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COX-2 expression in ampullary carcinoma: correlation with angiogenesis process and clinicopathological variables
  1. G Perrone1,
  2. D Santini2,
  3. A Verzì1,
  4. B Vincenzi2,
  5. D Borzomati3,
  6. F Vecchio4,
  7. R Coppola3,
  8. A Antinori5,
  9. P Magistrelli5,
  10. G Tonini2,
  11. C Rabitti1
  1. 1Surgical Pathology, Campus Bio-Medico University, Rome, Italy
  2. 2Oncology Unit, Campus Bio-Medico University, Rome, Italy
  3. 3General Surgery Department, Campus Bio-Medico University, Rome, Italy
  4. 4Anatomic Pathology And Histology, Catholic University of Sacred Heart, Rome, Italy
  5. 5General Surgery Department, Catholic University of the Sacred Heart, Rome, Italy
  1. Correspondence to:
 Dr Giuseppe Perrone
 Surgical Pathology, Campus Bio-Medico University, Via Emilio Longoni 83, 00155 Rome, Italy; g.perrone{at}


Background: There is evidence that the anti-neoplastic effect of non-steroidal anti-inflammatory drugs is attributable to cyclooxygenase-2 (COX-2) inhibition, but the exact mechanisms whereby COX-2 can promote tumour cell growth remain unclear. One hypothesis is the stimulation of tumour angiogenesis by the products of COX-2 activity. To data, there have been few clinicopathological studies on COX-2 expression in human ampullary carcinoma and no data have been reported about its relation with tumour angiogenesis.

Objective: To investigate by immunohistochemistry the expression of COX-2 and the angiogenesis process in a series of primary untreated ampullary carcinomas.

Methods: Tissue samples from 40 archival ampullary carcinomas were analysed for COX-2, vascular endothelial growth factor (VEGF), and an endothelial cell marker von Willebrand factor (vWF) by immunohistochemistry, using specific antibodies.

Results: COX-2 expression was detected in 39 tissue samples (97.5%), of which two (5%) were graded as weak, 26 (65%) as moderate, and 11 (27.5%) as strong. Only one lesion (2.5%) was negative for COX-2 expression. VEGF expression was detected in 36 tissue samples (90%). A significant positive correlation was found between COX-2 and VEGF expression. No statistic correlation was found between COX-2 expression and microvessel density.

Conclusions: COX-2 is highly expressed in ampullary carcinomas. This suggests an involvement of the COX-2 pathway in ampullary tumour associated angiogenesis, providing a rationale for targeting COX-2 in the treatment of ampullary cancer.

  • COX-2, cyclooxygenase-2
  • HIF, hypoxia inducible factor
  • HIS, immunohistochemical score
  • IQR, interquartile range
  • MVD, microvessel density
  • PGE2, prostaglandin E2
  • VEGF, vascular endothelial growth factor
  • vWF, von Willebrand factor
  • ampullary carcinoma
  • angiogenesis
  • COX-2
  • VEGF
  • microvessel density

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