Emory Pancreatobiliary Pathology Research

N. Volkan Adsay, MD -

Professor, Pathology & Laboratory Medicine, Emory University School of Medicine
Director, Anatomic Pathology, Pathology & Laboratory Medicine, Emory University School of Medicine
Vice-Chair, Pathology & Laboratory Medicine, Emory University School of Medicine

There are, in essence, two long term goals of my research:

  1. to achieve more reliable criteria in the accurate diagnosis, classification and prognostication of tumors, and
  2. to elucidate the mechanisms of cancer formation.

Towards these purposes, I have focused on what is considered one of the most challenging organ groups in the body, the pancreatobiliary tract.  

Research - Pancreatobiliary Tract

1) Pancreas cancer is the 3rd leading cause of cancer deaths in the US. Currently, more Americans die of pancreas cancer than of prostate cancer, and it is estimated that in a few years, it will surpass breast cancer too in this regard. Its 5-year survival is < 5%. The reasons for the dismal prognosis of pancreas cancer are largely unraveled. I was a part of an international group of researchers who characterized the early steps of cancer formation in this organ, pancreatic intraepithelial neoplasia (PanINs). Later, we (my collaborators and I, including Dr. Ralph Hruban, Johns Hopkins University; and David Klimstra, Memorial Sloan-Kettering) have also shown that a distinct tumor type, intraductal papillary mucionous neoplasms, represent a different pathway of cancer formation in the pancreas, independent of PanINs. Our research in the past few years has mostly focused in this distinct pathway. Separately, we have identified other types of cancers that occur in the pancreas that are biologically and prognostically distinct from that of ordinary pancreas cancer, for example, colloid cancers, and the mechanisms that lead these tumors to behave far more favorably is likely to be important in solving the puzzles of carcinogenesis (cancer formation). We continue to investigate these cancers from both molecular, clinical and morphologic perspectives.

2) Ampulla of Vater is the region where pancreas and bile ducts adjoin the intestines. This is a small but complex area and the cancers of this region are poorly characterized, partly due to imprecise definition of this complex region. There has been a general impression that the prognosis of the cancers of the ampulla may somehow be better than those of the pancreas or bile ducts, but this impression had not been yet substantiated with careful pathologic analysis. Along with Drs. Ohike and Tajiri from Showa University, Japan, and collaborators from University of Pittsburgh as well as University of California at San Francisco, we performed the most detailed analysis of ampullary cancers based on the largest series to date, and have already discovered many facets of these cancers not previously recognized. Our recent studies have confirmed that ampullary cancers do indeed have a better prognosis than pancreas cancers overall, and we have also elucidated some of the reasons for this favorable outcome.

3) Gallbladder cancer is relatively less common than pancreas cancer in the US, but carries a similarly poor prognosis. Due to its relative rarity and the disinterest in this tumor type, gallbladder cancer is also poorly characterized pathologically. In Chile, gallbladder cancer is common and is the leading cause of cancer deaths among adult women. In our collaboration with J. C. Roa, Pontificia Universidad Catolica de Chile, Santiago, Chile; J. C. Araya, Universidad de La Frontera, Temuco, Chile; and K. T. Jang, Samsung Medical Center, Seoul Korea, we performed a detailed pathologic analysis of more than 600 primary invasive GB carcinomas, a huge undertaking, comprising the largest number of patients to date. In our ongoing studies, we defined the clinicopathologic characteristics of various types of gallbladder carcinomas such as mucinous and squamous cancers. Most importantly, we identified a distinct pathway of early cancer formation in this organ that we termed intracholecystic papillary tubular neoplasms, and we have made significant inroads into the characterization of these tumors, which will have major impact in our understanding of gallbladder carcinogenesis.

By all accounts, we have had yet another tremendously successful year working towards these goals.

Honors and Awards

Dr. Adsay, along with the Pancreatic Cancer Sequencing Team led by Dr. Ralph Hruban in the Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins University, received the Seventh Annual AACR Team Science Award during the American Association for Cancer Research’s Annual Meeting 2013.
For a listing of additional awards received by Dr. Adsay, see his Curriculum Vitae
To view a brief biosketch of Dr. Adsay, click HERE.

Emory University - Winship Cancer Institute: Collaborators and Pancreatobiliary Team

For more information on the Emory Team Collaborators, CLICK HERE.

Selected Publications

  1. Ohike N, Kim GE, Tajiri T, Krasinskas A, Basturk O, Coban I, Bandyopadhyay S, Morohoshi T, Goodman M, Kooby DA, Sarmiento JM, Adsay NV. Intraampullary papillary-tubular neoplasm (IAPN) - characterization of tumoral intraepithelial neoplasia occuring within the ampulla (A clinicopathologic analysis of 82 cases).American Journal of Surgical Pathology 34(12):1731-48, 2010. PMID: 21084962 [PubMed - indexed for MEDLINE] PMCID: PMC3168573 Free article
  2. Tanaka M, Fernández-Del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. May;12(3):183-97, 2012. PMID:22687371[PubMed - indexed for MEDLINE]
  3. Adsay V, Jang KT, Roa JC, Dursun N, Ohike N, Bagci P, Basturk O, Bandyopadhyay S, Cheng JD, Sarmiento JM, Escalona,OT, Goodman M, Kong SY, Terry P. Intracholecystic Papillary-Tubular Neoplasms (ICPN) of the Gallbladder (Neoplastic Polyps, Adenomas, and Papillary Neoplasms That Are ≥1.0 cm): Clinicopathologic and Immunohistochemical Analysis of 123 Cases. American Journal of Surgical Pathology. Sep;36(9):1279-1301, 2012. PMID:22895264[PubMed - indexed for MEDLINE]
  4. Adsay V, Ohike N, Tajiri T, Kim GE, Krasinskas A, Balci S, Bagci P, Basturk O, Bandyopadhyay S, Jang KT, Kooby DA, Maithel SK, Sarmiento J, Staley CA, Gonzalez RS, Kong SY, Goodman M. Ampullary Region Carcinomas: Definition and Site Specific Classification with Delineation of Four Clinicopathologically and Prognostically Distinct Subsets in an Analysis of 249 Cases. American Journal of Surgical Pathology. Nov; 36(11):1592-608. Dec;36(12):1782-95 Sep 28,2012. PMID:23026934[PubMed - indexed for MEDLINE]
  5. Adsay NV, Basturk O, Saka B. Pathologic staging of tumors: pitfalls and opportunities for improvements. Seminars in Diagnostic Pathology. Aug;29(3):103-8, 2012. PMID:23062417[PubMed - indexed for MEDLINE]
  6. Adsay NV, Bagci P, Tajiri T, Oliva I, Ohike N, Balci S, Gonzalez RS, Basturk O, Jang KT, Roa JC. Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement. Seminars in Diagnostic Pathology. Aug;29(3):127-41, 2012. PMID:23062420[PubMed - indexed for MEDLINE]
  7. Adsay V. Ki67 labeling index in neuroendocrine tumors of the gastrointestinal and pancreatobiliary tract: to count or not to count is not the question, but rather how to count. American Journal of Surgical Pathology. Dec;36(12):1743-6, 2012. PMID:23154766[PubMed - indexed for MEDLINE]
  8. Krasinskas AM, Moser AJ, Saka B, Adsay NV, Chiosea SI. KRAS mutant allele-specific imbalance is associated with worse prognosis in pancreatic cancer and progression to undifferentiated carcinoma of the pancreas. Modern Pathology. 2013 Apr 19. [Epub ahead of print]. PMID:23599154[PubMed - as supplied by publisher]