Intra-ampullary papillary tubular neoplasm (IAPN): Clinicopathologic analysis of 72 cases highlights the distinctive characteristics of a poorly recognized entity Journal Article
| Authors: | Tarcan, Z. C.; Esmer, R.; Akar, K. E.; Bagci, P.; Bozkurtlar, E.; Saka, B.; Armutlu, A.; Sahin Ozkan, H.; Ozcan, K.; Taskin, O. C.; Kapran, Y.; Aydin Mericoz, C.; Balci, S.; Yilmaz, S.; Cengiz, D.; Gurses, B.; Alper, E.; Tellioglu, G.; Bozkurt, E.; Bilge, O.; Cheng, J. D.; Basturk, O.; Adsay, N. V. |
| Article Title: | Intra-ampullary papillary tubular neoplasm (IAPN): Clinicopathologic analysis of 72 cases highlights the distinctive characteristics of a poorly recognized entity |
| Abstract: | The guidelines recently recognized the intra-ampullary papillary tubular neoplasm (IAPN) as a distinct tumor entity. However, the data on IAPN and its distinction from other ampullary tumors remain limited. A detailed clinicopathologic analysis of 72 previously unpublished IAPNs was performed. The patients were: male/female=1.8; mean age=67 years (range: 42 to 86 y); mean size=2.3 cm. Gross-microscopic correlation was crucial. From the duodenal perspective, the ampulla was typically raised symmetrically, with a patulous orifice, and was otherwise covered by stretched normal duodenal mucosa. However, in 6 cases, the protrusion of the intra-ampullary tumor to the duodenal surface gave the impression of an "ampullary-duodenal tumor," with the accurate diagnosis of IAPN established only by microscopic correlation illustrating the abrupt ending of the lesion at the edge of the ampulla. Microscopically, the preinvasive component often revealed mixed phenotypes (44.4% predominantly nonintestinal). The invasion was common (94%), typically small (mean=1.2 cm), primarily pancreatobiliary-type (75%), and showed aggressive features (lymphovascular invasion in 66%, perineural invasion in 41%, high budding in 30%). In 6 cases, the preinvasive component was pure intestinal, but the invasive component was pancreatobiliary. LN metastasis was identified in 42% (32% in those with ≤1 cm invasion). The prognosis was significantly better than ampullary-ductal carcinomas (median: 69 vs. 41 months; 3-year: 68% vs. 55%; and 5-year: 51% vs. 35%, P=0.047). In conclusion, unlike ampullary-duodenal carcinomas, IAPNs are often (44.4%) predominantly nonintestinal and commonly (94%) invasive, displaying aggressive features and LN metastasis even when minimally invasive, all of which render them less amenable to ampullectomy. However, their prognosis is still better than that of the "ampullary-ductal" carcinomas, with which IAPNs are currently grouped in CAP protocols (while IAPNs are kindreds of intraductal tumors of the pancreatobiliary tract, the latter represents the ampullary counterpart of pancreatic adenocarcinoma/cholangiocarcinoma). © 2024 Wolters Kluwer Health. All rights reserved. |
| Keywords: | adult; cancer chemotherapy; cancer survival; controlled study; human tissue; aged; aged, 80 and over; middle aged; survival rate; major clinical study; clinical feature; histopathology; mortality; microscopy; cancer growth; cancer adjuvant therapy; cancer staging; follow up; lymph node metastasis; pancreaticoduodenectomy; phenotype; tumor volume; carcinoma, papillary; practice guideline; pathology; retrospective study; medical record; tumor cell; pancreas adenocarcinoma; surgery; cancer registry; immunophenotyping; invasive carcinoma; neoplasm invasiveness; bile duct carcinoma; papillary carcinoma; adjuvant radiotherapy; radiodiagnosis; signet ring carcinoma; perineural invasion; neuroendocrine carcinoma; medullary carcinoma; vater papilla carcinoma; surgical margin; bile duct tumor; ampulla of vater; common bile duct neoplasms; clinical outcome; demographics; ampulla; tumor invasion; tumor budding; ampullectomy; duodenal neoplasms; cancer prognosis; lymph vessel metastasis; very elderly; humans; human; male; female; article; duodenum carcinoma; duodenum tumor; poorly differentiated carcinoma; duodenum mucosa; neoplasms by histologic type; pancreatobiliary cancer; iapn; intra ampullary papillary tubular neoplasm; ampullary cancer; ampullary ductal carcinoma; intraductal papillary mucinous carcinoma; poorly cohesive carcinoma |
| Journal Title: | American Journal of Surgical Pathology |
| Volume: | 48 |
| Issue: | 9 |
| ISSN: | 0147-5185 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2024-09-01 |
| Start Page: | 1093 |
| End Page: | 1107 |
| Language: | English |
| DOI: | 10.1097/pas.0000000000002275 |
| PUBMED: | 38938087 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Source: Scopus |
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