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Difference between revisions of "Ampulla of Vater"
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→Ampullary adenocarcinoma: rename, add subclassification
(→IHC: tweak) |
(→Ampullary adenocarcinoma: rename, add subclassification) |
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:''See [[tubular adenoma of the gastrointestinal tract|tubular adenoma]]''. | :''See [[tubular adenoma of the gastrointestinal tract|tubular adenoma]]''. | ||
==Ampullary | ==Ampullary carcinoma== | ||
*[[AKA]] ''ampullary | *[[AKA]] ''ampullary adenocarcinoma''. | ||
===General=== | ===General=== | ||
*Uncommon. | *Uncommon. | ||
*Textbook association: [[familial adenomatous polyposis]].<ref name=pmid15756395>{{Cite journal | last1 = Tran | first1 = TC. | last2 = Vitale | first2 = GC. | title = Ampullary tumors: endoscopic versus operative management. | journal = Surg Innov | volume = 11 | issue = 4 | pages = 255-63 | month = Dec | year = 2004 | doi = | PMID = 15756395 }}</ref><ref name=pmid9834381>{{Cite journal | last1 = Soravia | first1 = C. | last2 = Berk | first2 = T. | last3 = Haber | first3 = G. | last4 = Cohen | first4 = Z. | last5 = Gallinger | first5 = S. | title = Management of advanced duodenal polyposis in familial adenomatous polyposis. | journal = J Gastrointest Surg | volume = 1 | issue = 5 | pages = 474-8 | month = | year = | doi = | PMID = 9834381 }}</ref> | *Textbook association: [[familial adenomatous polyposis]].<ref name=pmid15756395>{{Cite journal | last1 = Tran | first1 = TC. | last2 = Vitale | first2 = GC. | title = Ampullary tumors: endoscopic versus operative management. | journal = Surg Innov | volume = 11 | issue = 4 | pages = 255-63 | month = Dec | year = 2004 | doi = | PMID = 15756395 }}</ref><ref name=pmid9834381>{{Cite journal | last1 = Soravia | first1 = C. | last2 = Berk | first2 = T. | last3 = Haber | first3 = G. | last4 = Cohen | first4 = Z. | last5 = Gallinger | first5 = S. | title = Management of advanced duodenal polyposis in familial adenomatous polyposis. | journal = J Gastrointest Surg | volume = 1 | issue = 5 | pages = 474-8 | month = | year = | doi = | PMID = 9834381 }}</ref> | ||
====Classification==== | |||
Adsay ''et al.'' proposed a four subtype classification system:<ref name=pmid23026934>{{Cite journal | last1 = Adsay | first1 = V. | last2 = Ohike | first2 = N. | last3 = Tajiri | first3 = T. | last4 = Kim | first4 = GE. | last5 = Krasinskas | first5 = A. | last6 = Balci | first6 = S. | last7 = Bagci | first7 = P. | last8 = Basturk | first8 = O. | last9 = Bandyopadhyay | first9 = S. | title = Ampullary Region Carcinomas: Definition and Site Specific Classification with Delineation of Four Clinicopathologically and Prognostically Distinct Subsets in an Analysis of 249 Cases. | journal = Am J Surg Pathol | volume = | issue = | pages = | month = Sep | year = 2012 | doi = 10.1097/PAS.0b013e31826399d8 | PMID = 23026934 }}</ref> | |||
{| class="wikitable sortable" | |||
! Subtype | |||
! Prevalence | |||
! Definition | |||
! Subclassification | |||
|- | |||
| Intra-ampullary carcinoma | |||
| ~25% of cases | |||
| intra-ampullary epithelium and/or distal end of CBD or pancreatic duct | |||
| | |||
|- | |||
| Ampullary-ductal carcinoma | |||
| ~15% of cases | |||
| arise from intra-ampullary ducts | |||
| | |||
|- | |||
| Peri-ampullary duodenal carcinoma | |||
| ~5% of cases | |||
| primary duodenal, ampullary orficie must be clearly within lesion | |||
| (1) intestinal type, (2) mixed mucinous-intestinal type | |||
|- | |||
| Ampullary carcinoma not otherwise specified | |||
| ~55% of cases | |||
| arise from papillary projection into duodenum - from foveolar-like epithelium with goblet cells | |||
| | |||
|} | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Dependent on subtype. | *Dependent on subtype:<ref name=pmid15549428/><ref name=pmid23026934> | ||
*#Intestinal ampullary carcinoma. | |||
*#Pancreaticobiliary ampullary carcinoma. | |||
*#Other. | |||
Notes: | Notes: | ||
*May lack desmoplastic stroma.<ref name=Ref_Sternberg5_1640>{{Ref Sternberg5|1640}}</ref> | *May lack desmoplastic stroma.<ref name=Ref_Sternberg5_1640>{{Ref Sternberg5|1640}}</ref> | ||
DDx: | DDx: | ||
*[[Invasive ductal carcinoma of the pancreas]]. | *[[Invasive ductal carcinoma of the pancreas]] - has a much worse prognosis. | ||
*Ectopic pancreas.<ref name=pmid18304504>{{Cite journal | last1 = Hsu | first1 = SD. | last2 = Chan | first2 = DC. | last3 = Hsieh | first3 = HF. | last4 = Chen | first4 = TW. | last5 = Yu | first5 = JC. | last6 = Chou | first6 = SJ. | title = Ectopic pancreas presenting as ampulla of Vater tumor. | journal = Am J Surg | volume = 195 | issue = 4 | pages = 498-500 | month = Apr | year = 2008 | doi = 10.1016/j.amjsurg.2007.01.043 | PMID = 18304504 }} | *Ectopic pancreas.<ref name=pmid18304504>{{Cite journal | last1 = Hsu | first1 = SD. | last2 = Chan | first2 = DC. | last3 = Hsieh | first3 = HF. | last4 = Chen | first4 = TW. | last5 = Yu | first5 = JC. | last6 = Chou | first6 = SJ. | title = Ectopic pancreas presenting as ampulla of Vater tumor. | journal = Am J Surg | volume = 195 | issue = 4 | pages = 498-500 | month = Apr | year = 2008 | doi = 10.1016/j.amjsurg.2007.01.043 | PMID = 18304504 }} | ||
</ref> | </ref> | ||