Clinicopathological features of superficial non-ampurally duodenal epithelial tumor; gastric phenotype of histology correlates to higher malignant potency.

Abstract

Superficial non-ampullary duodenal epithelial tumors (SNADETs) are relatively rare, but they are now being detected more frequently due to advances in endoscopic technology. Nevertheless, the pathological nature of SNADETs remains unclear and a management strategy for these tumors has not been established. To elucidate the clinicopathological features, we conducted a retrospective analysis of 138 endoscopically resected SNADETs. Lesions were classified into two groups by histological grade according to the Vienna classification: category 3 (71 lesions, 51.4%) and category 4/5 (67 lesions, 48.6%). Compared with category 3 lesions, category 4/5 lesions were significantly more common in elderly patients (p<0.001) and had a significantly larger tumor diameter (p=0.001). Immunohistochemical analysis showed that category 4/5 lesions expressed MUC5AC (p=0.002), MUC6 (p<0.001), and p53 (p=0.003) significantly more frequently and expressed CD10 (p=0.002) and CDX2 (p=0.029) significantly less frequently. Multivariate regression analysis showed that advanced age (p<0.001), MUC6 expression (p=0.001), and p53 expression (p=0.004) were independent risk factors for a classification of category 4/5. In addition, advanced age (p=0.010) and MUC5AC expression (p=0.011) were identified as risk factors for lesions classified as category 4.2 (noninvasive carcinoma) or higher. All category 5 lesions expressed MUC5AC. The gastric phenotype of MUC5AC and MUC6 may be linked to the malignant potential of SNADETs.