Clinicopathologic correlation of p53 protein overexpression in adenoma andcarcinoma of the ampulla of vater

It has been well documented that ampullary carcinoma arises from a precance rous lesion, but there have been fe, studies concerning changes at the mole cular level during the adenoma-carcinoma sequence. In this study, p53 overe xpression during the progression of carcinoma was compared and the relation between p53 expression and prognosis was analyzed. Ninety-four cases of ad enocarcinoma of the ampulla of Vater were reviewed histopathologically and examined for overexpression of p53 protein using the DO-7 (mouse monoclonal ; DAKO, Glostrup, Denmark) antibody. The correlation of p53 overexpression with the existence of adenoma, clinical stage, histologic grade, and overal l survival was investigated. The proportion of p53-positive cases among nor mal mucosa, adenoma, early stage carcinoma (I and II), advanced stage carci noma (III and TV), and metastatic lesion was 0% (0/94), 14.3% (6/42), 32.3% (20/62), 53.1% (17/32), and 63.3% (19/30), respectively. The existence of adenoma or histologic grade of carcinoma did not correlate with p53 overexp ression. The carcinoma having adenomatous component was more common in earl y stages 54.8% in stages I and II, 25% in stages III and TV; p = 0.000 and in well-differentiated carcinoma (p = 0.001). The existence of adenoma or p 53 overexpression did not independently correlate with prognosis. In contra st, the p53 overexpressed group without adenoma shelved a worse prognosis t han the remaining patients (p = 0.0006) and this trend was still demonstrab le when the groups were compared stage by stage. In ampullary carcinoma, p5 3 abnormality occurs during malignant transformation from the adenoma and c ontinues during the tumor progression in carcinoma. The clinical prognosis of de novo carcinomas with p53 overexpression was worse than that of the re maining patients.