Skip to main content

Advertisement

SpringerLink
Log in

Clinicopathological features and risk factors for lymph node metastasis in early-stage non-ampullary duodenal adenocarcinoma

  • Original Article—Alimentary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Management strategies for primary non-ampullary duodenal adenocarcinoma (NADAC) in early stage are not well established given its low incidence. This study aimed to elucidate clinicopathological features of early NADAC, including risk for lymph nodal metastasis (LNM).

Methods

In total, 166 patients with early NADAC underwent initial treatment at our institution between 2006 and 2019, of whom 153 had intramucosal (M-) and 13 had submucosal (SM-) NADAC. These endoscopic and pathological features were retrospectively analyzed. Risk factors for LNM were evaluated in 46 early NADAC patients who underwent surgery with lymph node dissection.

Results

Compared with M-NADAC, SM-NADAC was significantly more frequently located at the proximal side of the papilla, with mixed elevated and depressed macroscopic type, histologically poorly differentiated tumor and lymphovascular invasion (LVI) (85% vs. 47%, P = 0.009; 54% vs. 5%, P < 0.001; 23% vs. 0%, P < 0.001; and 46% vs. 0%, P < 0.001, respectively). The frequency of LNM was significantly higher in SM-NADAC than in M-NADAC (5/12, 42% vs. 0/34, 0%; P < 0.001). In SM-NADAC, the frequency of LNM was higher in poorly differentiated than in well to moderately differentiated tumors (3/3, 100% vs. 2/9, 22%) and higher in tumors with LVI than in those without LVI (3/5, 60% vs. 2/7, 29%). Regarding invasion depth, 2 of 4 patients with SM invasion (400 ≤ × < 500 µm) showed LNM. However, in this study, no patients developed very shallow SM invasion (0 < × < 400 µm).

Conclusions

SM-NADAC showed high LNM risk. Surgical treatment with regional lymph node dissection is recommended as a treatment strategy for SM-NADAC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Darling RC, Welch CE. Tumors of the small intestine. N Engl J Med. 1959;260:397–408.

    Article  CAS  Google Scholar 

  2. Hoffman BP, Grayzel DM. Benign tumors of the duodenum. Am J Surg. 1945;70:394–400.

    Article  CAS  Google Scholar 

  3. Shukla SK, Elias EG. Primary neoplasms of the duodenum. Surg Gynecol Obstet. 1976;142:858–60.

    CAS  PubMed  Google Scholar 

  4. Alwmark A, Andersson A, Lasson A. Primary carcinoma of the duodenum. Ann Surg. 1980;191:13–8.

    Article  CAS  Google Scholar 

  5. LH Sobin MK Gospodarowicz C Wittekind eds. TNM classification of malignant tumours. John Wiley and Sons, 2011.

  6. Sakamoto T, Saiura A, Ono Y, et al. Optimal lymphadenectomy for duodenal adenocarcinoma: does the number alone matter? Ann Surg Oncol. 2017;24:3368–75.

    Article  Google Scholar 

  7. Nagatani K, Takekoshi T, Baba Y, et al. Indications for endoscopic treatment of early duodenal cancer based on cases reported in the literature (in Japanese). Endosc Digest. 1993;5:969–76.

    Google Scholar 

  8. Jurisić D, Doko M, Glavan E, et al. Local recurrence of primary non-ampullary adenocarcinoma of duodenum after surgical treatment–a case report and a literature review. Coll Antropol. 2006;30:225–9.

    PubMed  Google Scholar 

  9. Scott-Coombes DM, Williamson RC. Surgical treatment of primary duodenal carcinoma: a personal series. Br J Surg. 1994;81:1472–4.

    Article  CAS  Google Scholar 

  10. Han SL, Cheng J, Zhou HZ, et al. The surgical treatment and outcome for primary duodenal adenocarcinoma. J Gastrointest Cancer. 2010;41:243–7.

    Article  Google Scholar 

  11. Abdelfatah MM, Barakat M, Lee H, et al. The incidence of lymph node metastasis in early gastric cancer according to the expanded criteria in comparison with the absolute criteria of the Japanese Gastric Cancer Association: a systematic review of the literature and meta-analysis. Gastrointest Endosc. 2018;87:338–47.

    Article  Google Scholar 

  12. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.

    Article  Google Scholar 

  13. Sekiguchi M, Oda I, Taniguchi H, et al. Risk stratification and predictive risk-scoring model for lymph node metastasis in early gastric cancer. J Gastroenterol. 2016;51:961–70.

    Article  CAS  Google Scholar 

  14. Association JGC. Japanese gastric cancer treatment guidelines 2010. Gastric Cancer. 2011;14(2):113–23.

    Article  Google Scholar 

  15. Beaton C, Twine CP, Williams GL, et al. Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis. 2013;15:788–97.

    Article  CAS  Google Scholar 

  16. Bosch SL, Teerenstra S, de Wilt JH, et al. Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions. Endoscopy. 2013;45:827–34.

    Article  Google Scholar 

  17. Watanabe T, Muro K, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2018;23:1–34.

    Article  Google Scholar 

  18. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(6 Suppl):S3–43.

  19. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumors of the digestive system. 4th ed. Lyon: IARC; 2010.

    Google Scholar 

  20. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English eds. Gastric Cancer. 14:101–12.

  21. Ushiku T, Arnason T, Fukayama M, et al. Extra-ampullary duodenal adenocarcinoma. Am J Surg Pathol. 2014;38:1484–93.

    Article  Google Scholar 

  22. Park DY, Srivastava A, Kim GH, et al. Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia. Am J Surg Pathol. 2008;32:524–33.

    Article  Google Scholar 

  23. Minatsuki C, Yamamichi N, Inada KI, et al. Expression of gastric markers is associated with malignant potential of nonampullary duodenal adenocarcinoma. Dig Dis Sci. 2018;63:2617–25.

    Article  CAS  Google Scholar 

  24. Niwa A, Kuwano S, Tomita H, et al. The different pathogeneses of sporadic adenoma and adenocarcinoma in non-ampullary lesions of the proximal and distal duodenum. Oncotarget. 2017;8:41078–90.

    Article  Google Scholar 

  25. Kushima R, Stolte M, Dirks K, et al. Gastric-type adenocarcinoma of the duodenal second portion histogenetically associated with hyperplasia and gastric-foveolar metaplasia of Brunner’s glands. Virchows Arch. 2002;440:655–9.

    Article  Google Scholar 

  26. Kushima R, Rüthlein HJ, Stolte M, et al. ‘Pyloric gland-type adenoma’ arising in heterotopic gastric mucosa of the duodenum, with dysplastic progression of the gastric type. Virchows Arch. 1999;435:452–7.

    Article  CAS  Google Scholar 

  27. Toba T, Inoshita N, Kaise M, et al. Clinicopathological features of superficial non-ampurally duodenal epithelial tumor; gastric phenotype of histology correlates to higher malignant potency. J Gastroenterol. 2018;53:64–70.

    Article  Google Scholar 

  28. Hida R, Yamamoto H, Hirahashi M, et al. Duodenal neoplasms of gastric phenotype: an immunohistochemical and genetic study with a practical approach to the classification. Am J Surg Pathol. 2017;41:343–53.

    Article  Google Scholar 

Download references

Funding

None declared.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Shoichi Yoshimizu, Yusuke Horiuchi, Akiyoshi Ishiyama, Tomohiro Tsuchida, Toshiyuki Yoshio, Toshiaki Hirasawa & Junko Fujisaki

  2. Department of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Hiroshi Kawachi & Kaoru Nakano

  3. Division of Gastroenterology, Endoscopy Center, Showa University Fujigaoka Hospital, Yokohama, Japan

    Yorimasa Yamamoto

  4. Department of Hepatobiliary and Pancreatic Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Hiromichi Ito

Authors
  1. Shoichi Yoshimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Kawachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yorimasa Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kaoru Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yusuke Horiuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akiyoshi Ishiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomohiro Tsuchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Toshiyuki Yoshio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toshiaki Hirasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiromichi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Junko Fujisaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SY: conception and design; analysis and interpretation of the data; drafting of the article. HK: conception and design; analysis and interpretation of the data; drafting of the article. YY: critical revision of the article for important intellectual content. KN: critical revision of the article for important intellectual content. YH: critical revision of the article for important intellectual content. AI: critical revision of the article for important intellectual content. TT: critical revision of the article for important intellectual content. TH: critical revision of the article for important intellectual content. HI: critical revision of the article for important intellectual content. JF: critical revision of the article for important intellectual content; final approval of the article.

Corresponding author

Correspondence to Hiroshi Kawachi.

Ethics declarations

Conflict of interest

None declared.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshimizu, S., Kawachi, H., Yamamoto, Y. et al. Clinicopathological features and risk factors for lymph node metastasis in early-stage non-ampullary duodenal adenocarcinoma. J Gastroenterol 55, 754–762 (2020). https://doi.org/10.1007/s00535-020-01696-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-020-01696-6

Keywords

Search

Navigation