Department of Pathology, Charité University Hospital, Berlin, Germany.
Am J Clin Pathol. 2011 Feb;135(2):202-11. doi: 10.1309/AJCPCTCUQSYI89YT.
We further characterize the heterogeneous carcinomas of the papilla of Vater (CPVs) in relation to various clinicopathologic patient characteristics and patient survival. Of the 71 reevaluated CPVs, 32 were intestinal, 26 were pancreatobiliary, 6 were mixed, 4 were mucinous, and 3 were poorly differentiated carcinomas. The prevalence of cytokeratin 20 and cytokeratin 7 correlated with the intestinal (25/32 [78%] vs 13/32 [41%]) and pancreatobiliary (6/26 [23%] vs 24/26 [92%]) phenotypes. CDX2 was found in mucinous (3/4 [75%]), intestinal (7/32 [22%]), and some mixed (1/6 [1%]) CPVs. A KRAS mutation was detected in all poorly differentiated CPVs and in about 20% of each of the other types. In multivariate analyses, tumor type, local tumor spread, and lymph node metastases were independent prognostic factors of patient survival. We provide further evidence of the prognostic relevance of the phenotypic and genotypic diversity of CPVs. Besides the poorly differentiated CPV, the most common KRAS wild type makes them a putative target for an anti-epidermal growth factor receptor therapy.
我们进一步描述了 Vater 乳头的异质性癌（CPV）与各种临床病理患者特征和患者生存之间的关系。在重新评估的 71 例 CPV 中，32 例为肠型，26 例为胰胆管型，6 例为混合性，4 例为黏液性，3 例为低分化癌。细胞角蛋白 20 和细胞角蛋白 7 的表达与肠型（25/32 [78%] 与 13/32 [41%]）和胰胆管型（6/26 [23%] 与 24/26 [92%]）表型相关。CDX2 在黏液性（3/4 [75%]）、肠型（7/32 [22%]）和一些混合性（1/6 [1%]）CPV 中发现。所有低分化 CPV 及其他各型约 20%均检测到 KRAS 突变。多变量分析显示，肿瘤类型、局部肿瘤扩散和淋巴结转移是患者生存的独立预后因素。我们提供了进一步的证据，表明 CPV 的表型和基因型多样性与预后相关。除了低分化 CPV，最常见的 KRAS 野生型使其成为抗表皮生长因子受体治疗的潜在靶点。
