Supplementary Material for: Clinicopathological and Endoscopic Features of Non-Ampullary Duodenal Epithelial Tumors with Gastrointestinal Mixed Phenotype

Introduction:
Non-ampullary duodenal epithelial tumors with a gastrointestinal mixed phenotype (mixed-type NADETs) have not been thoroughly analyzed. We aimed to elucidate the clinicopathological and endoscopic characteristics of mixed-type NADETs.
Methods:
A total of 229 NADETs from 218 patients collected from February 2010 to December 2023 were analyzed. Based on immunohistochemistry for MUC5AC, MUC6, MUC2, and CD10, the NADETs were classified into gastric phenotype (GP), gastric predominant mixed phenotype (GPP), intestinal predominant mixed phenotype (IPP), and intestinal type (IP).
Results:
Among the 229 NADETs, there were 20, 22, 69, and 118 lesions classified as GP, GPP, IPP, and IP, respectively. Tumor location (first/second/third) was GP=13/7/0, GPP=12/8/2, IPP=13/52/4, and IP=16/94/8 (P<0.01). Mean tumor sizes of GP, GPP, IPP, and IP were 14.7/18.5/10.9/10.3 mm (P<0.01), respectively. The ratio of category 4/5 by Vienna classification was 50.0, 68.2, 13.0, and 2.5% (P<0.01), respectively. In the comparisons between GP vs. GPP, and IP vs. IPP, white opaque substance was significantly less frequently observed in GP than in GPP (P<0.05), the ratio of category 4/ 5 was significantly higher in IPP than in IP (P<0.01), but no significant differences were observed in tumor location, coloration, macroscopic type, and endoscopic findings including magnifying endoscopy with narrow-band imaging.
Conclusion:
Mixed-type NADETs (GPP and IPP) exhibited similar endoscopic and clinicopathological characteristics to their predominant phenotypes, and may have a higher malignant potential than the pure phenotypes.

引言：
伴有胃肠道混合表型的非壶腹十二指肠上皮肿瘤（mixed-type NADETs）尚未得到充分分析。本研究旨在阐明混合表型NADETs的临床病理及内镜特征。
方法：
本研究分析了2010年2月至2023年12月期间收集的218例患者的229例NADETs病灶。基于针对MUC5AC、MUC6、MUC2及CD10的免疫组织化学检测，将NADETs分为胃表型（GP）、胃优势混合表型（GPP）、肠优势混合表型（IPP）及肠表型（IP）。
结果：
在229例NADETs病灶中，分别有20例、22例、69例及118例被归类为GP、GPP、IPP及IP。肿瘤部位（近端/中端/远端）分布为GP=13/7/0、GPP=12/8/2、IPP=13/52/4、IP=16/94/8（P<0.01）。GP、GPP、IPP及IP的平均肿瘤直径分别为14.7/18.5/10.9/10.3 mm（P<0.01）。依据维也纳分类标准，4/5类病灶占比分别为50.0%、68.2%、13.0%及2.5%（P<0.01）。在GP与GPP、IP与IPP的组间比较中，GP组的白色不透明物质检出率显著低于GPP组（P<0.05）；IPP组的4/5类病灶占比显著高于IP组（P<0.01）；但在肿瘤部位、着色情况、大体类型及包括窄带成像放大内镜在内的内镜表现方面未观察到显著差异。
结论：
混合表型NADETs（GPP与IPP）与对应优势表型的内镜及临床病理特征相似，其恶性潜能可能高于纯表型NADETs。