Lianda Siregar

Chronic inflammation is a crucial driver of carcinogenesis in pancreatic ductal adenocarcinoma (PDAC). Several studies have investigated the prognostic significance of cyclooxygenase−2 (COX−2) expression in PDAC patients, obtaining conflicting results. Nuclear factor kappa−B (NF−κB), specificity protein 1 (Sp1), and c−Jun are known as the transcription factors of the COX2 gene. This exploratory observational study investigated the association of the NF−κB, COX−2, Sp1, and c−Jun expressions with patient survival in PDAC. We used the immunohistochemical method to detect the PDAC tissue expressions of NF−κB (RelA/p65), COX−2, Sp1, and c−Jun. The expressions of these proteins were correlated with the overall survival (OS) and other clinicopathological characteristics of PDAC patients. We obtained 53 PDAC specimens from resections and biopsies. There were significant correlations between the four proteins’ expressions in the PDAC tissues. The expression of the cytoplasmic (aHR = 0.31; 95% CI 0.11–0.90; p = 0.032) or nuclear NF−κB (aHR = 0.22; 95% CI 0.07–0.66; p = 0.007) was independently associated with a better prognosis in the PDAC patients. COX−2, Sp1, and c−Jun showed no significant association with a prognosis in the PDAC patients. The PDAC patients who expressed NF−κB had a better prognosis than the other patients, which suggests that the role of inflammation in PDAC is more complex than previously thought.

Signet-ring cell carcinoma (SRCC) of the ampulla of Vater is a very rare case and only 28 cases have beed reported in the English literature. Herein, we report a 59-year-old woman with SRCC of the ampulla of Vater. She developed symptoms of obstructive jaundice at early stage of disease and underwent pylorus-preserving Whipple procedure as definitive treatment. Histopathology examination showed numerous tumor cells with intracytoplasmic mucin and eccentric nuclei. Her tumor has already invaded the serosa of duodenum, but no infiltration to the stomach, pancreas, and lymphovascular structure. Her surgical margins and regional lymph nodes were free of tumor. She was diagnosed with T2N0M0 (stage IB) SRCC of the ampulla of Vater. No adjuvant treatment was given and she has been doing well for five months after surgery.