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World Journal of Gastroenterology Jan 2016Duodenal polyps or lesions are uncommonly found on upper endoscopy. Duodenal lesions can be categorized as subepithelial or mucosally-based, and the type of lesion often... (Review)
Review
Duodenal polyps or lesions are uncommonly found on upper endoscopy. Duodenal lesions can be categorized as subepithelial or mucosally-based, and the type of lesion often dictates the work-up and possible therapeutic options. Subepithelial lesions that can arise in the duodenum include lipomas, gastrointestinal stromal tumors, and carcinoids. Endoscopic ultrasonography with fine needle aspiration is useful in the characterization and diagnosis of subepithelial lesions. Duodenal gastrointestinal stromal tumors and large or multifocal carcinoids are best managed by surgical resection. Brunner's gland tumors, solitary Peutz-Jeghers polyps, and non-ampullary and ampullary adenomas are mucosally-based duodenal lesions, which can require removal and are typically amenable to endoscopic resection. Several anatomic characteristics of the duodenum make endoscopic resection of duodenal lesions challenging. However, advanced endoscopic techniques exist that enable the resection of large mucosally-based duodenal lesions. Endoscopic papillectomy is not without risk, but this procedure can effectively resect ampullary adenomas and allows patients to avoid surgery, which typically involves pancreaticoduodenectomy. Endoscopic mucosal resection and its variations (such as cap-assisted, cap-band-assisted, and underwater techniques) enable the safe and effective resection of most duodenal adenomas. Endoscopic submucosal dissection is possible but very difficult to safely perform in the duodenum.
Topics: Adenomatous Polyps; Ampulla of Vater; Biopsy; Cholangiopancreatography, Endoscopic Retrograde; Duodenal Neoplasms; Duodenoscopes; Duodenoscopy; Endosonography; Equipment Design; Female; Humans; Intestinal Mucosa; Intestinal Polyps; Male; Middle Aged; Postoperative Complications; Sphincterotomy, Endoscopic; Treatment Outcome
PubMed: 26811610
DOI: 10.3748/wjg.v22.i2.600 -
Journal of Translational Internal... Sep 2023The surface of the small bowel mucosa is covered more than any other section of the digestive canal; however, the overall prevalence of small bowel tumors of the whole...
The surface of the small bowel mucosa is covered more than any other section of the digestive canal; however, the overall prevalence of small bowel tumors of the whole gastrointestinal tract is evidently low. Owing to the improvement in endoscopic techniques, the prevalence of small bowel tumors has increased across multiple countries, which is mainly due to an increase in duodenal tumors. Superficial non-ampullary duodenal epithelial tumors (SNADETs) are defined as tumors originating from the non-ampullary region in the duodenum that share similarities and discrepancies with their gastric and colorectal counterparts in the pathogenesis and clinicopathologic characteristics. To date, white light endoscopy (WLE) remains the cornerstone of endoscopic diagnosis for SNADETs. Besides, narrow-band imaging (NBI) techniques and magnifying endoscopy (ME) have been widely used in the clinic and endorsed by multiple guidelines and consensuses for SNADETs' evaluation. Confocal laser endomicroscopy (CLE), endocytoscopy (ECS), and artificial intelligence (AI) are also up-and-coming methods, showing an exceptional value in the diagnosis of SNADETs. Similar to the endoscopic treatment for colorectal polyps, the choices for SNADETs mainly include cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and laparoscopic endoscopic cooperative surgery (LECS). However, owing to the narrow lumen, rich vascularity, weak muscle layer, abundant Brunner's gland, and the hardship of endoscope control, the duodenum ranks as one of the most dangerous operating areas in the digestive tract. Therefore, endoscopists must anticipate the difficulties in endoscopic maneuverability, remain aware of the increased risk of complications, and then select the appropriate treatment according to the advantages and disadvantages of each method.
PubMed: 37662895
DOI: 10.2478/jtim-2023-0102 -
Folia Morphologica 2022The present investigation was prepared to describe the accessory sex glands of the Barki bucks grossly and by light microscopy.
BACKGROUND
The present investigation was prepared to describe the accessory sex glands of the Barki bucks grossly and by light microscopy.
MATERIALS AND METHODS
There are four sex glands: ampullary, vesicular, prostate, and bulbourethral. The ampullary gland is an enlargement of the terminal part of the ductus deferens, its glandular part has branched tubuloalveolar glands, and its secretory alveoli lined with a pseudo-stratified epithelium composed of cuboidal to columnar cells. The vesicular gland takes the appearance of a cluster of grapes and the left vesicular gland is enlarged and higher than the right one. The vesicular gland is a lobulated tubuloalveolar gland with wide intralobular space and the gland contain a secretory unit which lined by pseudo-stratified columnar epithelium, and the interlobular ductules lined by the stratified epithelium, while the interlobular duct lined by simple cuboidal epithelium; moreover, the lining epithelium of secretory part consists of tall columnar cells. The prostate gland consists only of the disseminated part and is enclosed by a connective tissue capsule that was thin dorsally, thick laterally, and reduced in thickness ventrally. The prostatic acini are lined by simple cuboidal epithelium.
RESULTS
The bulbourethral gland was similar in size to the walnut and surrounded by a capsule and there are interlobular connective tissue septa that divided the gland into lobes and lobules of different sizes. The bulbourethral gland contained secretory units lined by the tall simple columnar epithelium of mucous type with basely located nuclei and eosinophilic cytoplasm contains granular secretion.
CONCLUSIONS
The gross and microscopic examination of the four accessory sex glands gave valuable information in the future pathology diagnosis of the accessory sex glands of the Barki bucks.
Topics: Animals; Bulbourethral Glands; Epithelial Cells; Epithelium; Goats; Male
PubMed: 34060642
DOI: 10.5603/FM.a2021.0057 -
The Journal of Pathology Nov 2020The molecular and clinical characteristics of non-ampullary duodenal adenomas and intramucosal adenocarcinomas are not fully understood because they are rare. To clarify...
The molecular and clinical characteristics of non-ampullary duodenal adenomas and intramucosal adenocarcinomas are not fully understood because they are rare. To clarify these characteristics, we performed genetic and epigenetic analysis of cancer-related genes in these lesions. One hundred and seven non-ampullary duodenal adenomas and intramucosal adenocarcinomas, including 100 small intestinal-type tumors (90 adenomas and 10 intramucosal adenocarcinomas) and 7 gastric-type tumors (2 pyloric gland adenomas and 5 intramucosal adenocarcinomas), were investigated. Using bisulfite pyrosequencing, we assessed the methylation status of CpG island methylator phenotype (CIMP) markers and MLH1. Then using next-generation sequencing, we performed targeted exome sequence analysis within 75 cancer-related genes in 102 lesions. There were significant differences in the clinicopathological and molecular variables between small intestinal- and gastric-type tumors, which suggests the presence of at least two separate carcinogenic pathways in non-ampullary duodenal adenocarcinomas. The prevalence of CIMP-positive lesions was higher in intramucosal adenocarcinomas than in adenomas. Thus, concurrent hypermethylation of multiple CpG islands is likely associated with development of non-ampullary duodenal intramucosal adenocarcinomas. Mutation analysis showed that APC was the most frequently mutated gene in these lesions (56/102; 55%), followed by KRAS (13/102; 13%), LRP1B (10/102; 10%), GNAS (8/102; 8%), ERBB3 (7/102; 7%), and RNF43 (6/102; 6%). Additionally, the high prevalence of diffuse or focal nuclear β-catenin accumulation (87/102; 85%) as well as mutations of WNT pathway components (60/102; 59%) indicates the importance of WNT signaling to the initiation of duodenal adenomas. The higher than previously reported frequency of APC gene mutations in small bowel adenocarcinomas as well as the difference in the APC mutation distributions between small intestinal-type adenomas and intramucosal adenocarcinomas may indicate that the adenoma-carcinoma sequence has only limited involvement in duodenal carcinogenesis. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinogenesis; DNA Copy Number Variations; DNA Methylation; Duodenal Neoplasms; Duodenum; Epigenesis, Genetic; Female; Gene Expression Regulation, Neoplastic; High-Throughput Nucleotide Sequencing; Humans; Intestinal Mucosa; Male; Middle Aged; Mutation
PubMed: 32770675
DOI: 10.1002/path.5529 -
Modern Pathology : An Official Journal... Feb 2017Literature on non-ampullary-duodenal carcinomas is limited. We analyzed 47 resected non-ampullary-duodenal carcinomas. Histologically, 78% were tubular-type... (Comparative Study)
Comparative Study
Literature on non-ampullary-duodenal carcinomas is limited. We analyzed 47 resected non-ampullary-duodenal carcinomas. Histologically, 78% were tubular-type adenocarcinomas mostly gastro-pancreatobiliary type and only 19% pure intestinal. Immunohistochemistry (n=38) revealed commonness of 'gastro-pancreatobiliary markers' (CK7 55, MUC1 50, MUC5AC 50, and MUC6 34%), whereas 'intestinal markers' were relatively less common (MUC2 36, CK20 42, and CDX2 44%). Squamous and mucinous differentiation were rare (in five each); previously, unrecognized adenocarcinoma patterns were noted (three microcystic/vacuolated, two cribriform, one of comedo-like, oncocytic papillary, and goblet-cell-carcinoid-like). An adenoma component common in ampullary-duodenal cancers was noted in only about a third. Most had plaque-like or ulcerating growth. Mismatch repair protein alterations were detected in 13% (all with plaque-like growth and pushing-border infiltration). When compared with ampullary (n=355) and pancreatic ductal (n=227) carcinomas, non-ampullary-duodenal carcinomas had intermediary pathologic features with mean invasive size of 2.9 cm (vs 1.9, and 3.3) and 59% nodal metastasis (vs 45, and 77%). Its survival (3-, 5-year rates of 57 and 57%) was similar to that of ampullary-duodenal carcinomas (59 and 52%; P=0.78), but was significantly better than the ampullary ductal (41 and 29%, P<0.001) and pancreatic (28 and 18%, P<0.001) carcinomas. In conclusion, non-ampullary-duodenal carcinomas are more histologically heterogeneous than previously appreciated. Their morphologic versatility (commonly showing gastro-pancreatobiliary lineage and hitherto unrecognized patterns), frequent plaque-like growth minus an adenoma component, and frequent expression of gastro-pancreatobiliary markers suggest that many non-ampullary-duodenal carcinomas may arise from Brunner glands or gastric metaplasia or heterotopic pancreatobiliary epithelium. The clinical behavior of non-ampullary-duodenal carcinoma is closer to that of ampullary-duodenal subset of ampullary carcinomas, but is significantly better than that of ampullary ductal and pancreatic cancers. The frequency of mismatch repair protein alterations suggest that routine testing should be considered, especially in the non-ampullary-duodenal carcinomas with plaque-like growth and pushing-border infiltration.
Topics: Adenocarcinoma; Aged; Ampulla of Vater; Biomarkers, Tumor; Common Bile Duct Neoplasms; Duodenal Neoplasms; Female; Humans; Immunohistochemistry; Male; Middle Aged; Mucins; Pancreatic Neoplasms
PubMed: 27739441
DOI: 10.1038/modpathol.2016.174 -
Oncotarget Jun 2017Non-ampullary duodenal adenoma with activation of Wnt/β-catenin signalling is common in familial adenomatous polyposis (FAP) patients, whereas sporadic non-ampullary...
Non-ampullary duodenal adenoma with activation of Wnt/β-catenin signalling is common in familial adenomatous polyposis (FAP) patients, whereas sporadic non-ampullary adenoma is uncommon. The adenoma-carcinoma sequence similar to colon cancer is associated with duodenal tumors in FAP, but not always in sporadic tumors. We obtained 37 non-ampullary duodenal tumors, including 25 adenomas and 12 adenocarcinomas, were obtained from biopsies and endoscopic resections. We performed immunohistochemistry for β-catenin, the hallmark of Wnt activation, and aldehyde dehydrogenase 1 (ALDH1), a putative cancer stem cell marker. In non-ampullary lesions, abnormal nuclear localization of β-catenin was observed in 21 (84.0%) of 25 adenomas and 4 (33.3%) of 12 adenocarcinomas. In the proximal duodenum, nuclear β-catenin was less frequent in both adenomas and adenocarcinomas. Gastric duodenal metaplasia (GDM) was observed only in the proximal duodenum. All adenomas with GDM were the gastric foveolar and pyloric gland types, and showed only membranous β-catenin. The intestinal-type adenomas had nuclear β-catenin in the proximal and distal duodenum. ALDH1-positive cells were more frequent in adenocarcinomas than adenomas. Nuclear β-catenin accumulation frequently occurred in ALDH1-positive cells in adenoma, but not in adenocarcinoma. In the non-ampullary proximal duodenum, Wnt/β-catenin pathway activation was more closely associated with adenomas than adenocarcinomas, and while it might cooperate with ALDH1 in adenoma, it does not in adenocarcinoma. The pathogenesis thus may differ between sporadic adenoma and adenocarcinoma of non-ampullary duodenal lesions, especially in the proximal and distal duodenum.
Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aldehyde Dehydrogenase 1 Family; Duodenal Neoplasms; Duodenum; Female; Humans; Immunohistochemistry; Isoenzymes; Male; Metaplasia; Middle Aged; Retinal Dehydrogenase; Wnt Signaling Pathway; beta Catenin
PubMed: 28467793
DOI: 10.18632/oncotarget.17051 -
Animals : An Open Access Journal From... Mar 2023Aquaporins (AQP) are involved in bidirectional transfers of water and small solutes across cell membranes. They are present in all tissues. However, the expression of...
Aquaporins (AQP) are involved in bidirectional transfers of water and small solutes across cell membranes. They are present in all tissues. However, the expression of AQP-7 has not yet been demonstrated in the reproductive tract of the camelid . The study presented here concerns the immunohistochemical evidence of aquaporin-7 (AQP-7) in different parts of the male genital tract of To check the immune reactivity levels of anti-AQP-7 antibody in the male genital tract of , the testes (proximal part, distal part and rete testis), epididymis (head, body and tail), ductus deferens (initial, middle and ampullary part) and prostate gland (compact and disseminated part) were collected from 12 male camels during the rutting and non-rutting seasons and subjected to immunohistochemistry. The result showed that the highest level of AQP-7 mRNA expression was in the testis of rutting and non-rutting males compared to the ductus deferens, epididymis and prostate. In addition, the highest mRNA gene expression of AQP-7 was in rutting males compared to non-rutting males. AQP-7 mRNA expression was higher in the ret testis, the body of the epididymis, the ampullary part of the ductus deferens and the compact part of the prostate. The immune reactivity levels of AQP-7 in rutting males showed strong reactivity in the testis and prostate compared to the epididymis and ductus deferens. On the basis of the results, it can be concluded that the distribution of the AQP-7 transcript and protein varied among rutting and non-rutting seasons and that the physiological roles of AQP-7 in the transportation of lipids, energy and water should be considered the main challenge in the activity and establishment of male fertility during the rutting and non-rutting seasons. Moreover, AQP-7 detection is critical in assessing regulation and screening for new modulators that can prompt the development of effective medication to enhance fertility during rutting and non-rutting seasons.
PubMed: 37048414
DOI: 10.3390/ani13071158 -
Genes Dec 2022Familial adenomatous polyposis (FAP) is an autosomal dominant disease caused by a germline mutation in the adenomatous polyposis coli () gene. Patients with FAP develop... (Review)
Review
Familial adenomatous polyposis (FAP) is an autosomal dominant disease caused by a germline mutation in the adenomatous polyposis coli () gene. Patients with FAP develop up to thousands of colorectal adenomas as well as lesions in the upper GI tract. In FAP, the upper digestive lesions include gastric fundic gland polyps (FGPs), antrum adenomas, duodenal or small intestinal adenomas, and carcinoma. Patients, after colectomy, are still at significant risk for extracolonic malignancies. Advances in endoscope resolution and optical enhancement technologies allow endoscopists to provide assessments of benign and malignant polyps. For this reason, in the past decades, endoscopic resection techniques have become the first line of treatment in patients with polyps in the upper GI, whereby polyps and even early cancers can be successfully cured. In FAP patients, endoscopic ampullectomy appears to be a safe and effective way of treating patients with ampullary tumors. According to current indications, endoscopic retrograde cholangiopancreatography (ERCP) and stenting of the main pancreatic duct follow ampullectomy.
Topics: Humans; Adenomatous Polyposis Coli; Polyps; Genes, APC; Adenoma; Upper Gastrointestinal Tract
PubMed: 36553595
DOI: 10.3390/genes13122329 -
Annals of Diagnostic Pathology Dec 2023Endoscopic biopsies from the ampulla of Vater are challenging due to specimen sampling limitation, small size, interventional artifacts, and the nature of local complex...
Endoscopic biopsies from the ampulla of Vater are challenging due to specimen sampling limitation, small size, interventional artifacts, and the nature of local complex anatomy. We retrospectively reviewed 318 in-house ampulla of Vater biopsy specimens from 252 patients over a 10-year period. The biopsy findings were compared to those in subsequent biopsy and/or resection specimens. Of the 318 biopsy cases, 104 (32.7 %) cases were diagnosed as adenoma (96 with low-grade dysplasia; 8 with high-grade dysplasia), 19 (6.0 %) adenocarcinomas (ampullary-12, distal bile duct-6, pancreatic-1), 5 (1.6 %) other carcinomas/tumors, and the rest were benign findings (unremarkable, ulcer and acute inflammation, reactive changes, and rare atypical cells/gland). Of the 90 cases with follow-up specimens, 55 cases (61.1 %) had concordant results and 35 (38.9 %) were discordant. Eight (22.9 %) of the 35 discordant cases had major discrepancies (benign biopsy diagnosis with malignant resection diagnosis); 27 (77.1 %) cases had minor discrepancies (normal, reactive, atypical, and dysplastic). We found that vast majority of the false negative biopsy results were due to sampling limitations. Combined biopsy and cytology specimens may help decrease the false negative rate. Careful correlation with endoscopic/cytology/clinical findings and acknowledging the limitation of the biopsy material in the pathology report are important, when malignancy is suspected but cannot be established in a small ampullary biopsy.
Topics: Humans; Ampulla of Vater; Retrospective Studies; Common Bile Duct Neoplasms; Biopsy; Bile Ducts
PubMed: 37595391
DOI: 10.1016/j.anndiagpath.2023.152189 -
The Turkish Journal of Gastroenterology... May 2018Endoscopic papillectomy (EP) has emerged as an alternative to surgery in the management of ampullary lesions. The aim of this study is to evaluate feasibility, efficacy,...
BACKGROUND/AIMS
Endoscopic papillectomy (EP) has emerged as an alternative to surgery in the management of ampullary lesions. The aim of this study is to evaluate feasibility, efficacy, safety, outcome, and impact of EP in the management of benign ampullary lesions.
MATERIALS AND METHODS
This is a multicenter, retrospective study of 44 patients who had EP of benign ampullary lesions.
RESULTS
Over the 11-year period, 44 (55.7%) of 79 patients underwent EP for benign ampullary lesions. Complete resection was achieved in 40 patients (91%). An underlying adenocarcinoma was the only risk factor for incomplete resection. Twenty-eight lesions (63.6%) were resected en-bloc and 16 lesions (36.4%) were resected in piecemeal fashion. Post-papillectomy histopathologic diagnoses were tubular adenoma in 14 patients (32%), invasive adenocarcinoma in 9 patients (20.5%), tubullovillous adenoma in 7 patients (16%), tubullovillous adenoma with carcinoma limited to the mucosal layer in 5 patients (11.3%), adenoma with high-grade dysplasia in 4 patients (9%), neuroendocrine tumor in 1 patient (2.3%), ganglioneuroma in 1 patient (2.3%), hamartomatous polyp in 1 patient (2.3%), adenofibroma in 1 patients (2.3%), and Brunner gland hyperplasia in 1 patient (2.3%). Seven (15.9%) procedure-related complications occurred: 3 (6.8%) bleeding, 2 (4.5%) pancreatitis, 1 (2.3%) abdominal pain, and 1 (2.3%) stent migration to the pancreatic duct. Seven patients (17%) had recurrence.
CONCLUSION
Endoscopic papillectomy is a safe and effective method and can be considered as a first-line approach in patients with benign ampullary lesions with intent for cure. It also allows for correct histological diagnosis and staging.
Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aged, 80 and over; Ampulla of Vater; Carcinoma; Common Bile Duct Neoplasms; Feasibility Studies; Female; Humans; Male; Middle Aged; Retrospective Studies; Sphincterotomy, Endoscopic; Treatment Outcome
PubMed: 29755017
DOI: 10.5152/tjg.2018.17378