TY - JOUR
T1 - Recognition and pathological features of periampullary region adenocarcinoma with an indeterminable origin
AU - Komine, Ryuji
AU - Kojima, Motohiro
AU - Ishi, Genichiro
AU - Kudo, Masashi
AU - Sugimoto, Motokazu
AU - Kobayashi, Shin
AU - Takahashi, Shinichiro
AU - Konishi, Masaru
AU - Kobayashi, Tatsushi
AU - Akimoto, Tetsuo
AU - Murakami, Ayumi
AU - Sasaki, Motoko
AU - Tanaka, Mariko
AU - Matsuzaki, Akiko
AU - Ohike, Nobuyuki
AU - Uchida, Katsunori
AU - Sugiyama, Tomoko
AU - Hirabayashi, Kenichi
AU - Tajiri, Takuma
AU - Ishida, Kazuyuki
AU - Kai, Keita
AU - Omori, Yuko
AU - Notohara, Kenji
AU - Yamaguchi, Hiroshi
AU - Matsuda, Yoko
AU - Naito, Yoshiki
AU - Fukumura, Yuki
AU - Hamada, Yoshihiro
AU - Mihara, Yumi
AU - Masugi, Yohei
AU - Gotohda, Naoto
AU - Harada, Kenichi
AU - Fukushima, Noriyoshi
AU - Furukawa, Toru
N1 - Funding Information:
This work was supported by JPSS KAKENHI Grant Number 18007279.
Publisher Copyright:
© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
PY - 2021/6
Y1 - 2021/6
N2 - Determination of the primary tumor in periampullary region carcinomas can be difficult, and the pathological assessment and clinicopathological characteristics remain elusive. In this study, we investigated the current recognition and practices for periampullary region adenocarcinoma with an indeterminable origin among expert pathologists through a cognitive survey. Simultaneously, we analyzed a prospective collection of cases with an indeterminable primary tumor diagnosed from 2008 to 2018 to elucidate their clinicopathological features. All cases with pathological indeterminable primary tumors were reported and discussed in a clinicopathological conference to elucidate if it was possible to distinguish the primary tumor clinically and pathologically. From the cognitive survey, over 85% of the pathologists had experienced cases with indeterminable primary tumors; however, 70% of the cases was reported as pancreatic cancer without definitive grounds. Interpretation of the main tumor mass varied, and no standardized method was developed to determine the primary tumor. During a prospective study, 42 of the 392 periampullary carcinoma cases (10.7%) were considered as tumors with a pathological indeterminable origin. After the clinicopathological conferences, 21 (5.4%) remained indeterminable and were considered final indeterminable cases. Histological studies showed that the tumors spread along both the bile duct and main pancreatic duct; this was the most representative finding of the final indeterminable cases. This study is the first to elucidate and recognize the current clinicopathological features of periampullary region adenocarcinomas with an indeterminable origin. Adequate assessment of primary tumors in periampullary region carcinomas will help to optimize epidemiological data of pancreatic and bile duct cancer.
AB - Determination of the primary tumor in periampullary region carcinomas can be difficult, and the pathological assessment and clinicopathological characteristics remain elusive. In this study, we investigated the current recognition and practices for periampullary region adenocarcinoma with an indeterminable origin among expert pathologists through a cognitive survey. Simultaneously, we analyzed a prospective collection of cases with an indeterminable primary tumor diagnosed from 2008 to 2018 to elucidate their clinicopathological features. All cases with pathological indeterminable primary tumors were reported and discussed in a clinicopathological conference to elucidate if it was possible to distinguish the primary tumor clinically and pathologically. From the cognitive survey, over 85% of the pathologists had experienced cases with indeterminable primary tumors; however, 70% of the cases was reported as pancreatic cancer without definitive grounds. Interpretation of the main tumor mass varied, and no standardized method was developed to determine the primary tumor. During a prospective study, 42 of the 392 periampullary carcinoma cases (10.7%) were considered as tumors with a pathological indeterminable origin. After the clinicopathological conferences, 21 (5.4%) remained indeterminable and were considered final indeterminable cases. Histological studies showed that the tumors spread along both the bile duct and main pancreatic duct; this was the most representative finding of the final indeterminable cases. This study is the first to elucidate and recognize the current clinicopathological features of periampullary region adenocarcinomas with an indeterminable origin. Adequate assessment of primary tumors in periampullary region carcinomas will help to optimize epidemiological data of pancreatic and bile duct cancer.
KW - ampulla of Vater carcinoma
KW - distal bile duct carcinoma
KW - indeterminable tumor primary
KW - pancreatic ductal adenocarcinoma
KW - periampullary region
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U2 - 10.1002/cam4.3809
DO - 10.1002/cam4.3809
M3 - Article
C2 - 34008914
AN - SCOPUS:85105935980
VL - 10
SP - 3499
EP - 3510
JO - Cancer Medicine
JF - Cancer Medicine
SN - 2045-7634
IS - 11
ER -