Rare Cancer News & Clinical Trials

Ampulla Of Vater (68 unread)

PubMed - Ampullary Cancer

Approaches and Postoperative Complications of Artery-First Pancreaticoduodenectomy in a Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study

Fetched: September 15th, 2021, 5:00am GMT by Roshan Ghimire

JNMA J Nepal Med Assoc. 2021 Jan 31;59(233):26-30. doi: 10.31729/jnma.5779.

ABSTRACT

INTRODUCTION: Superior mesenteric artery first pancreaticoduodenectomy is being increasingly used for pancreatic head and peri-ampullary tumors. The aim of our study was to determine the frequency of various approaches of superior mesenteric artery pancreaticoduodenectomy along with its postoperative complications in a tertiary care center.

METHODS: This is a descriptive cross-sectional study of patients undergoing superior mesenteric artery first pancreaticoduodenectomy with different approaches conducted at Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal, from May 2018 to April 2020. Ethical approval was taken from the Institutional Review Committee (reference no: 310520193). The whole sampling method was adopted. Thirty-four patients undergoing a superior mesenteric artery first pancreaticoduodenectomy at our center with different approaches were included in the study. The data analysis was done in the Statistical Package for the Social Sciences version 20.

RESULTS: For 34 patients chosen for the study, the male: female ratio was 1.6:1, with a mean age of 53.7 years. The medial uncinate approach was done in the majority of the cases, 26 (76.4%), whereas the inferior infracolic (mesenteric) approach was done in 1 (2.9%) case. Regarding postoperative complications, Clavien Dindo grade 3 and grade 4 were present in 11 (32.3%) patients, pancreatic fistula (Grade B and C) was observed in 6 (17.6%) patients, and mortality occurred in 2 (5.8%). The mean hospital stay was 16±9 days.

CONCLUSIONS: Superior mesenteric artery first pancreaticoduodenectomy with a different approach can be performed with acceptable morbidity and mortality. Early determination of resectibility is achieved in selected cases.

PMID:34508444 | PMC:PMC7893404 | DOI:10.31729/jnma.5779
APC mutations are common in adenomas but infrequent in adenocarcinomas of the non-ampullary duodenum

Fetched: September 14th, 2021, 5:00am GMT by Kenichi Ishizu

J Gastroenterol. 2021 Sep 12. doi: 10.1007/s00535-021-01823-x. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies highlighted the clinicopathological heterogeneity of non-ampullary duodenal adenomas and adenocarcinomas, but the detailed process of the malignant transformation remains unclear.

METHODS: We analyzed 144 adenomas and 54 adenocarcinomas of the non-ampullary duodenum for immunohistochemical phenotypes, genetic alterations, and mismatch repair (MMR) status to probe their histogenetic relationship.

RESULTS: The median ages of patients with adenoma and adenocarcinoma were the same (66 years). Adenomas were histologically classified as intestinal-type adenoma (n = 124), pyloric gland adenoma (PGA, n = 10), gastric-type adenoma, not otherwise specified (n = 9), and foveolar-type adenoma (n = 1). Protein-truncating APC mutations were highly frequent in adenomas (85%), with the highest prevalence in intestinal-type adenomas (89%), but rare in adenocarcinomas (9%; P = 2.1 × 10^-23). Close associations between phenotypic marker expression and genetic alterations were observed in adenomas, but not in adenocarcinomas, excluding the common association between GNAS mutations and MUC5AC expression. MMR deficiency was more frequent in adenocarcinomas (20%) than in adenomas (1%; P = 2.6 × 10^-6). One MMR-deficient adenoma and three MMR-deficient adenocarcinomas occurred in patients with Lynch syndrome. Additionally, three other patients with an MMR-deficient adenocarcinoma fulfilled the revised Bethesda criteria.

CONCLUSION: The discrepant APC mutation frequency between adenomas and adenocarcinomas suggests that APC-mutated adenomas, which constitute the large majority of non-ampullary duodenal adenomas, are less prone to malignant transformation. Non-ampullary duodenal adenocarcinomas frequently exhibit MMR deficiency and should be subject to MMR testing to determine appropriate clinical management, including the identification of patients with Lynch syndrome.

PMID:34514550 | DOI:10.1007/s00535-021-01823-x
The application of underwater EMR for non-ampullary duodenal adenomas

Fetched: September 7th, 2021, 5:00am GMT by Xiu-He Lv

Clin Gastroenterol Hepatol. 2021 Sep 3:S1542-3565(21)00922-8. doi: 10.1016/j.cgh.2021.08.042. Online ahead of print.

NO ABSTRACT

PMID:34487885 | DOI:10.1016/j.cgh.2021.08.042
Treatment of non-ampullary duodenal epithelial tumors: Does phenotype matter?

Fetched: September 2nd, 2021, 5:00am GMT by Yohei Yabuuchi

Endosc Int Open. 2021 Aug 16;9(9):E1303-E1305. doi: 10.1055/a-1495-5101. eCollection 2021 Sep.

NO ABSTRACT

PMID:34466351 | PMC:PMC8367449 | DOI:10.1055/a-1495-5101
Identification and prevalence of potentially therapeutic targetable variants of major cancer driver genes in ampullary cancer patients in India through deep sequencing

Fetched: August 30th, 2021, 5:00am GMT by Shravan Kumar Mishra

Cancer Genet. 2021 Aug 15;258-259:41-48. doi: 10.1016/j.cancergen.2021.08.001. Online ahead of print.

ABSTRACT

Ampulla is a complex region located at the confluence of pancreatic and common bile duct and intestinal epithelium. Tumors arising in this region are anatomically and morphologically heterogenous, however they show unique as well as overlapping molecular features. Cancers of both these anatomic sites share morphological as well as genetic profile despite having few unique differences. Targeted therapies are currently emerging as one of the demanding approaches for treatment in most cancer types especially for malignant epithelial tumors and therefore genetic profiling of cancers is the key for identification of potentially therapeutic targetable mutations to know their prevalence and prognostic impact. We studied 97 resected cases of formalin fixed paraffin-embedded AC by deep targeted sequencing using Ampliseq cancer hotspot panel comprising of 50 oncogenes and tumor suppressor genes. Potentially therapeutic targetable mutations were observed in 58/83 (70%) cases. Fourteen patients did not show any pathogenic mutation. TP53 (48.1%), KRAS (37.3%), APC (25.3%), SMAD4 (22.8%), MET (16.8%), CTNNB1 (15.6%) and PIK3CA (10.8%) were the major mutated potential therapeutic targets. KRAS mutation (43.2 Vs. 32.6%) was more prevalent in pancreatobiliary subtype, while TP53 (58.6 Vs 35.1), APC (36.9 Vs 10.8), SMAD4 (28.2 Vs 16.2), MET (21.7 Vs 10.8) and CTNNB1 (19.5 Vs 10.8) were more prevalent in intestinal subtype. WNT signaling pathway was the major altered pathway in intestinal subtype. These mutated genes and pathways may be targeted with currently available drugs and may be explored for future development of targetable agents to improve the disease course in patients of AC.

PMID:34455261 | DOI:10.1016/j.cancergen.2021.08.001
Clinical and phenotypical characteristics of submucosal invasive carcinoma in non-ampullary duodenal cancer

Fetched: August 29th, 2021, 5:00am GMT by Katsunori Matsueda

PLoS One. 2021 Aug 27;16(8):e0256797. doi: 10.1371/journal.pone.0256797. eCollection 2021.

ABSTRACT

OBJECTIVE: The rare incidence of submucosal invasive non-ampullary duodenal carcinoma has led to scant information in literature; therefore, we compared the clinicopathological features between submucosal invasive carcinoma (SM-Ca), mucosal carcinoma (M-Ca), and advanced carcinoma (Ad-Ca).

MATERIALS: We retrospectively analyzed 165 patients with sporadic non-ampullary duodenal carcinomas (SNADCs) from four institutions between January 2003 and December 2018. The SNADCs were divided to three groups according to histological diagnosis: SM-Ca, M-Ca, and Ad-Ca. The clinicopathological characteristics and mucin phenotypes were compared between groups.

RESULTS: Among the 165 SNADCs, 11 (7%) were classified as SM-Ca, 70 (42%) as M-Ca, and 84 (51%) as Ad-Ca. We found that all SM-Ca (P = 0.013) and most Ad-Ca (P = 0.020) lesions were located on the oral-Vater; however, an almost equal distribution of M-Ca lesions was found between the oral- and anal-Vater. No significant difference was observed between the tumor diameter of M-Ca and SM-Ca; however, 45% (5/11) of SM-Ca were ≤10 mm. A total of 73% (8/11) of SM-Ca were classified as gastric phenotype and no lesions were classified as intestinal phenotype; whereas most M-Ca were classified as intestinal phenotype (67%, 8/12).

CONCLUSIONS: SM-Ca lesions were all located on the oral-Vater and were highly associated with the gastric mucin phenotype, which were different from the features of most M-Ca.

PMID:34449813 | PMC:PMC8396771 | DOI:10.1371/journal.pone.0256797
Establishment of Pancreatobiliary Cancer Zebrafish Avatars for Chemotherapy Screening

Fetched: August 29th, 2021, 5:00am GMT by Mariana Tavares Barroso

Cells. 2021 Aug 13;10(8):2077. doi: 10.3390/cells10082077.

ABSTRACT

BACKGROUND: Cancers of the pancreas and biliary tree remain one of the most aggressive oncological malignancies, with most patients relying on systemic chemotherapy. However, effective biomarkers to predict the best therapy option for each patient are still lacking. In this context, an assay able to evaluate individual responses prior to treatment would be of great value for clinical decisions. Here we aimed to develop such a model using zebrafish xenografts to directly challenge pancreatic cancer cells to the available chemotherapies.

METHODS: Zebrafish xenografts were generated from a Panc-1 cell line to optimize the pancreatic setting. Pancreatic surgical resected samples, without in vitro expansion, were used to establish zebrafish patient-derived xenografts (zAvatars). Upon chemotherapy exposure, zAvatars were analyzed by single-cell confocal microscopy.

RESULTS: We show that Panc-1 zebrafish xenografts are able to reveal tumor responses to both FOLFIRINOX and gemcitabine plus nanoparticle albumin-bound (nab)-paclitaxel in just 4 days. Moreover, we established pancreatic and ampullary zAvatars with patient-derived tumors representative of different histological types.

CONCLUSION: Altogether, we provide a short report showing the feasibility of generating and analyzing with single-cell resolution zAvatars from pancreatic and ampullary cancers, with potential use for future preclinical studies and personalized treatment.

PMID:34440847 | PMC:PMC8393525 | DOI:10.3390/cells10082077
Genome-derived Classification Signature for Ampullary Adenocarcinoma to Improve Clinical Cancer Care

Fetched: August 27th, 2021, 5:00am GMT by Saptarshi Chakraborty

Clin Cancer Res. 2021 Aug 25:clincanres.1906.2021. doi: 10.1158/1078-0432.CCR-21-1906. Online ahead of print.

ABSTRACT

BACKGROUND: The clinical behavior of ampullary adenocarcinoma varies widely. Targeted tumor sequencing may better define biologically distinct subtypes to improve diagnosis and management.

METHODS: The hidden genome algorithm, a multilevel meta-feature regression model, was trained on a prospectively sequenced cohort of 3,411 patients (1,001 pancreatic adenocarcinoma, 165 distal bile duct adenocarcinoma, 2,245 colorectal adenocarcinoma) and subsequently applied to targeted panel DNA sequencing data from ampullary adenocarcinomas. Genomic classification (i.e., colorectal vs. pancreatic) was correlated with standard histological classification (i.e., intestinal [INT] vs. pancreatobiliary [PB]) and clinical outcome.

RESULTS: Colorectal genomic subtype prediction was primarily influenced by mutations in APC and PIK3CA, tumor mutational burden, and DNA mismatch repair (MMR) deficiency signature. Pancreatic genomic subtype prediction was dictated by KRAS gene alterations, particularly KRAS G12D, KRAS G12R, and KRAS G12V. Distal bile duct adenocarcinoma genomic subtype was most influenced by copy number gains in the MDM2 gene. Despite high (73%) concordance between immunomorphologic subtype and genomic category, there was significant genomic heterogeneity within both histologic subtypes. Genomic scores with higher colorectal probability were associated with greater survival compared to those with a higher pancreatic probability.

CONCLUSIONS: The genomic classifier provides insight into the heterogeneity of ampullary adenocarcinoma and improves stratification, which is dictated by the proportion of colorectal and pancreatic genomic alterations. This approach is reproducible with available molecular testing and obviates subjective histologic interpretation.

PMID:34433650 | DOI:10.1158/1078-0432.CCR-21-1906
Mixed adenoneuroendocrine carcinomas of stomach and ampulla of vater after curative-intent resection: a single center cases series

Fetched: August 27th, 2021, 5:00am GMT by Sishu Yang

BMC Gastroenterol. 2021 Aug 25;21(1):329. doi: 10.1186/s12876-021-01909-z.

ABSTRACT

BACKGROUND: Mixed adenoneuroendocrine carcinoma is a rare clinical manifestation, especially in the gastric and ampullary. The purpose of this study was to investigate the clinicopathological features and prognosis of mixed adenoneuroendocrine carcinoma in the gastric and ampullary and summarize related treatment suggestions.

METHODS: In all, 32 cases of mixed adenoneuroendocrine carcinoma in the gastric and ampullary that were diagnosed from resected specimens were analyzed from 2009 to 2015. The corresponding demographic, clinicopathological and survival data were retrospectively reviewed.

RESULTS: The 1-year, 3-year and 5-year survival rates were 78.1%, 28.1 and 9.4%, respectively, and the median overall survival was 28.0 months. In all, 75.0% (24/32) had lymph node metastasis at the time of initial diagnosis. A multivariate analysis revealed that TNM stage (HR 6.444 95%CI 1.477-28.121 P = 0.013), lymph nodes metastasis (HR10.617 95%CI 1.409-79.997 P = 0.022), vascular invasion (HR 5.855 95%CI 1.719-19.940 P = 0.005), grade of the adenocarcinoma component (HR 3.876 95%CI 1.451-10.357 P = 0.007) and CD56 positivity (HR 0.265 95%CI 0.100-0.705 P = 0.008) were independent predictors of overall survival.

CONCLUSIONS: Mixed adenoneuroendocrine carcinoma is an aggressive clinical entity with a poor prognosis. Taking both the neuroendocrine component and the adenocarcinoma component into consideration of optimal treatment is strongly recommended.

PMID:34433421 | PMC:PMC8390255 | DOI:10.1186/s12876-021-01909-z
Preoperative diagnostics in periampullary adenocarcinomas

Fetched: August 27th, 2021, 5:00am GMT by Ulrich Friedrich Wellner

Chirurg. 2021 Sep;92(9):771-775. doi: 10.1007/s00104-021-01452-3. Epub 2021 Jul 15.

ABSTRACT

BACKGROUND: Approximately 30-40% of pancreatoduodenectomies for adenocarcinomas result in nonpancreatic periampullary adenocarcinoma as the final diagnosis. Depending on the origin, a distinction is made between four different carcinomas with histomorphological subtypes.

OBJECTIVE: Carcinoma location and subtype are of prognostic and therapeutic relevance; however, the preoperative differentiation is often incorrect despite modern diagnostics.

MATERIAL AND METHODS: Overview of the current literature on the classification and preoperative diagnostics of periampullary adenocarcinomas.

RESULTS: A precise knowledge of the papillary anatomy is necessary for the correct classification of diagnostic findings. Current studies demonstrate diagnostically valuable information from the anamnesis, imaging and endoscopy.

CONCLUSION: In ca. 70-80% of cases a correct diagnosis of the type of periampullary adenocarcinoma is possible on the basis of interdisciplinary diagnostics. This potentially enables a correspondingly individualized treatment planning in the preoperative phase.

PMID:34264368 | DOI:10.1007/s00104-021-01452-3
Multimodal treatment of periampullary carcinoma

Fetched: August 27th, 2021, 5:00am GMT by Timm M Reißig

Chirurg. 2021 Sep;92(9):803-808. doi: 10.1007/s00104-021-01454-1. Epub 2021 Jul 6.

ABSTRACT

Ampullary carcinoma is a rare malignant neoplasm and arises in the region of Vater's ampulla. The differentiation from pancreatic and distal cholangiocarcinoma can be difficult. The prognosis is more favorable than for pancreatic ductal adenocarcinoma but recurrences are frequent. An exact diagnostic clarification and differentiation from pancreatic carcinoma is therefore essential. Although the resection of periampullary carcinoma is established, prospectively controlled studies on the role of multimodal treatment are rare. Adjuvant chemotherapy is oriented to the protocols for pancreatic carcinoma and could be of benefit in lymph node metastases, advanced T stage and low differentiation of tumors. Intestinal and pancreatobiliary subtypes can be differentiated histologically, which is relevant for systemic treatment strategies. Patients with pancreatobiliary differentiated tumors in particular could benefit from gemcitabine-based treatment but insufficient evidence exists for chemoradiotherapy. The role of neoadjuvant and perioperative treatment strategies is currently unclear. Molecular characterization can help to identify familial risk constellations and targeted treatment strategies for this rare tumor entity.

PMID:34228145 | DOI:10.1007/s00104-021-01454-1
Laparoscopic versus open pancreatoduodenectomy for pancreatic or peri-ampullary tumours - Authors' reply

Fetched: August 25th, 2021, 5:00am GMT by Min Wang

Lancet Gastroenterol Hepatol. 2021 Sep;6(9):689-690. doi: 10.1016/S2468-1253(21)00258-2.

NO ABSTRACT

PMID:34391520 | DOI:10.1016/S2468-1253(21)00258-2
Proposal of a new T-stage classification system for ampullary carcinoma based on surveillance, epidemiology and end result (SEER) database

Fetched: August 22nd, 2021, 5:00am GMT by Shi-Jie Wang

Hepatobiliary Pancreat Dis Int. 2021 Aug 10:S1499-3872(21)00153-3. doi: 10.1016/j.hbpd.2021.07.009. Online ahead of print.

ABSTRACT

BACKGROUND: Tumor size is still considered a useful prognostic factor in currently available tumor-node-metastasis (TNM) classification staging systems for most solid tumors, but the significance of tumor size on the prognosis of ampullary carcinoma remains controversial. The aim of the current study was to propose a new T-stage classification system for ampullary carcinoma to address the impact of tumor size on the prognostic outcome.

METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 1080 patients with ampullary carcinoma who underwent radical surgical resection between 2004 and 2015. Based on the results obtained from analysis of various clinicopathologic factors, a new T-stage classification system was proposed.

RESULTS: Among the 1080 patients, 618 were men and 462 were women, with a median tumor size of 2.3 (range 0.1-12) cm. Using the 7th edition of the American Joint Committee on Cancer (AJCC) staging manual, we noticed significant differences in overall survival (OS) between T2 vs. T3 tumors (P < 0.001) and T3 vs. T4 tumors (P = 0.002), but failed to observe significant differences between T1 vs. T2 tumors (P = 0.498) in our pair-wise comparison. Using the newly developed T-stage classification system, we were able to differentiate significant differences in OS between T1 vs. T2 tumors (P = 0.032), T2 vs. T3 tumors (P < 0.001) and T3 vs. T4 tumor (P = 0.003) in all pair-wise comparisons. The c-index of the new staging system was 0.653 (95% CI: 0.629-0.677), showing a better discriminatory power than the 0.636 of the 7th AJCC staging system (95% CI: 0.612-0.660).

CONCLUSIONS: The new T-stage classification system described herein can better differentiate prognostic outcomes after radical resection in patients with ampullary carcinoma by incorporating tumor size and depth of tumor infiltration.

PMID:34417142 | DOI:10.1016/j.hbpd.2021.07.009
Laparoscopic versus open pancreatoduodenectomy for pancreatic or peri-ampullary tumours

Fetched: August 16th, 2021, 5:00am GMT by Jony van Hilst

Lancet Gastroenterol Hepatol. 2021 Sep;6(9):688-689. doi: 10.1016/S2468-1253(21)00227-2.

NO ABSTRACT

PMID:34391519 | DOI:10.1016/S2468-1253(21)00227-2
Transduodenal surgical ampullectomy for intra-ampullary papillary tubular neoplasm (IAPN): A case report

Fetched: August 15th, 2021, 5:00am GMT by Susan Pradhan

Int J Surg Case Rep. 2021 Sep;86:106253. doi: 10.1016/j.ijscr.2021.106253. Epub 2021 Aug 1.

ABSTRACT

INTRODUCTION AND IMPORTANCE: Intra-ampullary papillary tubular neoplasms (IAPNs) are relatively rare kind of neoplasms occurring in the region of the papilla which exhibit significant malignant transformation. The patient was concerned about his pain and the possibility of malignancy.

CASE PRESENTATION: We report a case of a 47-year-old male who presented with persistent upper abdomen pain. Following detail investigations, he was diagnosed as IAPN and managed by transduonal ampullectomy (TDA).

CLINICAL DISCUSSION: The insidious onset of IAPN along with its high risk of malignancy makes it mandatory for its proper treatment. Although, endoscopic approach is advantageous for initial therapy, it has some technical difficulties. Hence TDA forms the cornerstone in the management of IAPN with good prognosis.

CONCLUSION: Transduodenal ampullectomy is a safe and feasible option for IAPN. It can be the first choice of treatment in selected cases where endoscopic papillectomy is not available.

PMID:34388591 | PMC:PMC8363816 | DOI:10.1016/j.ijscr.2021.106253

Google - Ampullary Cancer

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Mixed adenoneuroendocrine carcinomas of stomach and ampulla of vater after curative-intent resection: a single center cases series - DocWire News

Posted: September 3rd, 2021, 9:02am GMT

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Posted: May 29th, 2018, 5:00am GMT

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No Benefit From Adjuvant Therapy for Ampullary Tumors - Medscape

Posted: April 3rd, 2018, 5:00am GMT

No Benefit From Adjuvant Therapy for Ampullary Tumors Medscape
Diet and Nutrition - Pancreatic Cancer Action Network

Posted: February 22nd, 2018, 4:16pm GMT

Diet and Nutrition Pancreatic Cancer Action Network
Pancreatic cancer is often deadly, but new discoveries are raising hope - STAT

Posted: November 16th, 2017, 6:00am GMT

Pancreatic cancer is often deadly, but new discoveries are raising hope STAT
Cancer, redefined - Chemical & Engineering News

Posted: July 3rd, 2017, 5:00am GMT

Cancer, redefined Chemical & Engineering News
Cancer Drug Proves to Be Effective Against Multiple Tumors - The New York Times

Posted: June 8th, 2017, 5:00am GMT

Cancer Drug Proves to Be Effective Against Multiple Tumors The New York Times
Sequencing of 279 cancer genes in ampullary carcinoma reveals trends relating to histologic subtypes and frequent amplification and overexpression of ERBB2 (HER2) | Modern Pathology - Nature.com

Posted: May 15th, 2015, 5:00am GMT

Sequencing of 279 cancer genes in ampullary carcinoma reveals trends relating to histologic subtypes and frequent amplification and overexpression of ERBB2 (HER2) | Modern Pathology Nature.com
Actress Karen Black Dies Of Ampullary Cancer At Age 74, Was Bed-Bound And Lost Leg Function Before Death - Medical Daily

Posted: August 9th, 2013, 5:00am GMT

Actress Karen Black Dies Of Ampullary Cancer At Age 74, Was Bed-Bound And Lost Leg Function Before Death Medical Daily
Actress Karen Black Dies Of Ampullary Cancer At Age 74, Was Bed-Bound And Lost Leg Function Before Death - Medical Daily

Posted: August 9th, 2013, 5:00am GMT
1. Actress Karen Black Dies Of Ampullary Cancer At Age 74, Was Bed-Bound And Lost Leg Function Before Death Medical Daily
2. Easy Rider and Five Easy Pieces actress Karen Black dies from cancer The Independent
3. 'Five Easy Pieces' Actress Karen Black Dies at 74 Hollywood Reporter
4. Actress Karen Black dies at age 74 euronews
5. Actress Karen Black Dead at 74 Vulture
6. View Full Coverage on Google News
Karen Black’s Cancer Fight On Crowdfunding - Deadline.com

Posted: March 26th, 2013, 5:00am GMT

Karen Black’s Cancer Fight On Crowdfunding Deadline.com

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