Difference between revisions of "Ampulla of Vater"
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*CK20 +ve. | *CK20 +ve. | ||
*MUC2 +ve. | *MUC2 +ve. | ||
Others: | |||
*SMAD4 +ve (usually retained). | |||
**Lost in pancreatic neoplasia ~90% of cases vs. ~35% of ampullary tumours.<ref>{{Cite journal | last1 = McCarthy | first1 = DM. | last2 = Hruban | first2 = RH. | last3 = Argani | first3 = P. | last4 = Howe | first4 = JR. | last5 = Conlon | first5 = KC. | last6 = Brennan | first6 = MF. | last7 = Zahurak | first7 = M. | last8 = Wilentz | first8 = RE. | last9 = Cameron | first9 = JL. | title = Role of the DPC4 tumor suppressor gene in adenocarcinoma of the ampulla of Vater: analysis of 140 cases. | journal = Mod Pathol | volume = 16 | issue = 3 | pages = 272-8 | month = Mar | year = 2003 | doi = 10.1097/01.MP.0000057246.03448.26 | PMID = 12640108 }}</ref> | |||
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Revision as of 10:56, 16 October 2012
The ampulla of Vater, also hepatopancreatic ampulla, is found in the duodenum. It has a unique histology and is a relatively common site of disease.
Normal histology
Features:[1]
- Complex folding of epithelium - may for papillae.
- +/-Pancreatic heterotopia - common.
- +/-Gastric heterotopia - not common.
Ampullary tumours
Ampullary adenoma
General
- Uncommon.
- May be associated with familial adenomatous polyposis (FAP).
Microscopic
Features:
- +/-Paneth cells - may be prominent.[2]
- Similar to adenoma of colon - with:
- Less pseudostratification.
- Finer chromatin pattern.
DDx:
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- See tubular adenoma.
Ampullary adenocarcinoma
- AKA ampullary carcinoma.
General
- Uncommon.
- Textbook association: familial adenomatous polyposis.[3][4]
Microscopic
Features:
- Dependent on subtype.
Notes:
- May lack desmoplastic stroma.[2]
Main subtypes:[5]
- Intestinal ampullary carcinoma.
- Pancreatobiliary ampullary carcinoma.
DDx:
- Invasive ductal carcinoma of the pancreas.
- Ectopic pancreas.[6]
IHC
Features:[5]
- CK7 +ve.
- CK20 +ve.
- MUC2 +ve.
Others:
- SMAD4 +ve (usually retained).
- Lost in pancreatic neoplasia ~90% of cases vs. ~35% of ampullary tumours.[7]
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- Separate CAP protocol.[8]
See also
References
- ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. pp. 1639. ISBN 978-0781779425.
- ↑ 2.0 2.1 Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. pp. 1640. ISBN 978-0781779425.
- ↑ Tran, TC.; Vitale, GC. (Dec 2004). "Ampullary tumors: endoscopic versus operative management.". Surg Innov 11 (4): 255-63. PMID 15756395.
- ↑ Soravia, C.; Berk, T.; Haber, G.; Cohen, Z.; Gallinger, S.. "Management of advanced duodenal polyposis in familial adenomatous polyposis.". J Gastrointest Surg 1 (5): 474-8. PMID 9834381.
- ↑ 5.0 5.1 Fischer, HP.; Zhou, H. (2004). "Pathogenesis of carcinoma of the papilla of Vater.". J Hepatobiliary Pancreat Surg 11 (5): 301-9. doi:10.1007/s00534-004-0898-3. PMID 15549428.
- ↑ Hsu, SD.; Chan, DC.; Hsieh, HF.; Chen, TW.; Yu, JC.; Chou, SJ. (Apr 2008). "Ectopic pancreas presenting as ampulla of Vater tumor.". Am J Surg 195 (4): 498-500. doi:10.1016/j.amjsurg.2007.01.043. PMID 18304504.
- ↑ McCarthy, DM.; Hruban, RH.; Argani, P.; Howe, JR.; Conlon, KC.; Brennan, MF.; Zahurak, M.; Wilentz, RE. et al. (Mar 2003). "Role of the DPC4 tumor suppressor gene in adenocarcinoma of the ampulla of Vater: analysis of 140 cases.". Mod Pathol 16 (3): 272-8. doi:10.1097/01.MP.0000057246.03448.26. PMID 12640108.
- ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/Ampulla_12protocol_3101.pdf. Accessed on: 12 September 2012.