Younes M, Riley S, Genta R M, Mosharaf M, Mody D R
Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, USA.
Cancer. 1995 Oct 1;76(7):1150-4. doi: 10.1002/1097-0142(19951001)76:7<1150::aid-cncr2820760709>3.0.co;2-e.
Accurate preoperative diagnosis of tumors of the ampulla of Vater is difficult because ampullary biopsies have a high false-negative rate. Recently, it has been suggested that p53 mutations in tumors of the ampulla of Vater are associated with the transformation of adenomas and low grade carcinomas to high grade carcinomas. The purpose of this study was to determine the extent of p53 protein accumulation in tumors of the ampulla of Vater, and to determine whether p53 accumulation can be detected in false-negative biopsies.
Using a monoclonal anti-p53 antibody, sections of 4 normal ampullas, 5 adenomas, 17 carcinomas, and 9 initial biopsies of 9 of the tumors of the ampulla of Vater that had no morphologic evidence of carcinoma were immunostained.
None of the 4 normal ampullas (0%), 2 of 5 adenomas (40%), and 16 of 17 carcinomas (94%) were positive for p53. This p53 positivity was present through all stages of ampullary carcinoma. Of the nine initial biopsies negative for carcinoma, seven were positive for p53 and, of these, six (86%) were found to be carcinomas upon resection.
由于壶腹活检的假阴性率很高，因此准确术前诊断 Vater 壶腹肿瘤很困难。最近，有人提出 Vater 壶腹肿瘤中的 p53 突变与腺瘤和低级别癌向高级别癌的转变有关。本研究的目的是确定 p53 蛋白在 Vater 壶腹肿瘤中的积累程度，并确定在假阴性活检中是否能检测到 p53 积累。
使用单克隆抗 p53 抗体，对 4 个正常壶腹、5 个腺瘤、17 个癌以及 9 个 Vater 壶腹肿瘤的 9 份初始活检标本（这些标本无癌的形态学证据）进行免疫染色。
4 个正常壶腹中无一例（0%）、5 个腺瘤中有 2 例（40%）、17 个癌中有 16 例（94%）p53 呈阳性。这种 p53 阳性在壶腹癌的所有阶段均存在。在 9 份初始活检标本中，癌阴性的标本里有 7 份 p53 呈阳性；其中，6 例（86%）在切除后被发现为癌。
1）导致 Vater 壶腹肿瘤中 p53 积累的分子事件在肿瘤形成过程的早期就已发生。2）Vater 壶腹肿瘤活检恶性阴性但 p53 阳性的很可能是癌。
