array:22 [ "pii" => "S1699885524000199" "issn" => "16998855" "doi" => "10.1016/j.patol.2024.01.004" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "762" "copyright" => "Sociedad Española de Anatomía Patológica" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Patol. 2024;57:151-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:18 [ "pii" => "S1699885524000151" "issn" => "16998855" "doi" => "10.1016/j.patol.2024.01.002" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "758" "copyright" => "Sociedad Española de Anatomía Patológica" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Patol. 2024;57:146-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ARTÍCULO BREVE</span>" "titulo" => "Tumor espermatocítico variante anaplásica sincrónico bilateral: reporte de una neoplasia infrecuente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "146" "paginaFinal" => "150" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bilateral synchronous anaplastic variant spermatocytic tumor: Report of a rare neoplasm" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1346 "Ancho" => 760 "Tamanyo" => 119277 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Imagen macroscópica de la neoplasia testicular que muestra un aspecto sólido multinodular.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rosalía Sarabia Ochoa, Juan Pablo García de la Torre" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Rosalía" "apellidos" => "Sarabia Ochoa" ] 1 => array:2 [ "nombre" => "Juan Pablo" "apellidos" => "García de la Torre" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699885524000151?idApp=UINPBA00004N" "url" => "/16998855/0000005700000002/v1_202404090738/S1699885524000151/v1_202404090738/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Enteroblastic adenocarcinoma of the ampulla of Vater" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "151" "paginaFinal" => "155" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Amanda Rodríguez-Villena, Alejandra Veliz-Domínguez, Irene González-García, Ignacio Ruz-Caracuel" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Amanda" "apellidos" => "Rodríguez-Villena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Alejandra" "apellidos" => "Veliz-Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Irene" "apellidos" => "González-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "Ignacio" "apellidos" => "Ruz-Caracuel" "email" => array:1 [ 0 => "ignacio.ruz@salud.madrid.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital del Mar, Hospital del Mar Research Institute, 08003 Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adenocarcinoma enteroblástico de la ampolla de Vater" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2598 "Ancho" => 2007 "Tamanyo" => 1033853 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Microscopic features and immunohistochemical profile of the enteroblastic differentiation. The enteroblastic area was characterized by nests of glandular epithelium with clear cytoplasm, showing occasional comedo-like necrosis (A). In the surface, the tumor had a papillary pattern (B). In some areas, the cells showed subnuclear clear vacuoles in addition to the apical clear cytoplasm (C). Immunohistochemical study showed focal staining for embryonic markers, alpha-fetoprotein (D) and Sall-4 (E). The cells had positive staining for CDX2 (F), consistent with the intestinal phenotype. Liver metastasis had similar histology showing nests of glandular clear cells (G). It retained the positive staining for Sall-4, consistent with the enteroblastic differentiation (H).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Carcinomas of the ampulla of Vater are uncommon, representing <1% of all carcinomas.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> However, the ampulla is the most common location for small intestinal adenocarcinoma, probably related with the transition of intestinal to pancreatobiliary epithelium at this point and the chronic effect of biliary and pancreatic secretions.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> This is a complex anatomical area and sometimes it is difficult to assign a precise intra-ampullary or peri-ampullary primary location to certain tumors.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Most of the carcinomas have a growth pattern that can be predominantly papillary, villous, tubulovillous or tubular.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> The two well-recognized subtypes are the intestinal (50–80%) and the pancreatobiliary (15–20%) phenotype.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> However, other infrequent phenotypes have been sporadically described such as micropapillary,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> adenosquamous<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> or adenocarcinomas with fetal or hepatoid differentiation.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Hepatoid adenocarcinomas and related entities are well recognized in the stomach<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> in the gastrointestinal tract, and are less well defined in other locations, probably due to their rarity<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a>. In the current report, we describe a new case of an ampullary adenocarcinoma with enteroblastic differentiation together with a review of previously published cases.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">An 87-year-old male, with no personal or family history of interest and no symptoms, had a cholestasis alteration during a check-up. Serum chemistries revealed gamma-glutamyl transferase 121<span class="elsevierStyleHsp" style=""></span>U/L (normal 5–40<span class="elsevierStyleHsp" style=""></span>U/L), aspartate aminotranferase 121<span class="elsevierStyleHsp" style=""></span>U/L (normal 10–35<span class="elsevierStyleHsp" style=""></span>U/L), alanine aminotransferase 182<span class="elsevierStyleHsp" style=""></span>U/L (normal 6–29<span class="elsevierStyleHsp" style=""></span>U/L), alkaline phosphatase 363<span class="elsevierStyleHsp" style=""></span>U/L (normal 37–153<span class="elsevierStyleHsp" style=""></span>U/L) and lipase 27<span class="elsevierStyleHsp" style=""></span>U/L (normal 10–140<span class="elsevierStyleHsp" style=""></span>U/L).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Computer tomography and echoendoscopy revealed an enlarged extrahepatic bile duct (15<span class="elsevierStyleHsp" style=""></span>mm) up to the major duodenal papilla. It presented an unstructured, thickened, heterogeneous appearance, with hypoechoic areas inside. At direct inspection, it was a papillary lesion measuring 22<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>19<span class="elsevierStyleHsp" style=""></span>mm, friable on rubbing with depressed areas. Echoendoscopic diagnosis was an ampulloma stage T1b-T2.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Biopsies of the lesion showed high-grade dysplasia in several fragments. Therefore, an ampulectomy was performed. The surgical margins were free at the intraoperative evaluation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Gross evaluation revealed an ill-lobulated reddish fragment measuring 3<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.7<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.3<span class="elsevierStyleHsp" style=""></span>cm. One of its external faces had a thermal artifact consistent with the surgical margin. After serial sections, there was a dilated duct adjacent to an ill-defined tumor of 2<span class="elsevierStyleHsp" style=""></span>cm in its longest axis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Histologically, the tumor had a polypoid area with papillae and a large nest-forming infiltrative area. These nests were composed of admixed glands, papillae, and solid components, with frequent intratumoral comedonecrosis. Glandular epithelium was columnar, with frequent areas of clear cytoplasms and subnuclear vacuoles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Nuclei were oval, with fine granular chromatin, and discrete nucleoli. Mitotic figures were frequent, some of them atypical. There were some areas of classical intestinal phenotype, but no areas of clear hepatoid differentiation were observed. There was slight intra and peritumoral inflammation. Lymphovascular or perineural invasion were absent.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Immunohistochemical evaluation showed positivity of the neoplastic tumor cells with CDX2 and patchy immunopositivity with CK20 and MUC2 markers, staining consistent with the intestinal phenotype. Meanwhile, CK7, SATB2, and MUC1 staining were negative. The fetal-differentiation markers alpha-fetoprotein (AFP), HepPar1, and Sall-4 were focally positive (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Glypican-3 was negative. Staining for beta-catenin had membrane expression without nuclear positive staining. Mismatch repair proteins PMS2 and MSH6 expression was preserved.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient's post-operative evolution was favorable, with clinical-analytical improvement, good tolerance, and pain control. Fifteen months after the primary tumor excision, clinical progression with liver metastasis was detected and biopsied. The metastasis had a glandular pattern with columnar epithelium with clear cytoplasm and subnuclear vacuoles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The metastasis remained positive expression of Sall-4 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Adenocarcinoma with enteroblastic differentiation, also known as fetal-type gastrointestinal adenocarcinoma, is an infrequent special subtype of carcinoma of the digestive system with unique morphological and immunohistochemical features.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> The first description of this subtype was in 1981, after the evaluation of gastric cancers that produced alpha-fetoprotein.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> In 1994, it was named adenocarcinoma with enteroblastic differentiation by Matsunou et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Adenocarcinomas with enteroblastic differentiation are often misdiagnosed as well-differentiated adenocarcinomas due to their well-differentiated tubular and papillary structures on morphology. Histologically, this tumor has a predominant tubular or papillary pattern. Tumor cells are columnar or cuboidal with a clear cytoplasm. Marked subnuclear vacuolization, similar to primitive intestinal epithelium in the second to fourth month of fetal development, is a diagnostic clue.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Immunohistochemically, tumor cells express one or more of the embryonic markers Sall-4, Glypican-3, HepPar1, and AFP.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> At the same time, they retain the expression of the common gastro-intestinal transcription factor CDX2.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The most common location is the stomach, followed by the colorectum.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2,11</span></a> Adenocarcinoma with enteroblastic differentiation is recognized as a hepatoid-related entity in the stomach in the fifth edition of the WHO Classification of Tumors of the Digestive System.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> Hepatoid carcinoma appears as well as a subtype of pancreas adenocarcinoma without any mention to enteroblastic differentiation. Because both hepatoid carcinoma and adenocarcinoma with enteroblastic frequently express AFP and some tumors showed a transition of both phenotypes, there is no general consensus in the literature to consider them a single entity or split them. This may contribute to its poor identification in the routine diagnostic setting. In this respect, some authors have considered hepatoid adenocarcinoma in the stomach a subtype or pattern of adenocarcinoma with enteroblastic differentiation characterized by solid growth and AFP positive staining.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> The identification of this hepatoid variant, even in a small area, was considered important because it was associated with a lower overall survival.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> Prognosis compared with adenocarcinoma of the ampulla with conventional intestinal differentiation is unknown. Our patient developed liver metastasis 15 months after the surgical resection. There is only another publication reporting the follow-up of a patient with a 3<span class="elsevierStyleHsp" style=""></span>cm adenocarcinoma with sarcomatous, enteroblastic, and hepatoid differentiation that was surgically excised and treated with 12 sessions of high-dose chemotherapy with Folfirinox (Leucovorin-Fluorouracil-Irinotecan-Oxaplatin).<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> This patient was alive without recurrence 17 months after the initial treatment. This contrast with reports on the stomach where these adenocarcinomas are better characterized; at this location enteroblastic differentiation is considered an aggressive subtype. For example, Murakami et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> described that lymphatic invasion, venous invasion, lymph node metastasis, and liver metastases were significantly more frequently present in adenocarcinomas with enteroblastic differentiation compared with conventional gastric adenocarcinomas.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Few cases of adenocarcinoma with enteroblastic differentiation have been reported in the ampullary region (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). To our knowledge, there are six cases published, including our current patient. Patients’ age was between 55 and 87 years old, with equal distribution between men and women. Some lesions measured up to 3<span class="elsevierStyleHsp" style=""></span>cm. Histologically, enteroblastic differentiation was associated with moderately or poorly differentiated adenocarcinomas. Four out of five tumors were described to have papillary or tubular structures adjoined to solid areas.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">3,6,13,15</span></a> This solid component was termed as hepatoid differentiation in two reports,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">3,13</span></a> and prompt the designation of hepatoid carcinoma of two tumors.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">6,16</span></a> Interestingly, one case was associated with a neuroendocrine carcinoma and another with a carcinosarcoma. This may suggest that enteroblastic differentiation may be a type of dedifferentiation process. This is highlighted by immunohistochemistry, but more detailed molecular mechanisms are still unknown. Immunohistochemistry supports that almost all of the tumors had an intestinal phenotype. Sall-4 turned out to be positive in 3 out of 3 (100%) tumors analyzed. Meanwhile, Glypican-3 was positive in 3 out of 4 (75%) tumors and AFP in 5 out of 6 (83%) carcinomas. In four patients, AFP serum levels were determined before the surgical resection and were found above normal levels in three (75%) of them.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">In conclusion, we have described a new case of adenocarcinoma with enteroblastic differentiation at the ampulla. This is a rare and poorly recognized entity at the ampulla characterized by histological and immunohistochemical features resembling fetal intestinal epithelium. The impact on prognosis of identifying this differentiation at the ampulla is still unknown due to the few cases reported.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Keynotes</span><p id="par0085" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Adenocarcinomas with enteroblastic differentiation are very rare at the ampulla.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Histology differentiation resembles fetal intestinal epithelium.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Tumor cells express embryonic markers Sall-4, Glypican-3, HepPar1, and alpha-fetoprotein.</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical considerations and informed consent</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that the samples stored in the pathology department were collected for diagnostic purposes to promote and safeguard the health of patients, and not for an experimentation procedure on patients.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that the present research has not received specific support from public sector agencies, commercial sector or non-profit entities.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have nothing to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2124586" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1806583" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2124585" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1806584" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Keynotes" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical considerations and informed consent" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-09-06" "fechaAceptado" => "2024-01-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1806583" "palabras" => array:4 [ 0 => "Adenocarcinoma" 1 => "Enteroblastic differentiation" 2 => "Ampulla of Vater" 3 => "Hepatoid differentiation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1806584" "palabras" => array:4 [ 0 => "Adenocarcinoma" 1 => "Diferenciación enteroblástica" 2 => "Ampolla de Vater" 3 => "Diferenciación hepatoide" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Adenocarcinoma with enteroblastic differentiation is a rare histologic subtype of adenocarcinoma of the gastrointestinal tract that shows unique histologic and immunohistochemical features that resemble fetal intestinal epithelium. This histological subtype has been widely described in the stomach, where it most frequently appears, but, in other locations, it is misdiagnosed because of the poor experience in routine diagnostic setting. Here we present a case of an 87-year-old male with an adenocarcinoma of the ampulla of Vater with enteroblastic differentiation with a literature review of the cases described of this subtype in this location to date. The anatomical peculiarity of the ampulla, joined with the infrequent nature of this histological subtype, makes this case of great interest to aid to better characterize the biological behavior of these tumors.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El adenocarcinoma con diferenciación enteroblástica es un subtipo histológico poco frecuente de adenocarcinoma gastrointestinal que muestra características histológicas e inmunohistoquímicas únicas que se asemejan al epitelio intestinal fetal. Este subtipo histológico ha sido ampliamente descrito en el estómago, donde aparece con mayor frecuencia, pero en otras localizaciones es mal diagnosticado debido a la poca experiencia en el diagnóstico de rutina. Presentamos un caso de un varón de 87 años con adenocarcinoma de ampolla de Vater con diferenciación enteroblástica, junto a una revisión bibliográfica de los casos descritos de este subtipo en esta localización hasta el momento. La peculiaridad anatómica de la ampolla, sumada al carácter poco frecuente de este subtipo histológico, dotan a este caso de gran interés para ayudar a caracterizar mejor el comportamiento biológico de estos tumores.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2598 "Ancho" => 2007 "Tamanyo" => 1033853 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Microscopic features and immunohistochemical profile of the enteroblastic differentiation. The enteroblastic area was characterized by nests of glandular epithelium with clear cytoplasm, showing occasional comedo-like necrosis (A). In the surface, the tumor had a papillary pattern (B). In some areas, the cells showed subnuclear clear vacuoles in addition to the apical clear cytoplasm (C). Immunohistochemical study showed focal staining for embryonic markers, alpha-fetoprotein (D) and Sall-4 (E). The cells had positive staining for CDX2 (F), consistent with the intestinal phenotype. Liver metastasis had similar histology showing nests of glandular clear cells (G). It retained the positive staining for Sall-4, consistent with the enteroblastic differentiation (H).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0011" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">ENT</span>, adenocarcinoma with enteroblastic differentiation; <span class="elsevierStyleItalic">NEC</span>, neuroendocrine carcinoma; <span class="elsevierStyleItalic">WEL</span>, well-differentiated adenocarcinoma; <span class="elsevierStyleItalic">MOD</span>, moderately-differentiated adenocarcinoma; <span class="elsevierStyleItalic">ND</span>, not determined; <span class="elsevierStyleItalic">CC</span>, carcinomatous component; <span class="elsevierStyleItalic">HEP</span>, hepatoid; <span class="elsevierStyleItalic">SAR</span>, sarcomatous; + positive staining; − negative staining.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age/sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Size (cm) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Morphology \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cellular phenotype \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sall-4 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Glypican-3 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AFP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HepPar1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serum AFP levels \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poorly to WEL with clear cell components \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gardiner et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poorly or MOD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sato et al.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ENT, NEC and WEL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+(ENT) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+(ENT) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−(ALL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−(ALL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mitsuma et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">4</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carcinosarcoma; CC with clear and eosinophilic cytoplasm cell with trabecular architecture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal (CC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+(ENT) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+(SAR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+(HEP) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−(ALL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haider et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">5</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatoid adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Takahashi et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">6</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MOD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Our study \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3506769.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Summary of cases of adenocarcinoma with enteroblastic differentiation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumors of the intestines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.A. Montgomery" 1 => "R.K. Yantiss" 2 => "D.C. Snover" 3 => "L.H. Tang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "fecha" => "2017" "paginaInicial" => "433" "editorial" => "American Registry of Pathology, Armed Forces Inst. of Pathology" "editorialLocalizacion" => "Washington, DC" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0090" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Organisation mondiale de la santé, Centre international de recherche sur le cancer, editors. Digestive system tumours. 5th ed. Lyon: International Agency for Research on Cancer; 2019. (World Health Organization Classification of Tumours). ISBN: 978-92-832-4499-8." ] ] ] 2 => array:3 [ "identificador" => "bib0095" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of adenocarcinoma with enteroblastic differentiation of the ampulla of Vater" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Mitsuma" 1 => "H. Taniguchi" 2 => "Y. Kishi" 3 => "N. Hiraoka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pin.12402" "Revista" => array:6 [ "tituloSerie" => "Pathol Int" "fecha" => "2016" "volumen" => "66" "paginaInicial" => "230" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27016918" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0100" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Invasive micropapillary carcinomas of the ampullo-pancreatobiliary region and their association with tumor-infiltrating neutrophils" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Khayyata" 1 => "O. Basturk" 2 => "N.V. Adsay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/modpathol.3800460" "Revista" => array:6 [ "tituloSerie" => "Mod Pathol" "fecha" => "2005" "volumen" => "18" "paginaInicial" => "1504" "paginaFinal" => "1511" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16007065" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0105" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adenosquamous carcinoma of the ampulla of Vater – a rare disease at unusual location" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.J. Yang" 1 => "C.H. Ooyang" 2 => "S.Y. Wang" 3 => "Y.Y. Liu" 4 => "I.M. Kuo" 5 => "C.H. Liao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1477-7819-11-124" "Revista" => array:5 [ "tituloSerie" => "World J Surg Oncol" "fecha" => "2013" "volumen" => "11" "paginaInicial" => "124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23721111" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0110" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatoid adenocarcinoma of the papilla of Vater" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.W. Gardiner" 1 => "G. Lajoie" 2 => "R. Keith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2559.1992.tb01044.x" "Revista" => array:6 [ "tituloSerie" => "Histopathology" "fecha" => "1992" "volumen" => "20" "paginaInicial" => "541" "paginaFinal" => "544" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1318863" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0115" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fetal-type gastrointestinal adenocarcinoma: a morphologically distinct entity with unfavourable prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Arora" 1 => "M. Bal" 2 => "A. Shih" 3 => "A. Moy" 4 => "L. Zukerberg" 5 => "I. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/jclinpath-2017-204535" "Revista" => array:6 [ "tituloSerie" => "J Clin Pathol" "fecha" => "2018" "volumen" => "71" "paginaInicial" => "221" "paginaFinal" => "227" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28814568" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0120" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Production of alpha-fetoprotein, normal serum proteins, and human chorionic gonadotropin in stomach cancer: histologic and immunohistochemical analyses of 35 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Kodama" 1 => "T. Kameya" 2 => "T. Hirota" 3 => "Y. Shimosato" 4 => "H. Ohkura" 5 => "T. Mukojima" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1097-0142(19811001)48:7<1647::aid-cncr2820480729>3.0.co;2-v" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1981" "volumen" => "48" "paginaInicial" => "1647" "paginaFinal" => "1655" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6169423" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0125" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alpha-fetoprotein-producing gastric carcinoma with enteroblastic differentiation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Matsunou" 1 => "F. Konishi" 2 => "R.E. Jalal" 3 => "N. Yamamichi" 4 => "A. Mukawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1097-0142(19940201)73:3<534::aid-cncr2820730307>3.0.co;2-x" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1994" "volumen" => "73" "paginaInicial" => "534" "paginaFinal" => "540" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7507794" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0130" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary pancreatic adenocarcinoma with enteroblastic differentiation: report of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Wang" 1 => "B. Yang" 2 => "Y.H. Guo" 3 => "F.L. Zang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3760/cma.j.cn112151-20200610-00460" "Revista" => array:6 [ "tituloSerie" => "Zhonghua Bing Li Xue Za Zhi" "fecha" => "2021" "volumen" => "50" "paginaInicial" => "149" "paginaFinal" => "151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33535315" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0135" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colorectal adenocarcinoma with enteroblastic differentiation: a clinicopathological study of five cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Murakami" 1 => "T. Yao" 2 => "N. Yatagai" 3 => "Y. Yamashiro" 4 => "T. Saito" 5 => "N. Sakamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/his.13973" "Revista" => array:6 [ "tituloSerie" => "Histopathology" "fecha" => "2020" "volumen" => "76" "paginaInicial" => "325" "paginaFinal" => "332" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31429980" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0140" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Next-generation sequencing analysis for gastric adenocarcinoma with enteroblastic differentiation: emphasis on the relationship with hepatoid adenocarcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Akazawa" 1 => "T. Saito" 2 => "Y. Yanai" 3 => "S. Tsuyama" 4 => "K. Akaike" 5 => "Y. Suehara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.humpath.2018.04.022" "Revista" => array:6 [ "tituloSerie" => "Hum Pathol" "fecha" => "2018" "volumen" => "78" "paginaInicial" => "79" "paginaFinal" => "88" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29751042" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0145" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ampullary carcinosarcoma with enteroblastic differentiation: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. Haider" 1 => "S. Naqvi" 2 => "O. Barakat" 3 => "S.E. Wilken" 4 => "S. Dhingra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Clin Lab Sci" "fecha" => "2021" "volumen" => "51" "paginaInicial" => "131" "paginaFinal" => "135" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33653792" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0150" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinicopathologic and immunohistochemical characteristics of gastric adenocarcinoma with enteroblastic differentiation: a study of 29 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Murakami" 1 => "T. Yao" 2 => "H. Mitomi" 3 => "T. Morimoto" 4 => "H. Ueyama" 5 => "K. Matsumoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10120-015-0497-9" "Revista" => array:6 [ "tituloSerie" => "Gastric Cancer" "fecha" => "2016" "volumen" => "19" "paginaInicial" => "498" "paginaFinal" => "507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25893262" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0155" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alpha-fetoprotein-producing cancer of the ampulla of Vater" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Sato" 1 => "H. Tominaga" 2 => "A. Tangoku" 3 => "Y. Hamanaka" 4 => "Y. Yamashita" 5 => "T. Suzuki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hepatogastroenterology" "fecha" => "1992" "volumen" => "39" "paginaInicial" => "566" "paginaFinal" => "569" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1282896" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0160" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Establishment and biological characterization of a novel cell line derived from hepatoid adenocarcinoma originated at the ampulla of Vater" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Takahashi" 1 => "F. Aoyama" 2 => "M. Hiyoshi" 3 => "H. Kataoka" 4 => "A. Sawaguchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3892/ijo.2014.2282" "Revista" => array:6 [ "tituloSerie" => "Int J Oncol" "fecha" => "2014" "volumen" => "44" "paginaInicial" => "1139" "paginaFinal" => "1145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24481592" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16998855/0000005700000002/v1_202404090738/S1699885524000199/v1_202404090738/en/main.assets" "Apartado" => array:4 [ "identificador" => "5740" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Artículos breves" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/16998855/0000005700000002/v1_202404090738/S1699885524000199/v1_202404090738/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699885524000199?idApp=UINPBA00004N" ]
Información de la revista
Compartir
Descargar PDF
Más opciones de artículo