival.ConclusionOur findings indicate, that in ampullary carcinomas, loss of expression of EpCAM may be linked to a more aggressive tumor phenotype.

PMID: 22130902 [PubMed - as supplied by publisher]
An annular pancreas associated with carcinoma of the papilla of Vater: report of a case.

Fetched: November 27th, 2011, 10:00pm MST

An annular pancreas associated with carcinoma of the papilla of Vater: report of a case.

Surg Today. 2011 Nov 25;

Authors: Yazawa N, Imaizumi T, Furukawa D, Matsuyama M, Gunji H, Kato K, Tobita K, Nakagohri T, Makuuchi H, Hirabayashi K, Ogoshi K

Abstract
An annular pancreas is an uncommon congenital anomaly that usually presents early in childhood. Malignancy in the setting of an annular pancreas is unusual. We herein report a case of annular pancreas with carcinoma of the papilla of Vater. A 59-year-old man presented with epigastric discomfort and was referred to us after gastroduodenal endoscopy showed a tumor of the papilla of Vater. Preoperative imaging showed the pancreatic parenchyma encircling the descending duodenum and a tumor at the papilla of Vater. A pancreaticoduodenectomy was performed for the annular pancreas and the ampullary tumor. Histological examination confirmed a complete annular pancreas and carcinoma in situ of the papilla of Vater. We also provide a review of the reported cases of an annular pancreas with periampullary neoplasms and discuss the clinical characteristics of this anomaly.

PMID: 22116396 [PubMed - as supplied by publisher]
Acute recurrent pancreatitis: a possible clinical manifestation of ampullary cancer.

Fetched: November 12th, 2011, 10:00pm MST

Acute recurrent pancreatitis: a possible clinical manifestation of ampullary cancer.

JOP. 2011;12(6):593-7

Authors: Petrou A, Bramis K, Williams T, Papalambros A, Mantonakis E, Felekouras E

Abstract
CONTEXT: Acute recurrent pancreatitis still poses diagnostic difficulties. The coexistence or moreover the causative relationship of carcinoma of the ampulla of Vater and acute recurrent pancreatitis is fairly rare.
CASE REPORT: We present a case of carcinoma of the ampulla of Vater that presented with acute recurrent necrotizing pancreatitis complicated with pseudocysts. A diagnosis of malignancy in the ampulla was only made after several ERCP attempts due to residual inflammation at the periampullary area.
CONCLUSION: Malignancy at the ampulla of Vater causing recurrent episodes of pancreatitis represents a realistic risk and attempts to diagnose the underlying cause should always take into account the possibility of cancer.

PMID: 22072249 [PubMed - in process]
Late onset post renal transplant anaplastic large T-cell lymphoma of peri-ampullary region.

Fetched: November 5th, 2011, 11:00pm MDT

Late onset post renal transplant anaplastic large T-cell lymphoma of peri-ampullary region.

Trop Gastroenterol. 2011 Apr-Jun;32(2):136-8

Authors: Kaul S

PMID: 21922880 [PubMed - indexed for MEDLINE]

Rising Cases of Cancer Trigger Multi-Billion Shilling Investments
AllAfrica.com
By Diana Mwango, 2 February 2012 When Jane Muturi, an ampullary cancer survivor, started itching on a Thursday, little did she know that it would cost her about Sh2.6 million in treatment a year. This is the amount she has spent on three surgeries to ...

and more »

Rising cases of cancer trigger multi-billion shilling investments - Business Daily Africa

Posted: February 2nd, 2012, 9:22am MST

Business Daily Africa

Rising cases of cancer trigger multi-billion shilling investments
Business Daily Africa
PHOTO/ FILE | NATION By DIANA MWANGO (email the author) When Jane Muturi, an ampullary cancer survivor, started itching on a Thursday, little did she know that it would cost her about Sh2.6 million in treatment a year. This is the amount she has spent ...

and more »

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Rare Cancer News & Clinical Trials » Ampulla Of Vater

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Ampulla Of Vater (24 unread)

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