Difference between revisions of "Ampulla of Vater"

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Others:
 
Others:
*SMAD4 +ve (usually retained).
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*SMAD4 +ve/-ve.
**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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**Lost in pancreatic neoplasia ~90% of cases vs. ~35% of ampullary tumours.<ref name=pmid12640108>{{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 10:59, 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.

Others:

  • SMAD4 +ve/-ve.
    • Lost in pancreatic neoplasia ~90% of cases vs. ~35% of ampullary tumours.[7]

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  • Separate CAP protocol.[8]

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. 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.
  8. URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/Ampulla_12protocol_3101.pdf. Accessed on: 12 September 2012.