Difference between revisions of "Ampulla of Vater"

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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.
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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=
 
=Normal histology=

Revision as of 10:44, 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

  • AKA tumours of the ampulla of Vater.
  • AKA tumours of the hepatopancreatic ampulla.

Ampullary adenoma

General

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

Microscopic

Features:

  • Dependent on subtype.

Notes:

  • May lack desmoplastic stroma.[2]

Main subtypes:[5]

  • Intestinal ampullary carcinoma.
  • Pancreatobiliary ampullary carcinoma.

DDx:

IHC

Features:[5]

  • CK7 +ve.
  • CK20 +ve.
  • MUC2 +ve.

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  • Separate CAP protocol.[7]

See also

References

  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. 1639. ISBN 978-0781779425.
  2. 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.
  3. Tran, TC.; Vitale, GC. (Dec 2004). "Ampullary tumors: endoscopic versus operative management.". Surg Innov 11 (4): 255-63. PMID 15756395.
  4. 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. 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.
  6. 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.
  7. URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/Ampulla_12protocol_3101.pdf. Accessed on: 12 September 2012.