Clinical and phenotypical characteristics of submucosal invasive carcinoma in non-ampullary duodenal cancer

PLoS One. 2021 Aug 27;16(8):e0256797. doi: 10.1371/journal.pone.0256797. eCollection 2021.


Objective: The rare incidence of submucosal invasive non-ampullary duodenal carcinoma has led to scant information in literature; therefore, we compared the clinicopathological features between submucosal invasive carcinoma (SM-Ca), mucosal carcinoma (M-Ca), and advanced carcinoma (Ad-Ca).

Materials: We retrospectively analyzed 165 patients with sporadic non-ampullary duodenal carcinomas (SNADCs) from four institutions between January 2003 and December 2018. The SNADCs were divided to three groups according to histological diagnosis: SM-Ca, M-Ca, and Ad-Ca. The clinicopathological characteristics and mucin phenotypes were compared between groups.

Results: Among the 165 SNADCs, 11 (7%) were classified as SM-Ca, 70 (42%) as M-Ca, and 84 (51%) as Ad-Ca. We found that all SM-Ca (P = 0.013) and most Ad-Ca (P = 0.020) lesions were located on the oral-Vater; however, an almost equal distribution of M-Ca lesions was found between the oral- and anal-Vater. No significant difference was observed between the tumor diameter of M-Ca and SM-Ca; however, 45% (5/11) of SM-Ca were ≤10 mm. A total of 73% (8/11) of SM-Ca were classified as gastric phenotype and no lesions were classified as intestinal phenotype; whereas most M-Ca were classified as intestinal phenotype (67%, 8/12).

Conclusions: SM-Ca lesions were all located on the oral-Vater and were highly associated with the gastric mucin phenotype, which were different from the features of most M-Ca.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ampulla of Vater / diagnostic imaging
  • Ampulla of Vater / pathology
  • Carcinoma / diagnosis*
  • Carcinoma / diagnostic imaging
  • Carcinoma / epidemiology*
  • Carcinoma / pathology
  • Duodenal Neoplasms / diagnosis*
  • Duodenal Neoplasms / epidemiology*
  • Duodenal Neoplasms / genetics
  • Duodenal Neoplasms / pathology
  • Female
  • Humans
  • Intestinal Mucosa / diagnostic imaging
  • Intestinal Mucosa / pathology
  • Male
  • Middle Aged
  • Mucins / genetics
  • Neoplasm Invasiveness / genetics
  • Neoplasm Invasiveness / pathology
  • Phenotype


  • Mucins

Grants and funding

The authors received no specific funding for this work.